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Sodium Science: The Facts About Kids

Sodium Science: The Facts About Kids

Sodium Myths and Facts: research continues to support reducing children’s sodium intakes.

While sodium is necessary for health, most children eat more than what is safe and recommended. On an average school day during the 2009-2010 school year, a child received 26% of their daily sodium intake just from consuming school cafeteria foods. Sodium levels in school meals present an opportunity to improve children’s health by bringing the sodium level down. Schools are already working hard to meet the challenge and have an impact.

While schools have been encouraged to lower sodium in their foods since 1995, it wasn’t until the 2010 Healthy, Hunger-Free Kids Act and updated nutrition standards that school meals had to meet a moderate limit on sodium. Sodium levels are set to be lowered in three gradual phases until school year 2022-2023.

MYTH #1: Science does not support the recommended lowering of children’s sodium consumption. Research has concluded that national recommended levels of sodium are too low.

FACTS:

  • The Institute of Medicine in 2013, after reviewing evidence on sodium intake and health outcomes, affirmed the need to reduce population sodium intake to improve public health. ,
  • The science is strong enough to say that for children, one way to support a healthy blood pressure is to eat less sodium.
  • Public health recommendations are made after weighing all of the evidence, including studies of greater and lesser design and some with conflicting results. A vast body of diverse research indicates that lowering sodium intake lowers blood pressure, a major risk factor for heart disease.

MYTH #2: It’s impossible for schools to meet USDA’s sodium limits, because sodium is naturally occurring in all foods.

FACTS:

  • The sodium standards are phased in and the final target, which goes into effect for the 2022-2023 school year, is based on the upper limit recommendation of 2,300 mg per day. The extended timeline for implementation provides time for the development of appealing foods with less sodium. Studies have found that a few changes to current school meals would make a big impact on achieving the USDA’s sodium limits by the 2022-2023 school year.
  • Only about 12% of the sodium we eat and drink is from naturally-occurring sodium, which fits comfortably into a meal pattern based on the 2,300 mg levels. More than 75% of the sodium in our diets is added during processing.

Myth #3: Industry doesn’t provide enough foods that will meet USDA’s sodium targets for school meals or Smart Snacks.

FACTS:

  • Numerous multi-national food companies have commitments to reduce sodium in their products. Many companies already offer delicious foods that meet the target limits set by the USDA – even the 2022-2023 targets.
  • Industry is always innovating, and a variety of methods and technologies exist that can help reduce sodium in foods, and modelling suggests that some newly developed ingredients could make an impact.

MYTH #4: Children won’t like the taste of foods that are lower in sodium and will eat less of those foods. This will take away the beneficial nutrients provided by those foods.

FACTS:

  • Gradually lowering the sodium content in foods can decrease a taste for salty food over time, which for some people, could make foods with more moderate sodium levels taste delicious.
  • Foods naturally low in sodium, like most fruits and vegetables, can be an important source of beneficial nutrients. Replacing nutrient-poor high-sodium foods with healthier alternatives could improve overall consumption of other beneficial nutrients.
  • Children develop their palates very early in life. Exposing them to foods with moderate sodium levels can set them on the right path for a healthy diet.

MYTH #5: We don’t need to worry about children’s sodium levels. The only health issues associated with too much sodium are adult problems like high blood pressure and heart disease.

FACTS:

  • Factors contributing to higher blood pressure, heart disease, and stroke begin in childhood. The rate of high blood pressure is increasing in American children. More than 1 in 8 children aged 12-19 are at high risk for having (or already have) high blood pressure.
  • Children who eat high levels of sodium are about 35% more likely to have elevated blood pressure as children who eat lower sodium diets.
  • High sodium intake not only affects heart health—it can also increase the risk for stroke, kidney disease, stomach cancer, and potentially osteoporosis.

MYTH #6: Current sodium recommendations for children are too low. Scientific evidence to support a decrease in sodium for school meals is inconclusive.

