Reduced sodium meal plans are recommended by the Centers of Disease Control to lower blood pressure in older adults; however, this strategy has not been tested in a clinical trial. The Satter House Trial of Reduced Sodium Meals (SOTRUE) was an individual-level, double-blind, randomized controlled pilot study of adults living in a congregate living facility subsidized by the Federal Department of Housing and Urban Development (HUD). Adults over age 60 years ate 3 isocaloric meals with two snacks daily for 14 days. The meal plans differed in sodium density (<0.95 vs. >2 mg/kcal), but were equivalent in potassium and macronutrients. Seated systolic BP (SBP) was the primary outcome, while urine sodium-creatinine ratio was used to measure compliance. Twenty participants were randomized (95% women; 95% white; mean age 78 ± 8 years), beginning in 7 October 2019. Retention was 100% with the last participant ending November 4, 2019. Mean baseline SBP changed from 121 to 116 mmHg with the typical sodium diet (−5 mmHg; 95%CI: −18, 8) and from 123 to 112 mmHg with the low sodium diet (−11 mmHg; 95%CI: −15.2, −7.7). Compared to the typical sodium meal plan, the low sodium meal plan lowered SBP by 4.8 mmHg (95%CI: −14.4, 4.9; p = 0.31) and urine sodium-creatinine ratio by 36% (−36.0; 95%CI: −60.3, 3.4; p = 0.07), both non-significant. SOTRUE demonstrates the feasibility of sodium reduction in federally mandated meal plans. A longer and larger study is needed to establish the efficacy and safety of low sodium meals in older adults.

We evaluated the feasibility of using Computrition to design and implement a low vs. typical sodium meal plan intervention for older adults. Dietitians used Computrition to design a 7-day meal plan with three caloric levels (≤1750, 2000, ≥2250 kcals/day) and two sodium densities (low = 0.9 mg/kcal; n = 11 or typical = 2 mg/kcal; n = 9). Feasibility was determined by post-hoc definitions of effectiveness, sodium compliance, palatability of diet, sustainability, and safety. Given the low number of participants in one of the three calorie groups, the higher calorie groups were combined. Thus, comparisons are between low vs. typical meal plans at two calorie levels (≤1750 or ≥2000 kcals/day). Overall, regardless of the calorie group, the meal plans created with Computrition were effective in reaching the targeted sodium density and were safe for participants. Furthermore, individuals appeared to be equally compliant and reported similar palatability across meal plans. However, one of the three criteria for the sustainability definition was not met. In conclusion, we successfully used Computrition to design low and typical sodium meal plans that were effective, compliable, and safe. Future studies of older adults in similar settings should focus on improving the palatability of the meal plans and scaling this protocol to larger studies in older adults.

Objectives Computrition is a food service software utilized by dieticians in clinical settings to create recipes, design menus, and scale the menus to larger quantities, yet it is underutilized in the research setting. The objective was to determine the practicality of administering two meal plans (low sodium vs typical sodium) designed with Computrition in a double-blind, randomized pilot study in older adult residents of a congregate housing facility. Methods This pilot study included 19 females and 1 male aged ≥65y residing at Jack Satter House, Revere, MA. Participants were randomized to low sodium or typical sodium meals (&lt;0.95 or &gt;2 mg/kcal), designed with Computrition. A base 7-day meal plan (with breakfast, lunch, dinner, and two snacks) was generated. Recipes entered in Computrition were modified to reach three calorie levels (1750, 2000, 2250 kcal/d) and two sodium densities, while keeping potassium levels constant at ∼3500 mg/d. Finally, Computrition labels were generated to execute meals while maintaining blinding. To determine efficacy of these meal plans, compliance was evaluated by comparing change in urinary sodium (mmol/L) over 2-weeks between low sodium vs. typical sodium groups. These comparisons were also assessed in sub-groups by calorie intake (≤1750 kcal/d, n = 12 and ≥2000 kcal/d, n = 8). Results Mean age was 77 ± 6y and calorie intake was 1849 kcal (low sodium group, n = 11) and 80 ± 9y and 1785 kcal (typical sodium group, n = 9). Over 2-weeks, urinary sodium decreased by −30.6 mmol/L in the low sodium diet, compared to 2.4 mmol/L in the typical sodium diet (P = 0.003). In those consuming ≤ 1750 kcal/d on the low sodium diet, urinary sodium decreased non-significantly by −18.3 mmol/L, compared to −2.3 mmol/L in the typical sodium diet (P = 0.16). In those consuming ≥2000 kcal/d on the low sodium diet, urinary sodium decreased non-significantly by −22.0 mmol/L, compared to no change in the typical sodium diet (P = 0.26). Conclusions In this study, two sodium meal plans designed using Computrition altered urinary sodium over 2 weeks. Similar trends in reduction were seen in the sub-groups by calorie intake, although results were not significant due to small sample sizes. Future work should evaluate testing and standardization of this software for a multi-site nutrition intervention study. Funding Sources ISAC, Marcus Institute, Hebrew SeniorLife.

Objectives To determine the feasibility of a low sodium meal plan intervention aimed at reducing seated blood pressure (BP) in residents of a government-subsidized congregate, senior living facility. Methods The Satter House Trial of Reduced Sodium Meals (SOTRUE) was an individual-level, masked, randomized, controlled pilot study, testing the feasibility of administering a low versus typical sodium meal plan to adult residents of Jack Satter House, a section 202 congregate living facility in Revere, MA, subsidized by the Federal Department of Housing and Urban Development (HUD). Adults over age 60 years received 3 isocaloric meals with two snacks daily over a 14-day period. Both meal plans were equivalent in potassium and macronutrients, but differed in sodium density (&lt;0.95 mg/kcal vs &gt; 2 mg/kcal). The primary outcome was seated systolic BP (SBP) averaged over 2 visits (days 10 and 14) using an Omron HEM-907XL automated cuff. Our objective measure of compliance was morning urine sodium-creatinine ratio. Results We randomized 20 participants (95% women, 95% white, and mean age 78 +/− 8 years), beginning in October 7, 2019. Baseline characteristics were evenly distributed between groups. Dietary compliance was high (only 2 discontinued meals) and follow-up was 100% with the last participant ending November 4, 2019. Baseline SBP changed from 121 to 116 mm Hg on the typical sodium meal plan (N = 9; mean difference of −5 mm Hg; 95% CI: −18, 8) and 123 to 112 mm Hg on the low sodium meal plan (N = 11; mean difference of −11 mm Hg; 95% CI: −15.2, −7.7). Compared to the typical sodium meal plan, the low sodium meal plan non-significantly reduced SBP by 5 mm Hg (95% CI: −14, 4) and non-significantly reduced urine sodium-creatinine ratio (%-difference −36.0; 95% CI: −60.3, 3.4). Effects on SBP were greater in the subgroup using hypertension medications at baseline (−13 mm Hg; 95% CI: −26, −0) and changes in SBP from baseline were correlated with changes in urine sodium-creatinine ratio (Pearson's r = 0.31). Conclusions This trial represents an innovative, feasible, and practical approach to healthier eating by altering federally-mandated meal plans. A definitive study with a larger sample size is needed to establish the efficacy and safety of this approach in older adults who reside in section 202 housing. Funding Sources ISAC, Marcus Institute for Aging Research, Hebrew SeniorLife.