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Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health Association Meeting October 18, 2010
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Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Dec 16, 2015

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Page 1: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

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

Page 2: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.
Page 3: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Leading Causes of Death in Oregon: 2007

Nu

mbe

r of

death

s

Page 4: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Cost Per Heart Disease Hospitalization, Oregon, 1995-2008

Page 5: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Cost Per Stroke Hospitalization, Oregon, 1995-2008

Page 6: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

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%

Page 7: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Hypertension Prevalence, Oregon (Age-Adjusted)

1997 1999 2001 2003 2005 2007 20090

10

20

30

Pre

vale

nce

(%

)

Page 8: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Adults with Hypertension By Race/Ethnicity, Oregon, 2004-2005

Page 9: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Cost to treat Hypertension in Oregon

$800 Million

Page 10: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Behavior Change among People with Hypertension, Oregon, 2009

Page 11: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

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

Page 12: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Sources of salt in the diet

Processed and

restau-rant

foods; 77%

Natu-rally

occur-ing ; 12%

While eating;

6%

Home cooking;

5%

Page 13: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

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

Page 14: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

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

Page 15: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Salt reduction strategies

• Gradually reduce the amount of salt in processed and restaurant foods– National Salt Reduction Initiative– FDA Regulation (IOM Recommendation)

Page 16: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Salt gets added back, but not that much!

Beauchamp et al., 1987, JAMA 258(22):3275-3278

Page 17: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

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 {

Page 18: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

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%

Page 19: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

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

Page 20: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.

Salt reduction strategies

• Label foods so consumers canmake accurate choices– Menu labeling– Nutritional labeling

Page 21: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.
Page 22: Excessive sodium intake: Why it matters to public health Katrina Hedberg, M.D., MPH State Epidemiologist, Oregon Public Health Division Oregon Public Health.