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Three Steps to a Low Sodium Diet
How to reduce the amount of salt in your diet without sacrificing flavor.

More evidence for <2,300
Last week's review article was a look at the state of the research into dietary sodium and its association with blood pressure, heart disease and death from all causes. As the authors noted, most of the research on salt in the diet are observational studies: they can show association, but not causality. That said, some observational studies can be more convincing than others.

Even More Reason to Hold the Salt
...Yet there are still those scientists who argue, based on other studies, that improving overall dietary quality, including high intake of fruits and vegetables and adequate intake of minerals like potassium and calcium, is just as important as salt intake to reducing high blood pressure in humans.


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Sources of salt in your children's diet

a pepperoni pizza

You probably know that the current recommendations are for adults to try to limit their sodium intake to less than 2,400 milligrams of sodium per day - and that many Americans exceed this amount by 2 or three times or more, each and every day. That can mean a lot of high blood pressure, strokes, and heart disease. That excessive sodium intake isn't limited to adults, however: the most recent estimates are that 90% of kids between the ages of 6 and 18 consume too much salt. Indeed, 1 child in 9 actually has blood pressures above the normal range for their age, height, and gender - which in turn can lead to adults with diagnosed high blood pressure.

Where is all this salt in kids' diets coming from?

Scientists at the CDC (Centers for Disease Control) and the USDA (US Department of Agriculture) assessed the sodium intake among school-aged children (J Acad Nutr Diet 2017;117:39-47) by analyzing data from the 2011-2012 NHANES (National Health and Nutrition Examination Survey), a nationally representative survey of Americans carried out by the US Government that includes a detailed 24-hour dietary recall in addition to collecting demographic information along with height and weight. Children between 6 and 11 years of age were assisted in their recall by their parents, while those between 12 and 18 reported on their own diet.

With these detailed dietary records, the authors were able to assign a standardized food code to each food from the US Department of Agriculture's Food and Nutrient Database for Dietary Studies (FNDDS), which includes nutrient information such as sodium content.

They found that the average daily sodium intake for children ages 6 to 18 is about 3,250 milligrams - easily one third more than is recommended for adults. By comparison, the recommended intake for children between 4 and 8 is less than 1,900 milligrams per day, less than 2,200 milligrams per day for kids between 9 and 13, and less than 2,300 mg/day for those 14 to 18.

The top ten sources of salt in the children's diets were:

1. Pizza
2. Mexican "mixed dishes" (such as tacos or burritos)
3. Sandwiches including burgers, hot dogs on rolls, chicken or turkey sandwiches, and egg or breakfast sandwiches
4. Yeast breads, rolls, and buns
5. Cold cuts and cured meats
6. Soups
7. Savory snacks (including potato chips, corn or tortilla chips, pretzels, popcorn or "snack mix")
8. Cheese
9. Plain, unflavored milk
10. Chicken, whole pieces (but not chicken patties, nuggets, or tenders)

What this means for you

It doesn't surprise me that pizza is number one - after all, it's a combination of three of the other top ten offenders: bread, cheese, and cold cuts. This shouldn't be taken as a list of things to prohibit your child from eating: rather, it should be a reminder that limiting how often your child eats out, making your food at home, and being thoughtful with your food choices can have a big impact: you don't have to have both cheese and cold cuts on a sandwich, for example, and loading that sandwich up with veggies is a great way to add vegetables to your child's diet while making the sandwich appear bigger and cutting the amount of added salt. Similarly, instead of pepperoni and cheese alone on your pizza, add mushrooms, onions, olives, and other vegetables.

First posted: January 25, 2017