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1. Sodium and The Dietary Guidelines Nutrient Essentials Penny Kris-Etherton, Ph.D., R.D. Department of Nutritional Sciences Pennsylvania State University

8. Current Dietary Recommendations for Sodium & Potassium 2003-2006 Consume less than 2.4 g/d 2003 NIH/ NHLBI, JNC 7 AI = 1.5 g/d, UL = 2.3 g/d Potassium, AI = 4.7 g/d 2004 DRI from National Academies Consume less than 2.3 g/d; persons with hypertension, blacks, middle-age & older adults: 1.5 g/d. Increase potassium to 4.7 g/d 2005 Dietary Guidelines for Americans Lower salt intake as much as possible: 1.5 g/d Increase potassium to 4.7 g/d 2006 AHA Science Statement on Prevention and Treatment of Hypertension An achievable goal – 2.3 g/d; upper level could be as low as 1.5 g/d 2006 AHA Diet and Lifestyle Revision

9. Less Than 25% of Population has Sodium Intake of 2400 mg or Less National Health and Nutrition Examination Survey, NCHS, CDC

10. Less Than 5 % of U.S. Population Meets Adequate Intake (from DRI’s) for Potassium *AI from DRIs ** statistically unreliable National Health and Nutrition Examination Survey, NCHS, CDC

11. Lifestyle Modifications to Manage Hypertension Source: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7. Report. JAMA. 2003;289:2560-2572. 2-4 mm Hg Limit alcohol to no more than 2 drinks/d for men and 1 drinks/day for women. Moderate alcohol consumption 4-9 mm Hg Engage in regular aerobic activity such as walking (30 min/day on most days) Increase physical activity 2-8 mm Hg Reduce sodium to no more than 2.4 g/day sodium or 6 g/day NaCl Dietary sodium reduction 8-14 mm Hg Consume diets rich in fruits, vegetables, low fat dairy and low saturated fat Adapt DASH eating plan 5-20 mm Hg for each 10 kg weight loss Maintain normal body weight (BMI 18.5-24.9) Weight Reduction Approximate SBP Reduction Recommendations Modification

12. USDA Food Guide - Food Group Recommendations 132 22 g 3 c 5 oz. equivalent 5 oz. equivalent 3 oz. 2 oz. 2 c (4 serv) 2 c/wk 1.5 c/wk 2.5 c/wk 2.5 c/wk 5.5 c/wk 1.5 c (3 serv) 1600 kcals 31 g 24 g Oils 362 267 Discretionary kcal Milk Lean meat/beans Grains whole grains other grains Vegetables dark green orange legumes starchy other Fruits 3 c 3 c 6.5 oz. equivalent 5.5 oz. equivalent 8 oz. equivalent 4 oz. 4 oz. 6 oz. equivalent 3 oz. 3 oz. 3 c (6 serv) 3 c/wk 2 c/wk 3 c/wk 6 c/wk 7 c/wk 2.5 c (5 serv) 3 c/wk 2 c/wk 3 c/wk 3 c/wk 6.5 c/wk 2 c (4 serv) 2 c (4 serv) 2400 kcals 2000 kcals

16. Macronutrient Profile of a Mypyramid.gov Recommended 2000 kcal diet N/A Alcohol 1779 Sodium, mg/day 31 Fiber, gm/day 230 Cholesterol, mg/day N/A Trans FA 8.9 PUFA, % energy 10.7 MUFA, % energy 7.8 SFA, % energy 29 Total Fat, % energy 18 Protein, % energy 55 Carbohydrate, % energy 1987 Energy , kcal/day

17. DASH PYRAMID

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19. Sources of Sodium in the Diet Food Processing 77% Inherent in foods 12% Added at table 6% Added during cooking 5%

20. Food Group Contributions to Sodium Intake as a % of Total Intake Grain Products 37% Meat, Poultry, Fish, Beans, Eggs, Nuts 35% Vegetables 14% Milk Products 8% Fats & oils 4% Beverages, Sugars, Sweets 2% Fruits <1% CNPP Nutrition Insights 1997

21. Yes, Mr. Smith. You don’t salt anything, but you do eat a lot of sodium! But, Doctor, I Never Use A Salt Shaker

22. Low-Sodium Cookbooks

27. Lee S. et al., JADA, 107:213-222, 2007 Minnesota Heart Survey : Overall HDPEI Scores Between 1980 and 2002; improvements level off from 1995-2002

28. Improvements in Selected Variables Across Quintiles of the Heart Disease Prevention Eating Index (HDPEI) –Minnesota Heart Survey (n=11,439) mean score Lee S. et al., JADA, 107:213-222, 2007 <0.01 3088 3423 3427 3304 3437 Sodium, mg/d <0.01 167 226 266 295 378 Cholesterol, mg/d <0.01 1.8 2.3 2.6 2.7 3.0 % en from TFA <0.01 8.3 11.1 12.4 13.6 15.3 % en from SFA <0.01 27.0 32.6 35.0 37.2 40.9 % en from Total Fat <0.01 24.8 25.8 26.7 27.8 30.1 BMI P for trend Q5 44.0 Q4 36.9 Q3 32.8 Q2 28.7 Q1 22.3 Variable (means)