BRFSS Salt Intake Module
Epidemiology and Surveillance Team
Epidemiology and Surveillance Branch
Division for Heart Disease and Stroke Prevention
National Center For Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
DHDSP Grantee Meeting
Sept, 2010
Sodium Recommendation
(Sodium Chloride is the chemical name for salt and 90% of the sodium we consume is in the form of salt)
• NHANES 05-06 revealed average sodium intake was 3,466mg/day
among US adults
• 2005 Dietary Guideline recommendation: <2,300 mg/day.
• “Specific Populations” recommended to consume ≤1,500 mg/day:
– Hypertensive
– Black
– Middle or Older American
Sodium and Public Health
• Higher consumption of sodium means higher blood
pressure. Therefore , it is also related to
–
–
–
–
Coronary heart disease
Stroke
Heart failure
Kidney disease
Burden of Heart Disease and Stroke
• In the US
– >79 million CVD related doctors visit every year;
– > 6 millions hospitalizations annually;
– > 4 millions emergency visits annually and circulatory
disorders were the most frequent reason for admission
to the hospital through emergency department;
– The cost for cardiovascular is $503.2 billion in 2010.
Reducing Salt, Reducing Mortality
• The lower the blood pressure, the lower the risk of
heart disease (even for those without hypertension).
• Decreasing sodium intake from 3,500 mg/day to
1,500 mg/day could lead to a 30% decrease in
hypertension prevalence.*
*Source: Joffres MR, Campbell NR, Manns B, Tu K. Estimate of the benefits of a population-based
reduction in dietary sodium additives on hypertension and its related health care costs in Canada.
Can J Cardiol 2007 May 1;23(6):437-43.
Relative Amounts of Dietary Sodium in
the American Diet
Source: Mattes RD, Donnelly, D. Relative contributions of dietary-sodium sources. J Am Coll Nutr. 1991 Aug;10(4):383-93.
Sample Food Label, U.S.
BRFSS and salt intake
• There is no state-level salt intake survey
• Adding salt intake module into BRFSS questions will enable
CDC and states to assess salt intake behavior among US
adults.
• In the long term, the module will provide the opportunity to
evaluate the CDC funded heart disease and stroke prevention
program of reduction salt intake.
Purpose
• To provide state level surveillance of salt intake behavior
among American adults.
• The module will have the capability of measuring behavior,
knowledge of salt intake among American adults, as well as if
any action has been taking to reduce salt intake.
• Tracking these indicators allows CDC to monitor national and
state-specific trends in these measurements over time and to
compare these indicators across the states.
Funding
• If these questions are approved as a module for the 2012
BRFSS, ESB will provide support for the 4 questions contingent
upon availability of resources.
• ESB will fund this module again later in rotation with other
HDSP program modules during the odd years contingent upon
resources available through the CDC budget process.
Criteria for the questions
• Relationship to personal behaviors
• Pertinence to Healthy People 2010 objectives or priority
health issues
• Need to have state-specific data
• Alternate data sources
• Need to measure variable over time
• Relationship to other questionnaire topics
• Expected validity of questions
Analytic plan
• Descriptive in nature
• Frequency tables
• Combining questions from the core to estimate the
sociodemographic characteristics
Sample table shells
Question 1. Doctor or other health professional ever advised to
reduce salt intake
Yes
By age group
18-34
35-44
……
By sex
Males
Females
By race/ethnicity
……
No
Sample table shells
Question 2. Cutting down on salt intake now
Yes
By age group
18-34
35-44
……
By sex
Males
Females
By race/ethnicity
……
No
Sample table shells
Question 3. Frequency of eating processed meats during past 30
days
0
By age group
18-34
35-44
……
By sex
Males
Females
By race/ethnicity
……
<5
5-9
10-19
20-29
>=30
Sample table shells
Question 4. Frequency of eating salty snacks
during past 30 days
0
By age group
18-34
35-44
……
By sex
Males
Females
By race/ethnicity
……
<5
5-9
10-19
20-29
>=30
Sample table shells
Question 5. Frequency of eating frozen entrees
during past 30 days
0
By age group
18-34
35-44
……
By sex
Males
Females
By race/ethnicity
……
<5
5-9
10-19
20-29
>=30
Sample table shells
Question 6. Frequency of eating canned /package soup
during past 30 days
0
By age group
18-34
35-44
……
By sex
Males
Females
By race/ethnicity
……
<5
5-9
10-19
20-29
>=30
Sample table shells
Summary.
Frequency of eating high salt foods during past 30 days
<10
By age group
during
past 30 days
18-34
35-44
……
By sex
Males
Females
By race/ethnicity
……
10-19
20-29
30-59
60-99
>=100