Salt Intake In Children Research Articles

Salt Intake of Children and Adolescents: Influence of Socio-Environmental Factors and School Education.

(1) Background: The aim of this study was to investigate the salt consumption by children and adolescents from the Silesian Province (Poland), taking into account the region's dietary traditions and the age of the students+. (2) Methods: 300 students aged 10-18 from different types of schools were enrolled in the study and divided into groups in terms of school, sex, and the state of their nutrition. A survey questionnaire about dietary habits, including the frequency and serving size with respect to 12 salty products, was used. On the basis of the frequency and the amount of consumed products, as well as the data on salt content, the amount of total daily intake of salt was estimated. (3) Results: The mean daily intake of salt by children and adolescents was 1.083 g (0.433 g of sodium); children aged 10-12 consumed the highest amount of salt (1.296 g/day) compared to pupils aged 13-15 (1.131 g of sodium) and adolescents aged 16-18 (0.863 g/day). (4) Conclusions: With age, as a result of various factors, the consumption of salt declines. The parents' impact and the familial socio-environmental factors begin to wane, and other factors start to have influence, e.g., school education of a healthy lifestyle and health behavior of peers.

Consistency between 3 days' dietary records and 24-h urine in estimating salt intake in children and adolescents.

This study aimed to evaluate the salt intake in boarding school students and the consistency between salt intake measurements based on 24-h urine and weighed dietary records over 3 consecutive days in this population. This was a school-based cross-sectional study. Overweight (including obesity) or hypertensive students aged 6-14 years and their normal counterparts were recruited for this study at three boarding schools in China. Three consecutive 24-h urine samples were collected from all participants. During the collection period of 24-h urine, the weighed diet records were collected in children who had all three meals at the school canteens on weekdays. Incomplete 24-h urine or dietary records were excluded from the analysis. The median salt excretion was 6,218 [4,636, 8,290] mg by 24-h urine and 120 (82.2%) consumed excess salt among the participants. The median salt intake was 8,132 [6,348, 9,370] mg by dietary records and 112 (97.4%) participants consumed excess salt than recommended in participants who have all three meals in the school canteens. In children with complete dietary records and 24-h urine, the level of salt intake estimated by 24-h urine accounted for 79.6% of the dietary records. Our study showed that boarding school students consumed excessive salt from school canteens. Thus, policies or strategies targeting school canteens are urgently needed. Weighed dietary records are recommended if feasible.

Agreement between 24-hour urine and 24-hour food recall in measuring salt intake in primary school children in Australia

BackgroundMonitoring salt consumption in children is essential for informing and implementing public health interventions to reduce children’s salt intake. However, collection of 24-hour urines, considered as the most reliable approach, can be especially challenging to school children. This study aimed to assess the agreement between 24-hour urine (24hrU) and 24-hour food recall (24hrFR) in: (1) estimating salt intake in children; (2) classifying salt intakes above the recommended upper level set for children, and; (3) estimating change in mean salt intake over time.MethodsThis study utilised data from two cross-sectional surveys of school children aged 8 to 12 years living in the state of Victoria, Australia. A single 24hrU and 24hrFR were collected from each participant. Suspected inaccurate urine collections and implausible energy intakes were excluded based on pre-defined criteria. The agreement between the two methods was assessed using Bland-Altman methodology, the intraclass correlation coefficient (ICC), and the kappa statistic. The difference between the measured change in salt intake over time using 24hrU and 24hrFR was derived using mixed effects linear regression analysis.ResultsA total of 588 participants provided a 24hrU and 24hrFR. Overall, there was no meaningful difference in mean estimated salt intake between the two methods (− 0.2 g/day, 95% CI − 0.5 to 0.1). The Bland-Altman plot showed wide 95% limits of agreement (− 7.2 to 6.8). The ICC between the two methods was 0.13 (95% CI 0.05 to 0.21). There was poor interrater reliability in terms of classifying salt intake above the recommended upper level for children, with an observed agreement of 63% and kappa statistic of 0.11. The change in mean salt intake over time was 0.2 g/day (− 0.4 to 0.7) based on 24hrU, and 0.5 g/day (− 0.0 to 1.1) based on 24hrFR, with a difference-in-differences of 0.4 g/day (− 0.3 to 1.1).Conclusions24hrFR appears to provide a reasonable estimate of mean salt intake as measured by 24hrU in Australian school children. However, similar to previous observations in adults, and of studies exploring other alternative methods for estimating salt intake, 24hrFR is a poor predictor of individual-level salt intake in children.

