Background: Approximately 2 in 3 US adults have prehypertension or hypertension that increases their risk of cardiovascular disease. Reducing sodium intake can decrease blood pressure and prevent hypertension. Approximately 9 in 10 Americans consume excess sodium (≥2300 mg/d). Voluntary sodium standards for commercially processed and prepared foods were established in North America, but their impact on sodium intake is unclear.Objective: We modelled the potential impact on US sodium intake of applying voluntary sodium standards for foods.Design: We used NHANES 2007-2010 data for 17,933 participants aged ≥1 y to model predicted US daily mean sodium intake and the prevalence of excess sodium intake with the use of the standards of the New York City's National Salt Reduction Initiative (NSRI) and Health Canada for commercially processed and prepared foods. The Food and Nutrient Database for Dietary Studies food codes corresponding to foods reported by NHANES participants were matched to NSRI and Health Canada food categories, and the published sales-weighted mean percent reductions were applied.Results: The US population aged ≥1 y could have reduced their usual daily mean sodium intake of 3417 mg by 698 mg (95% CI: 683, 714 mg) by applying NSRI 2014 targets and by 615 mg (95% CI: 597, 634 mg) by applying Health Canada's 2016 benchmarks. Significant reductions could have occurred, regardless of age, sex, race/ethnicity, income, education, or hypertension status, up to a mean reduction in sodium intake of 850 mg/d in men aged ≥19 y by applying NSRI targets. The proportion of adults aged ≥19 y who consume ≥2300 mg/d would decline from 88% (95% CI: 86%, 91%) to 71% (95% CI: 68%, 73%) by applying NSRI targets and to 74% (95% CI: 71%, 76%) by applying Health Canada benchmarks.Conclusion: If established sodium standards are applied to commercially processed and prepared foods, a significant reduction of US sodium intake could occur.

Twenty-four-hour urine collection is the recommended method for estimating sodium intake. To investigate the strengths and limitations of methods used to assess completion of 24-hour urine collection, the authors systematically reviewed the literature on the accuracy and usefulness of methods vs para-aminobenzoic acid (PABA) recovery (referent). The percentage of incomplete collections, based on PABA, was 6% to 47% (n=8 studies). The sensitivity and specificity for identifying incomplete collection using creatinine criteria (n=4 studies) was 6% to 63% and 57% to 99.7%, respectively. The most sensitive method for removing incomplete collections was a creatinine index <0.7. In pooled analysis (≥2 studies), mean urine creatinine excretion and volume were higher among participants with complete collection (P<.05); whereas, self-reported collection time did not differ by completion status. Compared with participants with incomplete collection, mean 24-hour sodium excretion was 19.6 mmol higher (n=1781 specimens, 5 studies) in patients with complete collection. Sodium excretion may be underestimated by inclusion of incomplete 24-hour urine collections. None of the current approaches reliably assess completion of 24-hour urine collection.

BACKGROUND: Although evidence shows that reduced sodium intake lowers blood pressure, some studies suggest that sodium reduction may adversely affect insulin resistance and glucose tolerance. OBJECTIVES: The objectives were to assess the effects of sodium reduction on glucose tolerance, evaluate strengths and weaknesses of the relevant scientific literature, and provide direction for future research. METHODS: We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, and Web of Science through August 2014. Both randomized and nonrandomized intervention trials were included in our meta-analyses. The effects of sodium reduction on glucose tolerance were evaluated in 37 articles, but because of a lack of comparable data, 8 trials were excluded from the meta-analyses. RESULTS: Participants were 10-79 y old, either primarily healthy or with hypertension. In meta-analyses of 20 randomized, crossover trials (n = 504 participants) and 9 nonrandomized crossover trials (n = 337), circulating glucose concentrations of fasting participants were not affected by reduction in sodium intake. In contrast, in meta-analyses of 19 of the 20 randomized, crossover trials (n = 494), fasting insulin concentrations were 9.53 pmol/L higher (95% CI: 5.04, 14.02 pmol/L higher) with sodium reduction. In 9 nonrandomized trials (n = 337), fasting insulin did not differ with reduced sodium intake. Results differed little when the analyses were restricted to studies with a low risk of bias and duration of ≥7 d. CONCLUSIONS: This meta-analysis revealed no evidence that, in trials with a short intervention and large reductions in sodium, circulating glucose concentrations differed between groups. Recommendations for future studies include extending intervention durations, ensuring comparability of groups at baseline through randomization, and assessing sodium intakes relevant to population sodium reduction. In addition, analyses on other metabolic variables were limited because of the number of trials reporting these outcomes and lack of consistency across measures, suggesting a need for comparable measures of glucose tolerance across studies.

PURPOSE/OBJECTIVES: The objective of this study was to assess consumer support for policies lowering the sodium content of cafeteria foods in schools. METHODS: Data were used from 9,634 adults aged >18 years who responded to questions about sodium in general and in school foods in a 2010 national mail panel survey. Prevalence of consumer support was determined and logistic regression was used to estimate odds ratios. RESULTS: Ninety percent (95% CI: 89.1%-90.8%) of respondents support policies that lower sodium content of cafeteria foods in schools. Support for policies was >=78% for all subgroups examined. The odds of support were higher for females, non-Hispanic blacks and Hispanics compared with non-Hispanic whites and respondents who reside in the Northeast compared with the South. Those reporting "neutral" or "yes" to wanting to eat a diet low in sodium were more likely to support policies compared with those answering "no." In addition, the odds of support were higher for those with incomes between $40,000 and $59,999 compared to >=$60,000 and those with self-reported high blood pressure. APPLICATIONS TO CHILD NUTRITION PROFESSIONALS: Results suggest most adults support policies that lower sodium content of cafeteria foods in schools. School nutrition staff can leverage this support by promoting the healthy changes to school meals to parents and community members and communicating how the school meals contribute to healthful eating behaviors. Additional strategies for change include working with school nutrition stakeholders to adopt and implement strong nutrition standards for all school foods and engaging students to help identify lower sodium recipes that they enjoy.

BACKGROUND: Current recommendations target sodium reduction in the food supply and intake; however, information is limited on consumer readiness for these actions. PURPOSE: Prevalence and determinants of consumer agreement for government restriction of manufacturers and restaurants putting excess salt in food and support for policies limiting sodium content of quick service restaurant (QSR) foods were examined. METHODS: Data were analyzed from 9,579 adults aged ≥18 years who responded to consumer readiness for sodium reduction questions in the 2010 ConsumerStyles survey. Responses were collapsed into three categories. Consumer agreement was determined and logistic regression was used to estimate ORs. Analyses were conducted in 2012. RESULTS: The majority of consumers agree that it is a good idea for government to restrict food manufacturers (55.9%) from putting excess salt in foods. About half agreed that it is a good idea for government to restrict restaurants from putting excess salt in foods and 81.5% supported sodium reduction policies in QSRs. Odds of agreement/support were higher for non-Hispanic blacks compared with non-Hispanic whites, and those with incomes <$40,000 compared with ≥$60,000. Those reporting "neutral" or "yes" to wanting to eat a diet low in sodium were more likely to agree/support government action compared to those answering "no." CONCLUSIONS: Nearly half of consumers agree with government actions to reduce sodium in manufactured and restaurant foods, with even greater support for QSRs. These findings could inform industry and public health partners about consumer preferences to lower the sodium content of the food supply.