FACTS:

  • A systematic review of those types of studies showed that they tend to have several limitations which limit the usefulness of the studies in influencing sodium recommendations for the population.
  • A vast body of research indicates that lowering sodium intake lowers blood pressure. Many well-respected scientific and professional health organizations have sodium intake recommendations. What ALL of these recommendations have in common is that they are at least 1,000 mg/day lower than the average American sodium intake of 3,478 mg/day.
  • The current sodium standards for school meals based on the recommended upper level for sodium – 2,300 mg. Current efforts to weaken nutrition standards for school meals undermine an effective strategy aimed at improving the health of our children and our nation.

MYTH #7: We should not be focusing on schools meals to reduce children’s sodium intake. Instead, we should only focus on sodium reduction in restaurants and store foods.

FACTS:

  • Any meaningful strategy to reduce sodium intake at the population level must involve the efforts of all of us. It is important that sodium is reduced in foods offered in all environments —from schools, to restaurants, to the grocery aisle. In fact, the Institute of Medicine stated that “there is no evidence on which to base a prediction of the response to lower-sodium meals when offered at school without similar changes being made outside of school.”
  • A child eating a school meal consumes 26% of their daily sodium intake alone from that meal (on an average school day, measured during the 2009-2010 school year). Given that many children receive 50% or more of their calories in schools puts school meals in a unique position to bring sodium down to moderate levels and truly make an impact on kid’s health.
  • The good news is that advocates for sodium reduction are focused not only on less sodium in schools but also in the broader food environment. For example, many restaurants and food manufacturers are working to reduce sodium as a part of the National Salt Reduction Initiative. And more even food companies are committing to lower sodium options.

To learn more about healthy school meals, visit: www.heart.org/schoolmeals

References:

iInstitute of Medicine (IOM). 2004. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press.

iiU.S. Department of Agriculture, Agricultural Research Service.2012.Nutrient Intakes from Food: Mean Amounts Consumed per Individual, by Gender and Age, What We Eat in America, NHANES 2009-2010. Available: http://www.ars.usda.gov/SP2UserFiles/Place/80400530/pdf/1112/Table_1_NIN_GEN_11.pdf

iiiMMWR 2014 Sep 12;63(36):789-97. Accessed online 8/17/15 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6336a3.htm

ivAppel et al. Reducing Sodium Intake in Children: A Public Health Investment. Journal of Clinical Hypertension. 2015:1–6.

vS.1614 – Healthy Meals for Healthy Americans Act of 1994 https://www.congress.gov/bill/103rd-congress/senate-bill/1614

viUSDA. Final Rule “Nutrition Standards in the National School Lunch and School Breakfast Programs (1/26/12).” Accessed online 8/14/15 at: http://www.fns.usda.gov/sites/default/files/sodium.pdf

viiIOM. 2013. Sodium Intake in Populations: Assessment of Evidence. Washington, DC: The National Academies Press.

viiiLetter from IOM President to HHS Secretary, June 2013. https://cspinet.org/new/pdf/iom_fineberg_letter_to_sibelius06032013.pdf

ixAppel et al. Reducing Sodium Intake in Children: A Public Health Investment. Journal of Clinical Hypertension. 2015:1–6.

xWhelton et al. Sodium, blood pressure, and cardiovascular disease: Further evidence supporting the American Heart Association sodium reduction recommendations. Circulation. 2012;126:2880-2889. 4/14/2015

xiUSDA. Final Rule “Nutrition Standards in the National School Lunch and School Breakfast Programs (1/26/12).” Accessed online 8/14/15 at: http://www.fns.usda.gov/sites/default/files/sodium.pdf

xiiIOM. 2010. School Meals: Building Blocks for Healthy Children. Washington, DC: The National Academies Press.

xiiiMattes RD, Donnelly D. Relative contributions of dietary sodium sources. J Am Coll Nutr. 1991;10:383-393.