ESTIMATION OF DAILY SALT INTAKE IN CHILDREN WITH ESSENTIAL HYPERTENSION

Objective: The development of arterial hypertension is influenced by genetic and environmental factors, with high salt intake being a known environmental contributor. This study aimed to estimate daily salt intake in children with essential arterial hypertension and in normotensive children, and to assess the relationship between their blood pressure values and 24-h urinary sodium excretion. Design and method: Total of 26 children participated in this study; 12 children with essential arterial hypertension (HT) and 14 normotensive children (NT) (both sexes, age ranged 12–17). Systolic, diastolic and mean blood pressure and heart rate were measured. 24-h urine samples were analysed for excreted sodium concentration whereas daily salt intake based on 24-h urinary sodium excretion was calculated using appropriate formula. Statistical analysis was conducted by t-test (between groups), and Pearson’s or Spearman’s correlation test was used to determine the correlations between blood pressure (SBP, DBP and MAP) and 24-h urinary sodium excretion (p < 0.05 was considered statistically significant). Results: Body mass index (BMI) was similar between groups. Calculated salt intake was significantly higher in children with essential hypertension compared with normotensive children. Systolic (SBP), diastolic (DBP) and mean (MAP) arterial blood pressure were significantly higher in children with essential arterial hypertension compared with normotensive children, while there were no difference in heart rate between HT and NT groups. 24-h urinary sodium excretion was significantly higher in the HT compared with the NT group. 24-h urinary sodium excretion was positively associated with SBP (r = 0.673), DBP (r = 0.513) and MAP (r = 0.651). Conclusions: Even though BMI was similar, 24-h urinary sodium excretion was significantly higher in hypertensive children indicating their higher daily salt intake, which is associated with higher blood pressure in these children.

Obesity, Sodium Homeostasis, and Arterial Hypertension in Children and Adolescents.

Background: The relationship between obesity, arterial hypertension, and excessive salt intake has been known for a long time; however, the mechanism of this relationship remains not clear. Methods: The paper presents a current literature review on the relationship between salt consumption and the development of arterial hypertension in children and adolescents with obesity. Results: In addition to the traditional theory of hypertension development due to the increase in intravascular volume and disturbances of sodium excretion, recent studies indicate the existence of a complex mechanism related to excessive, pathological secretory activity of adipocytes, insulin resistance, and impaired function of the renin–angiotensin–aldosterone axis. That makes obese children and adolescents particularly vulnerable to the development of salt-sensitive arterial hypertension. Studies performed in many countries have shown that children and adolescents consume more sodium than recommended. It is worth noting, however, that the basis for these recommendations was the extrapolation of data from studies conducted on adults. Moreover, more important than sodium intake is the Na/K ratio and water consumption. Conclusion: Regardless of the population-wide recommendations on reducing salt intake in children, specific recommendations for overweight and obese patients should be developed.

Social support, social network and salt-reduction behaviours in children: a substudy of the School-EduSalt trial

ObjectivesHealthy behaviour changes, such as reducing salt intake, are important to prevent lifestyle-related diseases. Social environment is a major challenge to achieve such behaviours, but the explicit mechanisms remain largely...

Usefulness of a salt check sheet for elementary school and junior high school children.

There are no known methods to easily evaluate the dietary salt intake of children. We hypothesized that the salt check sheet, for which validity has been confirmed in both hypertensive outpatients and in the general population, can be used to assess dietary salt intake in children. We enrolled 188 healthy schoolchildren (mean age 11.2±1.1years, 53.2% boys) and asked them to answer both the salt check sheet and a brief self-administered dietary history questionnaire for Japanese schoolchildren aged 6-18years (BDHQ15y). The mean total salt check-sheet score was 12.7±4.0 points (range: 4-24 points), and the estimated daily salt intake from the BDHQ15y was 12.1±3.7g (range: 4.7-27.2g). The total check-sheet score was significantly positively correlated with the estimated daily salt intake from the BDHQ15y (r=0.408, P<0.001). Thirty-one study participants were assigned to the "low" salt group (total score on the salt check sheet was 0-8 points), 78 participants to the "medium" salt group (9-13 points), and 79 participants to the "high and very high" salt group (≥14 points), and a comparison estimating daily salt intake from the BDHQ15y among the three groups was performed. Daily salt-intake levels tended to increase as the group of total check-sheet scores increased: "low" vs "medium" vs "high and very high" salt group levels were 9.5±3.1 vs 11.6 vs 13.5±3.9, respectively (P<0.001). This demonstrates that the salt check sheet is a useful tool to easily assess dietary salt intake in children.

