Excessive Intake of Sodium in Children and Adolescents - Literature review Example

Excessive Intake of Sodium in Children and Adolescents Name Institution Course Unit Date Introduction Sodium chloride, simply known as table salt is a key ingredient in most meals. It is also an important dietary requirement as it provides essential sodium and iodine, in the case of iodized table salt, needed in the body. It provides chemical balance in the body and serves to assist in the functioning of the muscular and nervous system. However, it must be taken in moderation. Over consumption of salt leads to kidney problems, high blood pressure, oedema, increases the risk of cardiovascular diseases and stroke other risks. The Australia health department has enacted many campaigns to sensitize the public on sodium intake. The Australia Health Survey (AHS) seeks to investigate sodium intake behaviours in children and adolescents. This paper offers a critique of the AHS report and discusses the effect of excessive sodium intake. Critique of methodology (350) The AHS study is a combination of three studies from Australian Bureau of Statistic’s National Health Survey, the National Nutrition and Physical Activity Survey (NNPAS) and the National Health Measures Survey (NHMS). The sampling from these surveys however, excluded the Aboriginal and Torres Strait Islanders as a different survey that combined the three surveys was conducted specifically for the Aboriginal and Torres Strait Islander people living in remote and non-remote areas and discrete communities. The NHS survey relied on a sample of 20,500 persons from 16,000 households and the NNPAS used a sample of 13,000 persons from 10,000 households (1). The four surveys used varying criteria in identifying samples. The AHS survey thus imposed another criteria and shortlisted candidates with the main variant being age. Consequently, the core sample used in the AHS survey comprised of 33,500 persons all aged above two years. This allowed the survey access to a fully representative sample (1). Nonetheless, researchers claim that no single sampling method can provide an unbiased sample (2). By using multiple sources, the survey minimizes the bias. The NHS and NNPAS surveys used face-to-face Computer Assisted Personal Interview (CAPI) with the NNPAS using telephone Computer Assisted Telephone Interview (CATI) for follow-ups after about eight days. The participants, identified by their permanent dwellings were contacted first through a letter and informed of their selection as participants in the survey. Dwellings where all members were under 18 years of age were ignored. Trained interviewers from ABS conducted the interviews and collected data (1). Face to face interviews allow collection of non verbalized data which is usually not possible with other data collection methods. Mills and colleagues (2) say that face to face interviews also allow researchers a chance to clarify the suitability of the participants in the survey by for instance verifying age. Another key advantage is that there is a high response rate as compared to other methods such as questionnaires where the return rate of filled out questionnaires is markedly low. Telephone interviews are easier to arrange than face to face interviews, require less resources and are convenient to both interviewer and interviewee. However, they do not facilitate collection on non verbalized data. Telephone interviews also do not allow verification of data or responses given hence false information can be presented by the participant (2). Sodium intake and sodium Nutrient Reference Values (350) The AHS survey showed that the 14-18 year age group recorded the second highest level of sodium intake at 3,116.8 mg compared to other age groups. The highest sodium intake level was in the 19-30 years with the lowest sodium intake recorded in the 2-3yeas olds at 1,516.6mg and over 71 year-olds at 2,216.7mg (1). The amount of sodium consumed by the 14-18yrs olds outstrips the Adequate Intake (AI) of 460-920 mg/day, the Upper Level of Intake (UL) of 2,300 mg/day for 14-18and the Suggested Dietary Target of 1600mg/day (3,4). This points to the need to lower sodium intake in this age group. The amount of sodium required by the body increase with age according to NRV figures (3). Adequate amount of sodium in the body is necessary for various reasons. It helps maintain a healthy fluid balance in the body and also enable proper function of nervous and muscular systems. Although sodium deficiencies are rare, it can be caused by heart failure of diarrhoea (5). The amount of sodium intake considered in the study included amount that is naturally present in some foods and that is added during food processing but excluded sodium added to foods during meal times or in home-cooked meals. Table salt and processed foods are the two largest sources of sodium (5). One gram of table salt contains 390mg of pure sodium (4). Given that 64% of Australians reported adding salt very often or occasionally while preparing meals or at the table indicates that the average daily intake is higher (1). Health implications of sodium (700) Excess levels of sodium in the body have negative health implications. According to several sources, excessive levels of sodium in the body increase the risk of: high blood pressure, stroke, heart failure, osteoporosis, stomach cancer, kidney disease, kidney stones, enlarged heart muscle, headaches. Additionally, it may also lead to, weight gain, bloating and puffiness (6). However, WHO recognizes high blood pressure and cardiovascular issues as the major risks of high sodium intake (7). Several studies have assessed various risks posed by excessive sodium in the body. Yang et al (8) investigates how excessive sodium affects blood pressure in children and adolescents. The study sampled 6235 children and adolescents aged 8-18 years between 2003 and 2008. This sample was obtained from the 2003-2008 National Health and Nutrition Examination Survey (NHANES). Telephone interviews and physical examination at mobile examination centres were used to collect data. Participants provided a 24 hour dietary recall at the mobile examination centres