Usual Sodium Intakes Compared with Current Dietary Guidelines — United States, 2005–2008

Morbidity and Mortality Weekly Report Weekly / Vol. 60 / No. 41 October 21, 2011 Usual Sodium Intakes Compared with Current Dietary Guidelines — United States, 2005–2008 High sodium intake can increase blood pressure and the risk not recorded (694), and participants who reported being on for heart disease and stroke (1,2). According to the Dietary renal dialysis (39). Among participants aged ≥12 years, 5,508 Guidelines for Americans, 2010 (3), persons in the United States were randomly assigned to a morning examination, fasted for aged ≥2 years should limit daily sodium intake to <2,300 mg. 8–24 hours, and had fasting plasma glucose, glycohemoglobin Subpopulations that would benefit from further reducing (HbA1c), serum creatinine concentration, and urine albumin sodium intake to 1,500 mg daily include 1) persons aged ≥51 and creatinine measured. Excluded were persons with missing years, 2) blacks, and 3) persons with hypertension, diabetes, diabetes data (18) or blood pressure data (898), yielding an or chronic kidney disease (3). To estimate the proportion of analytic sample of 9,468 participants, 4,268 aged 2–11 years the U.S. population for whom the 1,500 mg recommenda- and 5,200 aged ≥12 years. tion applies and to assess the usual sodium intake for those Persons with a recommended daily sodium intake of 1,500 persons, CDC and the National Institutes of Health used mg had at least one of the following characteristics: age ≥51 data for 2005–2008 from the National Health and Nutrition years, non-Hispanic black race, or hypertension, diabetes, or Examination Survey (NHANES). This report summarizes the chronic kidney disease. Hypertension was defined as mean results of that assessment, which determined that, although systolic blood pressure ≥140 mm Hg, mean diastolic blood 47.6% of persons aged ≥2 years meet the criteria to limit pressure ≥90 mm Hg, or self-reported use of antihypertensive their daily sodium intake to 1,500 mg, the usual daily sodium intake for 98.6% of those persons was >1,500 mg. Moreover, for 88.2% of the remaining U.S. population, daily sodium INSIDE intake was greater than the recommended <2,300 mg. New 1418 Carbapenem-Resistant Klebsiella pneumoniae population-based strategies and increased public health and Associated with a Long-Term–Care Facility — private efforts will be needed to meet the Dietary Guidelines West Virginia, 2009–2011 recommendations. 1421 State Electronic Disease Surveillance Systems NHANES is a nationally representative, multistage survey of — United States, 2007 and 2010 the U.S. non-institutionalized population.* During NHANES 1424 Updated Recommendations for Use of Tetanus 2005–2008, a total of 18,823 participants aged ≥2 years were Toxoid, Reduced Diphtheria Toxoid and Acellular interviewed and examined. Blood pressure was measured, Pertussis Vaccine (Tdap) in Pregnant Women and blood and urine were collected for testing, and a 24-hour Persons Who Have or Anticipate Having Close dietary recall was administered. A second 24-hour dietary recall Contact with an Infant Aged <12 Months — Advisory Committee on Immunization Practices was administered by telephone 3–10 days later. Dietary intake (ACIP), 2011 for children aged 2–5 years was recalled by a proxy, for children 1427 Addition of History of Intussusception as a 6–11 years by the participant assisted by a proxy, and for all Contraindication for Rotavirus Vaccination others by the participant. Examination response rates were 1428 Notes from the Field: Yersinia enterocolitica 76% during the study period. Excluded from the initial sample Infections Associated with Pasteurized Milk — were pregnant women, women whose pregnancy status was Southwestern Pennsylvania, March–August, 2011 * Additional information available at http://www.cdc.gov/nchs/nhanes.htm. 1429 QuickStats U.S. Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report medication; diabetes as self-reported diagnosis by a health- Among persons aged ≥2 years with a 1,500 mg daily recom- care provider, HbA1c ≥6.5%, or fasting plasma glucose mendation, 98.6% consumed >1,500 mg sodium on a usual ≥126 mg/dL; and chronic kidney disease as an estimated daily basis, including 99.4% of those aged ≥18 years (Table 2). glomerular filtration rate <60 mL/min/1.73 m2 or urinary Among those with a sodium recommendation of <2,300 mg albumin-creatinine ratio >30 mg/g (4,5). daily, 88.2% consumed ≥2,300 mg on a usual daily basis, Mean usual sodium intakes and proportions of the sub- including 95.0% of those aged ≥18 years. population with intake above 1,500 mg/day and at or above Reported by 2,300/mg day were estimated from up to two 24-hour dietary recalls using statistical software to account for day-to-day Catherine M. Loria, PhD, Michael E. Mussolino, PhD, Div of variation in intake with jackknife replicate weights based on