title: Challenges in sodium intake reduction and meal consumption patterns among participants with metabolic syndrome in a dietary trial.
abstract: BACKGROUND
  Dietary guidelines suggest limiting daily sodium intake to <2,300 mg for the general population, and <1,500 mg/d for those with certain cardiovascular risk factors. Despite these recommendations, few Americans are able to achieve this goal. Identifying challenges in meeting these guidelines is integral for successful compliance. This analysis examined patterns and amount of daily sodium intake among participants with metabolic syndrome enrolled in a one-year dietary intervention study.
  
  
  METHODS
  Two hundred forty participants with metabolic syndrome enrolled in a dietary intervention trial to lose weight and improve dietary quality. Three 24-hour dietary recalls were collected at each visit which provided meal patterns and nutrient data, including sodium intake. A secondary data analysis was conducted to examine sodium consumption patterns at baseline and at one-year study visits. Sodium consumption patterns over time were examined using linear mixed models.
  
  
  RESULTS
  The percentage of meals reported eaten in the home at both baseline and one-year follow-up was approximately 69%. Follow-up for the one-year dietary intervention revealed that the participants who consumed sodium greater than 2,300 mg/d declined from 75% (at baseline) to 59%, and those that consumed higher than 1,500 mg/d declined from 96% (at baseline) to 85%. Average sodium intake decreased from 2,994 mg at baseline to 2,558 mg at one-year (P < 0.001), and the sodium potassium ratio also decreased from 1.211 to 1.047 (P < 0.001). Sodium intake per meal varied significantly by meal type, location, and weekday, with higher intake at dinner, in restaurants, and on weekends. At-home lunch and dinner sodium intake decreased (P < 0.05), while dinner sodium intake at restaurant/fast food chains increased from baseline to one-year (P < 0.05).
  
  
  CONCLUSIONS
  Sodium intake for the majority of participants exceeded the recommended dietary guidelines. Findings support actions that encourage low-sodium food preparation at home and encourage public health policies that decrease sodium in restaurants and prepared foods.
authors.forename: Jinsong
authors.initials: J
authors.lastname: Wang
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Olendzki
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Wedick
authors.forename: Gioia M
authors.initials: GM
authors.lastname: Persuitte
authors.forename: Annie L
authors.initials: AL
authors.lastname: Culver
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.forename: Philip A
authors.initials: PA
authors.lastname: Merriam
authors.forename: James
authors.initials: J
authors.lastname: Carmody
authors.forename: Hua
authors.initials: H
authors.lastname: Fang
authors.forename: Zhiying
authors.initials: Z
authors.lastname: Zhang
authors.forename: Gin-Fei
authors.initials: GF
authors.lastname: Olendzki
authors.forename: Liang
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA. Yunsheng.Ma@umassmed.edu.
authors.forename: Yunsheng
authors.initials: Y
authors.lastname: Ma
mesh_terms: D000367:Age Factors; D000572:American Heart Association; D004038:Diet, Reducing; D004039:Diet, Sodium-Restricted; D004043:Dietary Fiber / Q000008:administration & dosage / Q000627:therapeutic use; D057140:Fast Foods / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D006801:Humans; D008297:Male; D008404:Massachusetts; D062407:Meals; D024821:Metabolic Syndrome / Q000178:diet therapy*; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D064167:Recommended Dietary Allowances; D012147:Restaurants; D012727:Sex Characteristics; D012982:Sodium, Dietary / Q000008:administration & dosage* / Q000009:adverse effects; D014481:United States
chemical_list: D004043:Dietary Fiber; D012982:Sodium, Dietary