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Excessive sodium intake:Why it matters to public
healthKatrina Hedberg, M.D., MPHState Epidemiologist, Oregon
Public Health Division
Oregon Public Health Association Meeting
October 18, 2010
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Leading Causes of Death in Oregon: 2007
Nu
mbe
r of
death
s
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Cost Per Heart Disease Hospitalization, Oregon, 1995-2008
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Cost Per Stroke Hospitalization, Oregon, 1995-2008
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Stroke Hospitalization & Comorbidities, Oregon Medicare, 1995-2002• Hypertension (HBP) 58%• Atrial Fibrillation (AF) 22%• HBP+Diabetes 14%• Diabetes 21%• HBP+AF 12%• AF+Diabetes+HBP 3%
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Hypertension Prevalence, Oregon (Age-Adjusted)
1997 1999 2001 2003 2005 2007 20090
10
20
30
Pre
vale
nce
(%
)
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Adults with Hypertension By Race/Ethnicity, Oregon, 2004-2005
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Cost to treat Hypertension in Oregon
$800 Million
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Behavior Change among People with Hypertension, Oregon, 2009
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Recommended salt intake
Actual average salt intake
Recommended salt intake, general population
Recommended salt intake, high risk groups (70% of adult Oregonians)
0 1000 2000 3000 4000
3375
2300
1500
Milligrams sodium per day
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Sources of salt in the diet
Processed and
restau-rant
foods; 77%
Natu-rally
occur-ing ; 12%
While eating;
6%
Home cooking;
5%
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Mean sodium contribution (mg) of top five foods among U.S. population
Yeast breads
Chicken and chicken mixed dishes
Pizza Pasta and pasta dishes
Cold cuts0
100
200
300250
233 217
174155
Source: NHANES 2003-2006
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Why so much salt?
• Food tastes better• Preserves foods• Increases shelf life• Keeps meat from drying
out when cooked• Competition for market share• Increased consumption
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Salt reduction strategies
• Gradually reduce the amount of salt in processed and restaurant foods– National Salt Reduction Initiative– FDA Regulation (IOM Recommendation)
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Salt gets added back, but not that much!
Beauchamp et al., 1987, JAMA 258(22):3275-3278
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Salt preference is malleable
Elmer, PhD dissertation, U Minn, 1988
Baseline 6 12 18 24 48 54
-30%
-20%
-10%
0%
10%
Low Na {
Cha
nge
from
Bas
elin
e (%
)
Weeks on Low Na Diet
Change in Na Excretion Change in Optimal Na
Change in Na Excretion Change in Optimal Na
Control {
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Why a gradual change?
• Perceptual studies: people don’t detect differences when concentrations of a taste substance is less than 10%
• Just Noticeable Difference (JND) for food suggested at 20%
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Salt reduction strategies
• Reduce the amount of salt in foods served at large institutions
• Procurement policies at worksites that limit the amount of salty foods offered in cafeterias and vending machines
• State and local governments• Universities• Hospitals• Schools• Large private employers
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Salt reduction strategies
• Label foods so consumers canmake accurate choices– Menu labeling– Nutritional labeling
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