Effects of a behavioral intervention that emphasizes spices and herbs on adherence to recommended sodium intake: results of the SPICE randomized clinical trial.
BACKGROUND
For decades, dietary sodium intake in the United States has remained high, and few studies have examined strategies for maintaining recommended intakes.


OBJECTIVE
We examined the effects of a behavioral intervention, which emphasized spices and herbs, on the maintenance of sodium intake at the recommended intake of 1500 mg/d in individuals to whom the US Dietary Guidelines for Americans apply.


METHODS
We conducted a 2-phase study that included adults ≥18 y of age for whom Dietary Guidelines for Americans recommends 1500 mg Na/d. The study was conducted in Baltimore, Maryland, from 2012 to 2014. In phase 1, 55 individuals consumed a low-sodium diet for 4 wk. Participants were provided all foods, snacks, and calorie-containing drinks. In phase 2, 40 participants from phase 1 were randomly assigned to either a behavioral intervention to reduce sodium intake (n = 20) or a self-directed control group (n = 20) for 20 wk. The primary study outcome was the change in mean 24-h urinary sodium excretion during phase 2. Linear regression analyses were used to determine intervention effects on urinary sodium excretion.


RESULTS
Participant characteristics were as follows: women: 65%; African American: 88%; hypertension: 63%; diabetes: 18%; mean age: 61 y; and mean body mass index (in kg/m(2)): 30. At the end of phase 2, mean 24-h sodium excretion was lower in the behavioral intervention than in the self-directed group (mean difference: -956.8 mg/d; 95% CI: -1538.7, -374.9 mg/d) after sodium intake at screening was controlled for (P = 0.002). These findings persisted in sensitivity analyses that excluded potentially incomplete urine collections [Mage's equation mean difference: -1090 mg/d (P = 0.001); Joosens' equation mean difference: -796 mg/d (P = 0.04)].


CONCLUSIONS
A multifactorial behavioral intervention emphasizing spices and herbs significantly reduced sodium intake. Because of the ubiquity of sodium in the US food supply, multilevel strategies addressing individual behaviors and the food supply are needed to improve adherence to recommendations. This trial was registered at clinicaltrials.gov as NCT01615159.
Division of Preventive Medicine, University of California San Diego School of Medicine, San Diego, CA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; c1anderson@ucsd.edu.
Cheryl A M
CA
Anderson
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
Laura K
LK
Cobb
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD; Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD; and.
Edgar R
ER
Miller
The George Institute for Global Health, University of Sydney, Sydney, Australia; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;
Mark
M
Woodward
Sensational Sustenance Inc., Baltimore, MD;
Annette
A
Hottenstein
Division of Nephrology, Geisinger Health System, Danville, PA;
Alex R
AR
Chang
Division of Preventive Medicine, University of California San Diego School of Medicine, San Diego, CA;
Morgana
M
Mongraw-Chaffin
Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD; and.
Karen
K
White
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD; and.
Jeanne
J
Charleston
National Institute of Aging, Translational Gerontology Branch, Baltimore, MD.
Toshiko
T
Tanaka
Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD; and.
Letitia
L
Thomas
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD; Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD; and.
Lawrence J
LJ
Appel
D001741:Black or African American; D000368:Aged; D015142:Baltimore; D015992:Body Mass Index; D004039:Diet, Sodium-Restricted; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010349:Patient Compliance; D064167:Recommended Dietary Allowances; D012680:Sensitivity and Specificity; D012982:Sodium, Dietary / Q000008:administration & dosage* / Q000652:urine; D017365:Spices; D011795:Surveys and Questionnaires
D012982:Sodium, Dietary
adherence; behavioral intervention; clinical trial; diet; sodium