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Strategies to Reduce Sodium Intake in the United States
dium for the first time in 2005 (IOM, 2005). An Adequate Intake1 (AI) was established by the IOM ranging from 1,000 to 1,500 mg for persons 2 or more years of age depending on age, and is a value that reflects the recommended average daily intake level based on observed or experimentally determined approximations or estimates of nutrient intake.2 The IOM also established a Tolerable Upper Level of Intake3 (UL) for sodium ranging from 1,500 to 2,300 mg depending upon age, which is the highest daily intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population (IOM, 2005).
In setting the stage for the committee’s deliberations, Chapter 2 provides an overview of existing information about sodium intake in relation to evaluating the effectiveness of the major national public health initiatives. This chapter presents the results of analyses4 conducted for the committee’s study using data from NHANES,5 a large nationally representative survey conducted by CDC. Specifically, data from the 2003–2006 NHANES period were analyzed in order to specify current sodium intake. These dietary intake data are collected in the component of the NHANES known as What We Eat in America, but for the purposes of simplicity this chapter refers to them as NHANES data. The 2003–2006 NHANES data were also used to characterize current contributions to the diet based on food categories and to examine contributions to intake made by foods “from home” versus those “away from home.” Issues of monitoring and surveillance of intake and related factors are also considered.
Background information on the NHANES and the methodologies used
Adequate Intake: IOM reference value: the recommended average daily intake level based on observed or experimentally determined approximations of estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate (IOM, 2006).
The AI of 1,500 mg for adults 19 through 50 years of age was derived based on the following rationale: a diet that provides an average of 1,500 mg/day of sodium can meet recommended intakes of other nutrients; this level exceeds the levels of sodium intake that have been associated with adverse effects on blood lipid concentrations and insulin resistance, and this level allows for excess sodium loss in sweat by unacclimitized persons who are exposed to high temperatures or who are moderately physically active (IOM, 2005). The AIs for children and adolescents 1–18 years of age (1,000 mg/day for 1–3 years of age; 1,200 mg/day for 4–8 years of age; and 1,500 mg/day for 9–18 years of age) were extrapolated down from the AI for adults using the average of median energy intake levels of the age groups for adults and for children as the basis for extrapolation. The AI for adults 51 years and older (1,300 mg/day for 51–70 years of age and 1,200 mg/day for > 70 years of age) was extrapolated from younger individuals based on energy intake (IOM, 2005).
Tolerable Upper Intake Level: IOM reference value: the highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population. As intake increases above the UL, the potential risk of adverse effects may increase.
Analytical support provided by Mathematica Policy Research, Washington, DC.