Sodium Intake among US School-Aged Children: National Health and Nutrition Examination Survey, 2011-2012

Abstract

Background Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake, which occurs among 90% of US school-aged children. Objective To describe major food sources, places obtained, and eating occasions contributing to sodium intake among US school-aged children. Design Cross-sectional analysis of data from the 2011–2012 National Health and Nutrition Examination Survey. Participants/setting A nationally representative sample of 2,142 US children aged 6 to 18 years who completed a 24-hour dietary recall. Main outcome measures Population proportions of sodium intake from major food categories, places, and eating occasions. Statistical analyses performed Statistical analyses accounted for the complex survey design and sampling. Wald F tests and t tests were used to examine differences between subgroups. Results Average daily sodium intake was highest among adolescents aged 14 to 18 years (3,565±120 mg), lowest among girls (2,919±74 mg). Little variation was seen in average intakes or the top five sodium contributors by sociodemographic characteristics or weight status. Ten food categories contributed to almost half (48%) of US school-aged children’s sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. More than 80 food categories contributed to the other half of children’s sodium intake. Foods obtained from stores contributed 58% of sodium intake, fast-food/pizza restaurants contributed 16%, and school cafeterias contributed 10%. Thirty-nine percent of sodium intake was consumed at dinner, 31% at lunch, 16% from snacks, and 14% at breakfast. Conclusions With the exception of plain milk, which naturally contains sodium, the top 10 food categories contributing to US schoolchildren’s sodium intake during 2011–2012 comprised foods in which sodium is added during processing or preparation. Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the US food supply.

Diet quality of children in the United States by body mass index and sociodemographic characteristics

“…Age group differences also were similar in children with underweight, but significance was not reached likely due to smaller samples sizes. In agreement with the present study, others also have reported negative relationships between child age and intakes of fruit, whole and refined grains, and dairy (less healthful as age increases) , positive relationships between age and intakes of protein foods and fatty acids (more healthful as age increases) , and positive relationships between age and intakes of sodium and added sugars (less healthful as age increases) . The present study's results also confirm the lack of significant relationships between age and vegetable intake reported by some researchers .…”

“…Likewise, a systematic review and meta-analysis found no relationship between reduced saturated fats intake and BMI in children 17 . Similar to the present study, a positive relationship between diet quality related to sodium intake and body weight in children has been reported in two other studies 18,19 .…”

Estimation of salt intake and excretion in children in one region of Switzerland: a cross-sectional study

“…In Austria, a study conducted in 2010-2012 among 392 boys and girls between 7 and 14 years of age with casual urinary spots showed a salt intake of 6.2 and 7.1 g per day, respectively [37]. In the United States, using data from 2'142 children 6-18 years to the 2011-2012 NHANES survey, based on a 24-hour diet recall, the salt intake was 8.1 g per day [38]. In Switzerland, a national nutrition survey conducted in 2010-2011 among adults showed that salt excretion was on average 9.9 g salt per day [14].…”

Salt need needs investigation

“…The opposite is better evidenced: early Na restriction increases lifelong intake (31)(32)(33)(34)(35)(36)(37)(38)(39) . Moreover, growing children and adolescents ingest and prefer more salt than they were ever previously exposed to (16,39,40) (Fig. 1).…”

“…As it develops, the human child increasingly has a predilection for salt, marginally related to early dietary experience (32,92,93) , but significantly related to neonatal hyponatraemia and to growth (16,31,32,(36)(37)(38)(39)(40)88,89) . It is important to note that this increase in later salt appetite occurs with no experience of salt taste, a phenomenon established in rats (2,58,65,66,94) ; in babies, the neonatal Na supplementation is administered intravenously which may not condition a salt preference (95) .…”