Health Letter, June 2015
By Azza AbuDagga, M.H.A., Ph.D.
Consuming too much sodium is a well-known major risk factor for developing hypertension (high blood pressure) — a costly medical condition that can lead to heart disease and stroke, which are the first and fifth leading causes of death in the United States, respectively. Yet Americans’ enduring love for salt has continued unabated over the years.
A recent Centers for Disease Control and Prevention (CDC) report shows that high sodium intake is a pervasive problem among American school-aged children, not just adults. High sodium intake raises children’s lifelong risk of high blood pressure and its associated complications later in life. Even worse, the report refers to previous research showing that about one in every six American children age 8 to 17 already has hypertension or pre-hypertension. These findings necessitate action from parents to prevent high sodium intake and its associated problems among their school-aged children.
The CDC report
The report, published online in Morbidity and Mortality Weekly Report on Sept. 9, 2014, provides the most recent information describing how much sodium school-aged children consume, the common foods contributing to sodium intake, and when and where children consume sodium.
The report drew its data from in-person interviews held from 2009 to 2010 with more than 2,200 school-aged children ages 6 to 18. The children were asked to recall what they ate during the last 24 hours. The interviews were conducted as part of the “What We Eat in America” component of the National Health and Nutrition Examination Survey, a national survey conducted by the CDC to assess the health and nutritional status of children and adults in the United States.
School-aged children consume an average of about 3,300 milligrams (mg) of sodium per day — 1,000 mg more than the maximum daily intake of 2,300 mg (or one teaspoon of salt) recommended by the 2010 federal Dietary Guidelines for Americans. Sodium consumption was highest among high-school-aged children (3,700 mg per day), followed by the 11-13 and 6-10 age groups, who consumed 3,200 and 2,900 mg of sodium per day, respectively. Sodium consumption was higher among boys than girls, but it did not vary by race, ethnicity or weight.
Strikingly, the report found that of the overall sodium intake in children’s diet —excluding sodium from salt added at the table — comes from commercially processed foods purchased at grocery or convenience stores (65 percent) and food consumed at fast-food/pizza places and other restaurants (18 percent). The remaining 17 percent of consumed sodium comes from school cafeterias and other sources (such as home-cooked meals). These findings are consistent across age groups. Notably, among children who consume a school meal, 26 percent of consumed sodium comes from school cafeteria foods.
Dinner meals account for the largest share (approximately 40 percent) of daily consumed sodium, followed by lunch (nearly 30 percent), snacks (about 16 percent) and breakfast (almost 15 percent). High-school-aged children had a lower proportion of total sodium intake at breakfast than younger children.
Another important finding is that more than 40 percent of daily sodium consumed comes from 10 top ranked food types, listed here in descending order:
- Bread and rolls
- Cold cuts and cured meats
- Salty snacks such as chips, pretzels, and popcorn
- Sandwiches, including cheeseburgers
- Chicken nuggets and patties
- Pasta with sauce
- Tacos and burritos
The first five of these food types consistently appeared among the top 10 ranked categories for sources of sodium intake among all groups of children examined in the report.
National efforts aim to combat problem
The CDC report demonstrates that the sodium amounts consumed by U.S. children are dangerously high. This comes despite the efforts of initiatives such as Healthy People 2020 — a program of nationwide health promotion and disease prevention goals set by the federal government. In 2010, the program set a national objective to reduce average sodium intake in the U.S. population ages 2 and up to the recommended amount of 2,300 mg per day in order to decrease the risk of hypertension.
The CDC report mentions a rule issued in 2012 by the Department of Agriculture: Nutrition Standards in the National School Lunch and Breakfast Programs. The rule sets standards that require — among other things — gradual reductions in sodium content of school breakfast and lunch meals over a 10-year period. This initiative is estimated to slash sodium intake in schools by 25 to 50 percent by 2022.
More large-scale strategies in the food industry are needed to achieve the sodium reduction goal proposed by Healthy People 2020. One such strategy — recommended by a 2010 Institute of Medicine (IOM) report on sodium intake — is for the Food and Drug Administration (FDA) to set mandatory national standards to gradually reduce sodium content in all commercially processed and restaurant foods. Although it has been almost five years since the release of the IOM report —which was prepared at the request of Congress and supported by several agencies within the Department of Health and Human Services —, the FDA website still indicates that the agency “has not exercised its regulatory authority to limit the amount of salt added to processed foods.” The longer the FDA stalls in applying the IOM recommendations, the more American children will suffer the deadly consequences of high sodium intake as they grow older.
Recommendations for parents
Because taste for salt is a matter of habit, the best way to prevent high sodium intake among children is to instill low-sodium and other healthy dietary habits among children at an early age, ideally when they start eating solid foods. As children grow up and become more independent, parents should teach them how to make choices that maintain healthy eating habits.
Parents whose children already have acquired cravings for salty foods can take the following steps suggested by the CDC and other sources to curb this problem:
- Leading by example, parents should eat a healthy, low-sodium diet.
- To have more control over sodium content in prepared foods, parents can serve their children more home-cooked foods, using little or no salt when cooking. Instead of using salt to enhance flavor, parents should use herbs, spices or lemon juice. Low-sodium meal ideas and recipes and nutrition information are available from this CDC website. Parents should feed their children fresh natural foods, including fruits and vegetables, and avoid processed foods that are high in sodium.
- Parents should take the saltshaker off the table.
- When shopping for food, parents should read food labels and choose foods that are low in sodium. The nutrition label on food and beverage packages lists the percent daily value of sodium in one serving, based on 2,400 mg sodium intake per day. Foods providing 5 percent or less of sodium per serving are considered low in sodium, and those providing 20 or more percent are considered high.
- When eating at restaurants with children, parents should ask for nutrition information for foods, ask that salt not be added to foods or order low-sodium foods.
- Parents should pack their children low-sodium sandwiches and snacks, including vegetables and fruits, to provide healthy alternatives to school cafeteria and vending-machine foods.
- Parents should urge children’s schools to purchase and provide low-sodium, healthy meals, and to put low-sodium snacks in school cafeterias, stores and vending machines.
If healthy foods are constantly on the family table and in the refrigerator, children will adapt and eat these foods.
 Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey. Updated May 13, 2015. http://www.cdc.gov/nchs/nhanes.htm. Accessed April 29, 2015.
 Food and Drug Administration. Lowering salt in your diet. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm181577.htm. Accessed April 30, 2015.
 Food and Drug Administration Consumer Health Information. Helping consumers reduce sodium intake. http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM327379.pdf. Accessed April 29, 2015.