Doctors continue to endorse eating a low salt diet but patients remain confused on what exactly this means. Even experts cannot seem to agree on how much salt is too much; the American Heart Association, the Dietary Guidelines for Americans, and individual research groups all propose different recommendations for daily sodium intake. Furthermore, the American Academy of Pediatrics recommends to “use small amounts of sugar, salt, fats, and oils with highly nutritious foods to enhance enjoyment and consumption,” but the AAP does not quantify these amounts. It is difficult for patients to implement these recommendations without knowing exactly what they are. Regardless of the varying recommendations, the majority of research endorses that high sodium intake in children is a cause for concern. Thus, pediatricians should provide patient education for lowering sodium intake early in life, as research shows that preference for sodium is shaped by dietary exposure.

 The American Heart Association (AHA) recommends a maximum amount of 1,500 mg of sodium a day for all people regardless of age. However, the average child ages 2 through 19 eats more than 3,100 mg of sodium per day, more than twice the daily recommendation, according to the AHA. School-aged children consume most of their sodium at lunch and dinnertime, and processed and restaurant foods make up 83% of the sodium kids eat. The sodium is already contained in the foods kids are eating: it is not being added from the kitchen salt shaker. This is frightening because it presents a challenge to parents who may not pay attention to the sodium content of foods and who cannot take it out of the processed foods which they purchase.

High sodium intake is associated with high blood pressure which is a major risk factor for heart disease. High blood pressure also increases the risk of heart attacks, strokes, and heart failure. Heart disease is considered the leading cause of death worldwide, according to the AHA. Some research suggests that reducing sodium intake may lower blood pressure in some individuals while actually increasing blood pressure in others. In addition, this research tends to shift the blame from sodium to sugar as the true culprit behind heart disease. The AHA continues to endorse that the connection between sodium consumption and health adversities, and it recommends that Americans should lower sodium consumption for better health outcomes.

Pediatricians should provide resources and guidance to parents about monitoring and reducing as necessary a child’s consumption of sodium. The AHA’s How to Reduce Sodium article and the CDC’s section on salt (www.cdc.gov/salt) provide further information on how to decrease the amount of sodium in food consumption.

Additionally, pediatricians should take action to encourage food companies to reduce the sodium content in their products, because more than 80% of sodium intake comes from the consumption of pre-packaged and restaurant foods. The Food and Drug Administration (FDA) has announced a draft voluntary guidance, “Voluntary Sodium Reduction Goals: Target Mean and Upper Bound Concentrations in Commercially Processed, Packaged, and Prepared Foods,” and the agency is asking for public comments for it. The guidance will offer voluntary goals to reduce the amount of sodium in certain categories of processed and other foods. Electronic or written comments for the guidance must be submitted by August 31, 2016 for four issues and by October 31, 2016 for four other issues, all listed as questions in the announcement in the Federal Register. You can access the draft guidance through the FDA’s website here.

Rija Siddiqui, MD

Resources:

“AAP Recommends Whole Diet Approach to Children’s Nutrition.” American Academy of Pediatrics. February 23^rd, 2015.

“High Sodium Intake in Children and Adolescents: Cause for Concern.” Center for Disease Control and Prevention. March 2013.

“Sodium and Kids.” American Heart Association. 2016.

“Sugar Versus Salt: Which Has the Greater Impact on Your Heart Health?” Forbes. March 2015.