Comparison of Salt Intake in Children to that of their Parents

Background: High salt intake has been related to increased blood pressure and cardiovascular events. Few studies evaluated daily salt consumption in children. Objective: To compare urinary sodium (UNa) excretion in children to that of their parents using the gold standard of 24-h collections. Methods: We prospectively collected 633 urine samples, mean UNa = 133 ± 37 mmol/day (7.7 ± 2.1 g of salt) from 326 children aged 10–15 years and 94 urine samples, mean UNa = 136 ± 45 mmol/day (8.0 ± 2.6 g of salt), from 78 parents. Comparisons between sodium intake were made by analysis of variance. Results: We paired 24-h urine samples of 65 children, UNa = 134 ± 36 mmol/day, (7.9 ± 2.3 g of salt) to 75 corresponding parents, UNa = 136 ± 45 mmol/day (8.0 ± 2.6 g of salt). Within parents, 50 were mothers, UNa = 138 ± 49 mmol/day (8.1 ± 2.9 g of salt) and 25 were fathers, UNa = 116 ± 41 mmol/day (6.8 ± 2.4 g of salt). Sodium excretion did not differ between boys vs. girls and mothers vs. fathers. Salt intake of children was not different from that of mothers (n = 50; 7.9 ± 2.3 vs. 8.1 ± 2. 8 g/24 h, p = 0.515) but higher than that of fathers (n = 25; 8.0 ± 2.3 vs. 6.8 ± 2.4 g/24 h, p < 0.05). Only 9.2% of children and 30.8% of the parents had a salt intake below 5 g/24 h. Around 60% of the children had a salt intake higher than their parents. Parental educational level was not associated with differences in salt consumption in children and parents. Overall, parents and children UNa excretion showed a moderate positive and significant correlation (r = 0.45, p = 0.001). Conclusions: In 91% of children aged 10–15 years, daily salt intake was higher than recommended. Also, children’s salt consumption was closer to that of their mothers than that of their fathers, ­possibly because of closeness in dietary habits with their mothers.

Estimation of salt intake and excretion in children in one region of Switzerland: a cross-sectional study.

Salt intake among children in Switzerland is unknown. The objectives of this study were to determine salt excretion and to identify the main dietary sources of salt intake among children in one region of Switzerland. We conducted a cross-sectional study using a convenient sample of children 6-16years of age in Valais, Switzerland, between 2016 and 2018. All children visiting several regional health care providers and without any clinical condition that could affect sodium intake or excretion were eligible. Each child completed a 24-h urine collection to assess salt excretion and two dietary questionnaires to assess dietary sources of salt intake. Weight and height were measured. Data were available on 94 children (55 boys and 39 girls; mean age 10.5 years; age range 6-16years). The mean 24-h salt urinary excretion was 5.9g [SD 2.8; range 0.8-16.0; 95% confidence interval (CI) 5.3-6.5]. Two-thirds (62%) of the children had salt excretions above recommendations of maximum intake (i.e., ≥ 2g per day for children up to 6years of age and ≥ 5g per day for children 7-16years of age). The salt excretion tended to be higher during the week-end (6.0g, 95% CI 5.4-6.6) than during the week (5.4g, 95% CI 4.3-6.7). The main sources of salt intake were pastas, potatoes, and rice (23% of total salt intake), pastries (16%), bread (16%), and cured meats (10%). One child out of three (34%) added salt to their plate at the table. Salt intake in children in one region of Switzerland was high. Our findings suggest that salt intake in children could be reduced by lowering salt content in commonly eaten foods. NCT02900261.

Cost and cost-effectiveness of a school-based education program to reduce salt intake in children and their families in China.

ObjectiveThe School-based Education Program to Reduce Salt Intake in Children and Their Families study was a cluster randomized control trial among grade five students in 28 primary schools and their families in Changzhi, China. It achieved a significant effect in lowering systolic blood pressure (SBP) in all family adults by 2.3 mmHg and in elderlies (aged > = 60 years) by 9.5 mmHg. The aim of this study was to assess the cost-effectiveness of this salt reduction program.MethodsCosts of the intervention were assessed using an ingredients approach to identify resource use. A trial-based incremental cost-effectiveness ratio (ICER) was estimated based on the observed effectiveness in lowering SBP. A Markov model was used to estimate the long-term cost-effectiveness of the intervention, and then based on population data, extrapolated to a scenario where the program is scaled up nationwide. Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY). The perspective was that of the health sector.ResultsThe intervention cost Int$19.04 per family and yielded an ICER of Int$2.74 (90% CI: 1.17–12.30) per mmHg reduction of SBP in all participants (combining children and adult participants together) compared with control group. If scaled up nationwide for 10 years and assumed deterioration in treatment effect of 50% over this period, it would reach 165 million families and estimated to avert 42,720 acute myocardial infarction deaths and 107,512 stroke deaths in China. This would represent a gain of 635,816 QALYs over 10-year time frame, translating into Int$1,358 per QALY gained.ConclusionBased on WHO-CHOICE criteria, our analysis demonstrated that the proposed salt reduction strategy is highly cost-effective, and if scaled up nationwide, the benefits could be substantial.Trial registrationClinicalTrials.gov NCT01821144

