Dietary Sources of Sodium in China, Japan, the United Kingdom, and the United States, Women and Men Aged 40 to 59 Years: The INTERMAP Study

Abstract

Public health campaigns in several countries encourage population-wide reduced sodium (salt) intake, but excessive intake remains a major problem. Excessive sodium intake is independently related to adverse blood pressure and is a key factor in the epidemic of prehypertension/ hypertension. Identification of food sources of sodium in modern diets is critical to effective reduction of sodium intake worldwide. We used data from the INTERMAP Study to define major food sources of sodium in diverse East Asian and Western population samples. INTERMAP is an international, cross-sectional, epidemiologic study of 4, 680 individuals ages 40 to 59 years from Japan (four samples), People’s Republic of China (three rural samples), the United Kingdom (two samples), and the United States (eight samples); four in-depth, multipass 24-hour dietary recalls/person were used to identify foods accounting for most dietary sodium intake. In the People’s Republic of China sample, most (76%) dietary sodium was from salt added in home cooking, about 50% less in southern than northern samples. In Japan, most (63%) dietary sodium came from soy sauce (20%), commercially processed fish/seafood (15%), salted soups (15%), and preserved vegetables (13%). Processed foods, including breads/cereals/grains, contributed heavily to sodium intake in the United Kingdom (95%) and the United States (for methodological reasons, underestimated at 71%). To prevent and control prehypertension/hypertension and improve health, efforts to remove excess sodium from diets in rural China should focus on reducing salt in home cooking. To avoid excess sodium intake in Japan, the United Kingdom, and the United States, salt must be reduced in commercially processed foods.

Hypertension among Tunisian adults: results of the TAHINA project

“…1 Although the exact causes and mechanisms of hypertension are not known, it is generally believed that both genetic 12,13 and environmental factors, such as dietary salt, adiposity, cigarette smoking and mental stress were involved in determining the levels of BP and the prevalence of hypertension. [14][15][16] Knowledge of the prevalence of hypertension and the extent to which it is being detected, treated and controlled are essential to understand the magnitude of the problem and how well it is being addressed. In Tunisia, there were limited data about the prevalence of hypertension, 11,17,18 with no national estimates and no information about the levels of awareness, treatment and control of hypertension.…”

Relationship between sodium and potassium intake and blood pressure in a sample of overweight adults

“…While we did not analyse meal patterns and their sodium contribution to the total daily intake, a previous Australian study found that lunch had the highest sodium density compared to dinner and breakfast [29]. Our study did not assess the use of discretionary salt, but in low and low-middle income countries, this has been found to be a significant source of sodium which may account for up to 76% of total intake in China [13].…”

“…In contrast, sources of sodium may vary in other countries depending on the major foods consumed and cultural context. For instance, in Japan, most of the dietary sodium is derived from soy sauce, salted soups, processed fish/ seafood and preserved vegetables [13]. While we did not analyse meal patterns and their sodium contribution to the total daily intake, a previous Australian study found that lunch had the highest sodium density compared to dinner and breakfast [29].…”

“…In the INTERMAP study, major food sources of sodium included bread, grains and cereals in the United States and United Kingdom; added salt in China; and soy sauce, processed fish/ seafood and salted soups in Japan [13].…”

Dietary salt intake and diabetes complications in patients with diabetes: An overview

“…For example, according to the distribution of mean dietary sodium intake, the mean dietary salt intake by Japanese patients with type 2 diabetes was 10.7 g/d,8 and their intake was lower than that in the general Japanese population (11.7 g/d)19 and higher than that in the US and UK general populations (9.1 and 8.6 g/d, respectively),20 as well as a diabetic population in the United States (6.4–8.6 g/d) 21. Therefore, based on the current situation of dietary salt intake by countries, it is reasonable that the goals for daily intake of dietary salt in guidelines are below 6 g/d for Western diabetic patients regardless of the presence or absence of hypertension and/or diabetic complications although a clearly numerical target (<6 g/d) was set only for patients with diabetes having hypertension and/or diabetic complications in Japan.…”