Cardiovascular Sciences, National Heart, Lung, and Blood survey sample weights to estimate standard errors and confi- Institute, National Institutes of Health. Mary E. Cogswell, DrPH, dence intervals. For all other analyses, statistical software for Cathleen Gillespie, MS, Janelle P. Gunn, MPH, Darwin R. complex surveys was used with the survey sample weights. Labarthe, MD, PhD, Div for Heart Disease and Stroke For participants aged ≥12 years, survey sample weights for Prevention; Sharon Saydah, PhD, Meda E. Pavkov, MD, Div of the fasting subsample were used. For participants aged 2–11 Diabetes Translation, National Center for Chronic Disease years, survey sample weights for the medical examination and Prevention and Health Promotion, CDC. Corresponding first day diet sample were used. contributor: Mary E. Cogswell, [email protected], Among the U.S. population aged ≥2 years in 2005–2008, 770-488-8053. an estimated 47.6% of the population met the criteria to limit Editorial Note sodium intake to 1,500 mg daily, according to the 2010 Dietary Guidelines (Table 1). Although this proportion differed by sex, The findings in this report indicate that 47.6% of the U.S. that difference was not statistically significant after adjusting population aged ≥2 years meet the criteria of the 2010 Dietary for age and race/ethnicity. The proportion of the population Guidelines for persons who should limit sodium consumption with a 1,500 mg daily recommendation was higher among to 1,500 mg daily (3). For the Dietary Guidelines, the 2005 adults (57.1%) than among children (16.2%). Among non- Institute of Medicine (IOM), Dietary Reference Intakes were Hispanic blacks, non-Hispanic whites, and Mexican Americans used to define the specific subpopulations for whom the 1,500 aged ≥2 years, 100.0%, 44.1%, and 23.7%, respectively, were mg recommendation applies (2). These subpopulations tend to advised to limit their sodium intake to 1,500 mg daily. be more responsive than others to the blood pressure-raising The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Suggested citation: Centers for Disease Control and Prevention. [Article title]. MMWR 2011;60:[inclusive page numbers]. Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science James W. Stephens, PhD, Director, Office of Science Quality Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services Stephanie Zaza, MD, MPH, Director, Epidemiology and Analysis Program Office MMWR Editorial and Production Staff Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series John S. Moran, MD, MPH, Deputy Editor, MMWR Series Martha F. Boyd, Lead Visual Information Specialist Robert A. Gunn, MD, MPH, Associate Editor, MMWR Series Maureen A. Leahy, Julia C. Martinroe, Teresa F. Rutledge, Managing Editor, MMWR Series Stephen R. Spriggs, Terraye M. Starr Douglas W. Weatherwax, Lead Technical Writer-Editor Visual Information Specialists Donald G. Meadows, MA, Jude C. Rutledge, Writer-Editors Quang M. Doan, MBA, Phyllis H. King Information Technology Specialists MMWR Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN Patricia Quinlisk, MD, MPH, Des Moines, IA Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Patrick L. Remington, MD, MPH, Madison, WI David W. Fleming, MD, Seattle, WA Barbara K. Rimer, DrPH, Chapel Hill, NC William E. Halperin, MD, DrPH, MPH, Newark, NJ John V. Rullan, MD, MPH, San Juan, PR King K. Holmes, MD, PhD, Seattle, WA William Schaffner, MD, Nashville, TN Deborah Holtzman, PhD, Atlanta, GA Anne Schuchat, MD, Atlanta, GA John K. Iglehart, Bethesda, MD Dixie E. Snider, MD, MPH, Atlanta, GA Dennis G. Maki, MD, Madison, WI John W. Ward, MD, Atlanta, GA 1414 MMWR / October 21, 2011 / Vol. 60 / No. 41 Morbidity and Mortality Weekly Report TABLE 1. Percentage of persons aged ≥2 years for whom recommended daily sodium intake of 1,500 mg applies,* by sex, age group, and What is already known on this topic? racial/ethnic subpopulation — National Health and Nutrition Dietary Guidelines for Americans, 2010 recommends that persons Examination Survey (NHANES), United States, 2005–2008 in the United States aged ≥2 years limit sodium intake to <2,300 Subpopulation No. in sample† (%)§ (95% CI) mg daily and that 1) persons aged ≥51 years, 2) blacks, and 3) Total 9,468 (47.6) (45.1–50.1) persons with hypertension, diabetes, or chronic kidney disease Sex should limit sodium intake to 1,500 mg daily to reduce their risk Male 4,826 (45.9) (42.9–49.0) for hypertension, heart disease, and stroke. Female 4,642 (49.2) (46.5–52.0) What is added by this report? Age group (yrs) 2–17 5,188 (16.2) (13.3–19.6) According to the 2005–2008 National Health and Nutrition ≥18 4,280 (57.1) (54.3–60.0) Examination Survey, the recommendations to restrict daily 18–50 2,334 (30.6) (27.8–33.6) sodium intake to 1,500 mg applied to 47.6% of persons in the ≥51 1,946 (100.0) — United States aged >2 years.

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