PS 18-18 Economic evaluation of a school-based education programme to reduce salt intake in children and their families in China

PS 18-18 Economic evaluation of a school-based education programme to reduce salt intake in children and their families in China

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School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial

Objective To determine whether an education programme targeted at schoolchildren could lower salt intake in children and their families.Design Cluster randomised controlled trial, with schools randomly assigned to either the...

Salt intake in children and its consequences on blood pressure.

Sodium is the most abundant extracellular cation and therefore pivotal in determining fluid balance. At the beginning of life, a positive sodium balance is needed to grow. Newborns and preterm infants tend to lose sodium via their kidneys and therefore need adequate sodium intake. Among older children and adults, however, excessive salt intake leads to volume expansion and arterial hypertension. Children who are overweight, born preterm, or small for gestational age and African American children are at increased risk of developing high blood pressure due to a high salt intake because they are more likely to be salt sensitive. In the developed world, salt intake is generally above the recommended intake also among children. Although a positive sodium balance is needed for growth during the first year of life, in older children, a sodium-poor diet seems to have the same cardiovascular protective effects as among adults. This is relevant, since: (1) a blood pressure tracking phenomenon was recognized; (2) the development of taste preferences is important during childhood; and (3) salt intake is often associated with the consumption of sugar-sweetened beverages (predisposing children to weight gain).

Salt Intake of Children and Adolescents in South London

Since 2003/2004, the United Kingdom has implemented a salt reduction campaign; however, there are no data on salt intake in children as assessed by 24-hour urinary sodium, the gold standard method, to inform this campaign. We performed a cross-sectional study, involving South London school children across 3 age tiers: young children (5- to 6-year olds), intermediate-aged children (8- to 9-year olds), and adolescents (13- to 17-year olds). Dietary salt intake was measured by 24-hour urinary sodium excretion and compared with newly derived maximum salt intake recommendations. In addition, dietary sources of salt were assessed using a 24-hour photographic food diary. Valid urine collections were provided by 340 children (162 girls, 178 boys). The mean salt intakes were 3.75 g/d (95% confidence interval, 3.49–4.01), 4.72 g/d (4.33–5.11), and 7.55 g/d (6.88–8.22) for the 5- to 6-year olds, 8- to 9-year olds, and 13- to 17-year olds, respectively. Sixty-six percent of the 5- to 6-year olds, 73% of the 8- to 9-year olds, and 73% of 13- to 17-year olds had salt intake above their maximum daily intake recommendations. The major sources of dietary salt intake were cereal and cereal-based products (36%, which included bread 15%), meat products (19%), and milk and milk products (11%). This study demonstrates that salt intake in children in South London is high, with most of the salt coming from processed foods. Much further effort is required to reduce the salt content of manufactured foods.

Les enfants consomment-ils trop de sel ?

Very early in life, sodium intake correlates with blood pressure level. This warrants limiting the consumption of sodium by children. However, evidence regarding exact sodium requirements in that age range is lacking. This article focuses on the desirable sodium intake according to age as suggested by various groups of experts, on the levels of sodium intake recorded in consumption surveys, and on the public health strategies implemented to reduce salt consumption in the pediatric population. Practical recommendations are given by the Committee on nutrition of the French Society of Pediatrics in order to limit salt intake in children.

Salt Intake in Childhood and Adolescence

See related article, pp 1026–1032 Salt (sodium chloride) is an essential nutrient whose main role is to preserve the extracellular volume and hence contribute to the maintenance of an adequate circulatory volume. The crucial role of salt in maintaining volume is underscored by the fact that our kidneys have evolved over millions of years to become exquisitely efficient in prioritizing sodium conservation over all of the many regulatory functions of the kidney. This capability of our kidneys to retain salt was particularly important in ancient times when the availability of salt was scarce. However, as time passed, salt production increased and it became readily available to the general population. Eventually, the use of salt extended beyond food seasoning to food preservation. This led to remarkable increases in sodium consumption in most regions around the world; the exception being certain more primeval societies. There is abundant epidemiological evidence linking sodium intake to high blood pressure. Societies with a high salt intake tend to have a significantly higher rate of age-related increase in blood pressure, whereas those with low sodium intake, such as the Yanomamo Indians of northern Brazil who have intakes of <3 g/d, are associated with lower age-related blood pressure elevations.1 These trends are not just in adults. Studies in the United States have demonstrated that higher salt intake in children and adolescents is positively correlated with high systolic blood pressures and an elevated risk of prehypertension/hypertension.2 Indeed, such a notion aptly fits Guyton’s hypothesis,3 in that blood pressure goes up to achieve sodium balance through increased natriuresis. Although this increased natriuresis restores sodium …