while an additional 91% gave a second dietary recall via telephone interviews. Height, weight, BMI and BP data was collected during exams. Participants with missing data, those pregnant and underweight were excluded. The dietary information provided was used to estimate sodium and nutrient intake within a given 24 hour period. Results indicated that on average, children and adolescents consume 3387 mg/day which is high as that of adults. Average daily sodium intake among the obese and overweight was significantly higher than the average. Each 1000mg of daily sodium intake was associated with an increased 0.097 increase in systolic blood pressure for all subjects while among the obese/overweight, it increased by 0.141. The study thus concludes that high sodium intake is positively associated with high blood pressure and pre–high blood pressure and the association is higher among obese/overweight children and adolescents (8). Celermajer and Neal’s (5) employ several studies to present very insightful figures and facts about the necessity of addressing high sodium intake levels across populations. Their studies reveal that reduction from the usual sodium intake could have phenomenal health benefits. They point out that a 50% reduction in sodium intake or reduction of 1,200 mg salt daily across the population could have the following health benefits: 60,000 to 120,000 fewer coronary events, 32,000 to 60,000 fewer strokes, and healthcare cost savings of $10 to $24 billion each year. The study also warns against drastic cut in sodium intake noting that it can lead to sympathetic nerve activation, insulin sensitivity and aldosterone secretion. This is an affirmation of the important role that sodium plays in the body. However, addition of excess amounts of sodium especially in processed foods has led to an increase of sodium beyond the recommended daily intake. In fact, the authors observe that 75% of sodium consumed by an average person is sourced from processed foods (5). A study by Zhu et al (9) investigated the relationship of sodium intake with adiposity and inflammation in healthy adolescents. The study takes a different approach from the one followed by other studies such as Libuda et al (10) that claim that high sodium intake causes obesity indirectly by encouraging consumption of fluids high in sugar content. This particular study asserts that excessive sodium in the body is directly involved in adiposity in adolescents. The study sampled 766 healthy adolescents (389 whites and 377 African Americans) aged14-18 years. Sodium intake was estimated by 7-day 24-hour dietary recall. Those with any medical conditions or were on medication were excluded. Height and weight were measured to calculate BMI. Body fat percentage and fat mass were calculated using dual-energy x-ray absorptiometry with subcutaneous abdominal adipose tissue (SAAT) and visceral adipose tissue (VAT) calculated using magnetic resonance imaging (MRI) twice within a 7-day period (9). Results indicated that 97% of adolescents assessed in the study exceeded the recommended daily sodium intake with the average being recorded at 3280mg/day. Multiple linear regressions revealed further that dietary sodium intake was independently responsible for higher body weight, waist circumference, fat mass, percentage body fat, leptin and tumor necrosis factor. The authors thus concluded that the high sodium intake is positively associated with adiposity and inflammation independent of total energy intake or sweetened soft drink consumption (9). This contradicts the claim by Libuda et al (10) that high sodium intake encourages consumption of sweetened soft drinks to quench thirst which in turn leads to weight gain. Oral report to a journalist (100) The AHS survey report is an eye for the Australian people. For the country to a avoid catastrophe in future, dietary habits of 14-18 yr-olds need to change now. The issue should not be left alone to healthcare professionals but it should be the role of everyone to observe the amount of sodium consumed to keep it within acceptable levels. Furthermore, I think it is high time that our lawmakers created necessary legislations to control the amount of sodium in processed foods. Our schools and food processors should also take necessary measures to control the amount of sodium in their food as these meals form a major component of the diet of children and adolescents. References 1. AHS. (2012). Australian health survey: first results, 2011-12. [Internet] 2012 [cited 2014 Aug 30]. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.001Chapter1002011-12 2. Mills, Waters & Barks. Using research in healthcare practice. London; Lippincott Williams & Wilkins. 2009. 3. NRV (2014). Sodium. [Internet] 2014 [cited 2014 Aug 30]. Available from: http://www.nrv.gov.au/nutrients/sodium 4. Foodsmart. [Internet] 2014 [cited 2014 Aug 30]. Available from: http://www.foodsmart.govt.nz/whats-in-our-food/chemicals-nutrients-additives-toxins/food-additives/sodium/ 5. Celermajer, D. & Neal, B. Excessive sodium intake and cardiovascular disease. Journal of the American College of Cardiology 2013;61(3); 344-345. 6. American heart association. The effects of excess sodium on your health and appearance. [Internet] 2014 [cited 2014 Aug 30]. Available from: http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/The-Effects-of-Excess-Sodium-on-Your-Health-and-Appearance_UCM_454387_Article.jsp 7. WHO. Sodium intake for adults and children Guideline. [Internet] 2014 [cited 2014 Aug 30]. Available from: http://www.who.int/nutrition/publications/guidelines/sodium_intake/en/ 8. Yang, Q., Zhang, Z., Kuklina, E., Fang, J. Ayala, C. et al. Sodium intake and blood pressure among US children and adolescents. Paediatrics 2012; 130;611-619. 9. Zhu, H., Pollock, N., Kotak, I., Gutin, B., Wang, X., Bhagatwala et al. Dietary Sodium, Adiposity, and Inflammation in Healthy Adolescents. Pediatrics 2014;133(3): 635-642. 10. Libuda, L., Kersting, M. & Alexy, U. Consumption of dietary salt measured by urinary sodium excretion and its association with body weight status in healthy children and adolescents. Public Health Nutrition: 2011;15(3), 433–441. .. Read More