xvAntman et al. Stakeholder discussion to reduce population-wide sodium intake and decrease sodium in the food supply: A conference report from the American Heart Association sodium conference 2013 planning group. Circulation. 2014.

xviNational Alliance for Nutrition and Activity. Mission: Possible Companies Can Meet USDA’s New Sodium Limits for School Meals. Accessed online 8/14/2014: http://cspinet.org/new/pdf/NANA%20Sodium%20products%20that%20meet%20new%20guidelines%20oct%2014.pdf

xviiAntman et al. Stakeholder discussion to reduce population-wide sodium intake and decrease sodium in the food supply: A conference report from the American Heart Association sodium conference 2013 planning group. Circulation. 2014.

xviiiAgarwal et al. Sodium Intake Status in United States and Potential Reduction Modeling: an NHANES 2007-2010 analysis. Food Science and Nutrition. 2015. DOI: 10.1002/fsn3.248

IOM. 2010. Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press.

xixAppel et al. Reducing Sodium Intake in Children: A Public Health Investment. Journal of Clinical Hypertension. 2015:1–6.

xxLloyd-Jones et al. Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction: The American Heart Association’s Strategic Impact Goal through 2020 and Beyond. Circulation. 2010 Feb 2;121(4):586-613.

xxiMozaffarian et al. Heart Disease and Stroke Statistics—2015 Update. Circulation. 2015;131:00-00. Accessed online: http://circ.ahajournals.org/content/early/2014/12/18/CIR.0000000000000152.full.pdf

xxiiRosner et al. Childhood blood pressure trends and risk factors for high blood pressure: The NHANES experience 1998-2008. Hypertension 2013;62:247-254.

xxiiiAppel et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: A call to action from the American Heart Association. Circulation. 2011, 15;123(10):1138-43.

xxivCobb et al. Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes: A science advisory from the American Heart Association. Circulation. 2014;129:1173-1186.

xxvWhelton et al. Sodium, blood pressure, and cardiovascular disease: Further evidence supporting the American Heart Association sodium reduction recommendations. Circulation. 2012;126:2880-2889. 4/14/2015

xxviC. Anderson, P. Kris-Etherton, R. Johnson, and E.A. Miller. 2015. Commentary on Making Sense of the Science of Sodium. Nutrition Today 50(2).

xxviiUSDA Nutrient Intakes From Food and Beverages: Mean Amounts Consumed per Individual, by Gender and Age, What We Eat in America, NHANES 2011–2012 http://www.ars.usda.gov/SP2UserFiles/Place/80400530/pdf/1112/Table_1_NIN_GEN_11.pdf

xxviiiAppel, L. et al. Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate. Institute of Medicine, 2005. http://www.nal.usda.gov/fnic/DRI/DRI_Water/water_full_report.pdf

xxixAppel et al. Reducing Sodium Intake in Children: A Public Health Investment. Journal of Clinical Hypertension. 2015:1–6.

xxxIOM. 2010. School Meals: Building Blocks for Healthy Children. Washington, DC: The National Academies Press

xxxiMMWR 2014 Sep 12;63(36):789-97. Accessed online 8/17/15 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6336a3.htm

xxxiiIOM. 2010. School Meals: Building Blocks for Healthy Children. Washington, DC: The National Academies Press

xxxiiiAppel et al. Reducing Sodium Intake in Children: A Public Health Investment. Journal of Clinical Hypertension. 2015:1–6.

xxxivNSRI. National Salt Reduction Initiative Corporate Commitments. June, 2014. Accessed online 8/17/15 at: http://www.nyc.gov/html/doh/downloads/pdf/cardio/nsri-corporate-commitments.pdf

xxxvAmerican Heart Association. AHA, Aramark Join on Meals Initiative. Published 8/5/2015 online at http://blog.heart.org/aha-aramark-join-on-meals-initiative/

 

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