Salt intake in children 10–12 years old and its modification by active working practices in a school garden

The aim of the study was to evaluate the 24-h urinary sodium excretion in children of 10-12 years at a school in the north of Portugal and to examine the influence on salt intake and blood pressure of three different educational interventions for 6 months. Blood pressure (BP) and sodium excretion in 24-h urinary samples (UNa) validated with urinary creatinine were measured in 155 children 10-12 years old belonging to nine classes at baseline and after 6 months of three educational interventions in students from three classes each after parents consent was obtained. Interventions consisted in no additional action [control (CTR)], weekly lessons about the dangers of high salt intake [Theoretical (THEOR)] and both lessons and working practices in the school garden of planting, collection of herbs for salt substitution at home [practical (PRACT)]. At baseline 139 students (76 girls and 63 boys) were eligible showing average 24-h UNa of 132±43 mmol/24 h (mean salt intake of 7.8±2.5 g per day) and BP of 118/62 (13/9) mmHg that did not correlate to each other. At the end of the study, versus baseline, BP decreased by 8.2/6.5 mmHg in CTR (n=31), by 3.8/0.6 mmHg in THEOR (n=43) and by 3.5/0.7 mmHg in PRACT (n=53) and salt intake was reduced by 0.4±2.4 g per day in CTR, by 0.6±3.2 g per day in THEOR and by 1.1±2.5 g per day in PRACT. It was observed that salt intake variation was not independent of the group (CRT, THEOR and PRACT) (χ, 9.982, P=0.041). Salt intake was significantly reduced only in the PRACT group (1.1 g per day) and in the PRACT group the percentage of children who reduced salt intake by at least 1g per day from baseline to the end of the study was significantly higher (50.9%) than that of the other groups, THEOR, 48.8% and CTR, 32.2%. Our data indicates that children 10-12 years old have a high salt intake that is well above the proposed recommendations and that a strategy based on theoretical and practical education may achieve in some children an important reduction in daily salt intake which, if maintained over time, may assume important public health implications. These results suggest that in those children a more complete theoretical and practical intervention is more productive and efficient towards reduction of salt intake than single theoretical or no intervention.

A school-based education programme to reduce salt intake in children and their families (School-EduSalt): protocol of a cluster randomised controlled trial

IntroductionThe current salt intake is very high for children as well as adults in China. A reduction in salt intake is one of the most cost-effective measures to curb the...

Dietary salt intake assessed by 24 h urinary sodium excretion in Australian schoolchildren aged 5-13 years.

To measure total daily salt intake using 24 h urinary Na excretion within a sample of Victorian schoolchildren aged 5-13 years and to assess discretionary salt use habits of children and parents. Cross-sectional study. Completed within a convenience sample of independent primary schools (n 9) located in Victoria, Australia. Two hundred and sixty children completed a 24 h urine collection over a school (34%) or non-school day (66%). Samples deemed incomplete (n 18), an over-collection (n 1) or that were incorrectly processed at the laboratory (n 3) were excluded. The sample comprised 120 boys and 118 girls with a mean age of 9.8 (SD 1.7) years. The average 24 h urinary Na excretion (n 238) was 103 (SD 43) mmol/24 h (salt equivalent 6.0 (SD 2.5) g/d). Daily Na excretion did not differ by sex; boys 105 (SD 46) mmol/24 h (salt equivalent 6.1 (SD 2.7) g/d) and girls 100 (SD 41) mmol/24 h (salt equivalent 5.9 (SD 2.4) g/d; P=0.38). Sixty-nine per cent of children (n 164) exceeded the recommended daily Upper Limit for Na. Reported discretionary salt use was common: two-thirds of parents reported adding salt during cooking and almost half of children reported adding salt at the table. The majority of children had salt intakes exceeding the recommended daily Upper Limit. Strategies to lower salt intake in children are urgently required, and should include product reformulation of lower-sodium food products combined with interventions targeting discretionary salt use within the home.