Face to face interviews allow collection of non verbalized data which is usually not possible with other data collection methods. Mills and colleagues (2) say that face to face interviews also allow researchers a chance to clarify the suitability of the participants in the survey by for instance verifying age. Another key advantage is that there is a high response rate as compared to other methods such as questionnaires where the return rate of filled out questionnaires is markedly low. Telephone interviews are easier to arrange than face to face interviews, require less resources and are convenient to both interviewer and interviewee.

However, they do not facilitate collection on non verbalized data. Telephone interviews also do not allow verification of data or responses given hence false information can be presented by the participant (2). Sodium intake and sodium Nutrient Reference Values (350) The AHS survey showed that the 14-18 year age group recorded the second highest level of sodium intake at 3,116.8 mg compared to other age groups. The highest sodium intake level was in the 19-30 years with the lowest sodium intake recorded in the 2-3yeas olds at 1,516.

6mg and over 71 year-olds at 2,216.7mg (1). The amount of sodium consumed by the 14-18yrs olds outstrips the Adequate Intake (AI) of 460-920 mg/day, the Upper Level of Intake (UL) of 2,300 mg/day for 14-18and the Suggested Dietary Target of 1600mg/day (3,4). This points to the need to lower sodium intake in this age group. The amount of sodium required by the body increase with age according to NRV figures (3). Adequate amount of sodium in the body is necessary for various reasons. It helps maintain a healthy fluid balance in the body and also enable proper function of nervous and muscular systems.

Although sodium deficiencies are rare, it can be caused by heart failure of diarrhoea (5). The amount of sodium intake considered in the study included amount that is naturally present in some foods and that is added during food processing but excluded sodium added to foods during meal times or in home-cooked meals. Table salt and processed foods are the two largest sources of sodium (5). One gram of table salt contains 390mg of pure sodium (4). Given that 64% of Australians reported adding salt very often or occasionally while preparing meals or at the table indicates that the average daily intake is higher (1).

Health implications of sodium (700) Excess levels of sodium in the body have negative health implications. According to several sources, excessive levels of sodium in the body increase the risk of: high blood pressure, stroke, heart failure, osteoporosis, stomach cancer, kidney disease, kidney stones, enlarged heart muscle, headaches. Additionally, it may also lead to, weight gain, bloating and puffiness (6). However, WHO recognizes high blood pressure and cardiovascular issues as the major risks of high sodium intake (7).

Several studies have assessed various risks posed by excessive sodium in the body. Yang et al (8) investigates how excessive sodium affects blood pressure in children and adolescents. The study sampled 6235 children and adolescents aged 8-18 years between 2003 and 2008. This sample was obtained from the 2003-2008 National Health and Nutrition Examination Survey (NHANES). Telephone interviews and physical examination at mobile examination centres were used to collect data. Participants provided a 24 hour dietary recall at the mobile examination centres while an additional 91% gave a second dietary recall via telephone interviews.

Height, weight, BMI and BP data was collected during exams. Participants with missing data, those pregnant and underweight were excluded. The dietary information provided was used to estimate sodium and nutrient intake within a given 24 hour period. Results indicated that on average, children and adolescents consume 3387 mg/day which is high as that of adults. Average daily sodium intake among the obese and overweight was significantly higher than the average.

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