Moving beyond the salt shaker

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One of the most common interventions we do as cardiovascular nurses is advise patients to reduce their sodium intake. These efforts use enormous amounts of time and resources, frequently need to be repeated, and inconsistently result in behavior change and better health outcomes.

There are many reasons why our efforts with individual patients may not be successful; however, one of the main reasons is that relying on individuals to select and prepare reduced-sodium meals may be impractical.¹ Only approximately 20% of dietary salt comes from salt added at the table or during cooking, whereas 75% comes from processed food. Because of this, there is a growing awareness of the need to focus on public health interventions related to sodium reduction, rather than just relying on individuals to change their sodium-intake behaviors.

A recent article highlighted the potential effects of a population-wide reduction in dietary salt on cardiovascular disease.² Bibbins-Domingo and colleagues² used a computer model to study the effects of a 3 g per day reduction in dietary salt (3 g of salt = ∼1200 mg of sodium) and projected that this intervention would

The authors further noted that these expected reductions in cardiovascular events would be similar in magnitude to current interventions targeting tobacco, obesity, primary prevention with statins, and pharmacologic treatment of hypertension.

Multiple professional societies have endorsed a population-wide effort to reduce salt intake. The American Heart Association recently lowered its recommended amount of daily sodium intake from 2300 mg to less than 1500 mg, and it is also working with federal agencies to identify strategies to reduce the amount of sodium in the food supply. The American Heart Association is encouraging food manufacturers and restaurants to reduce the amount of sodium in foods by 50% over a 10-year period.³ Local communities are also getting involved; most notably, New York City health officials have called for a reduction in the amount of salt in packaged and restaurant foods by 25% over the next 5 years. In addition, the Institute of Medicine has been commissioned to issue a report on population-based strategies for reducing salt intake, which is due out in 2010.

As nurses, we need to keep apprised of these public health efforts and advocate to local and federal governments to make food supplies healthier for our patients.

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References 

1. Appel LJ, Anderson CAM. Compelling evidence for public health action to reduce salt intake. N Engl J Med. 2010 Jan 20;[Epub ahead of print]
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2. Bibbins-Domingo K, Chertow GM, Coxson PG, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010 Jan 20;[Epub ahead of print]
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3. American Heart Association. Sodium (Salt or Sodium Chloride). Available at: http://www.americanheart.org/presenter.jhtml?identifier=4708. Accessed January 23, 2010.
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