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Cogswell M.E.,Division for Heart Disease and Stroke Prevention | Yuan K.,Division for Heart Disease and Stroke Prevention | Gunn J.P.,Division for Heart Disease and Stroke Prevention | Gillespie C.,Division for Heart Disease and Stroke Prevention | And 8 more authors.
Morbidity and Mortality Weekly Report

Background: A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts.Methods: Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6–18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009–2010.Results: U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school–aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14–18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6–10 years or 11–13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%).Implications for Public Health Practice: Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%–50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75–150 mg per day and about 220–440 mg on days children consume school meals. © 2014, Department of Health and Human Services. All right reserved. Source

Losby J.L.,Division for Heart Disease and Stroke Prevention | Patel D.,Division for Heart Disease and Stroke Prevention | Schuldt J.,Schenectady County Public Health Services | Hunt G.S.,Schenectady County Public Health Services | And 2 more authors.
Journal of Public Health Management and Practice

This article describes lessons learned from implementing sodium-reduction strategies in programs that provide meals to older adults in 2 New York counties, with one county replicating the approaches of the other. The implemented sodium-reduction strategies were product substitutions, recipe modifications, and cooking from scratch. Both counties were able to achieve modest sodium reductions in prepared meals. Lessons learned to implement sodium reduction strategies include the following: (1) identifying partners with shared experience and common goals; (2) engaging experts; (3) understanding the complexity of the meals system for older adults; (4) conducting sodium nutrient analysis; (5) making gradual and voluntary reductions to sodium content; and (6) working toward sustainable sodium reduction. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Wang C.-Y.,Centers for Disease Control and Prevention | Cogswell E.M.,Division for Heart Disease and Stroke Prevention | Loria M.C.,U.S. National Institutes of Health | Chen T.-C.,Centers for Disease Control and Prevention | And 9 more authors.
Journal of Nutrition

Because of the logistic complexity, excessive respondent burden, and high cost of conducting 24-h urine collections in a national survey, alternative strategies to monitor sodium intake at the population level need to be evaluated. We conducted a calibration study to assess the ability to characterize sodium intake from timed-spot urine samples calibrated to a 24-h urine collection. In this report, we described the overall design and basic results of the study. Adults aged 18-39 y were recruited to collect urine for a 24-h period, placing each void in a separate container. Four timed-spot specimens (morning, afternoon, evening, and overnight) and the 24-h collection were analyzed for sodium, potassium, chloride, creatinine, and iodine. Of 481 eligible persons, 407 (54% female, 48% black) completed a 24-h urine collection. A subsample (n = 133) collected a second 24-h urine 4-11 d later. Mean sodium excretion was 3.54 ± 1.51 g/d for males and 3.09 ± 1.26 g/d for females. Sensitivity analysis excluding those who did not meet the expected creatinine excretion criterion showed the same results. Day-to-day variability for sodium, potassium, chloride, and iodine was observed among those collecting two 24-h urine samples (CV = 16-29% for 24-h urine samples and 21-41% for timed-spot specimens). Among all race-gender groups, overnight specimens had larger volumes (P ≪ 0.01) and lower sodium (P ≪ 0.01 to P = 0.26), potassium (P ≪ 0.01), and chloride (P ≪ 0.01) concentrations compared with other timed-spot urine samples, although the differences were not always significant. Urine creatinine and iodine concentrations did not differ by the timing of collection. The observed day-to-day and diurnal variations in sodium excretion illustrate the importance of accounting for these factors when developing calibration equations from this study. © 2013 American Society for Nutrition. Source

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