Diet Quality Associated with Total Sodium Intake among US Adults Aged ?18 Years—National Health and Nutrition Examination Survey, 2009–2012
Abstract
:1. Introduction
2. Materials and Methods
2.1. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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HEI-2010 Component | Score | Standard for Maximum Score | Standard for Minimum Score |
---|---|---|---|
Higher score indicates greater consumption | |||
Total fruit | 0–5 | ≥0.8 cup equivalent/1000 kcal | No fruit |
Whole fruit | 0–5 | ≥0.4 cup equivalent/1000 kcal | No whole fruit |
Total vegetables | 0–5 | ≥1.1 cup equivalent/1000 kcal | No vegetables |
Greens and beans | 0–5 | ≥0.2 cup equivalent/1000 kcal | No dark-green vegetables, beans, or peas |
Whole grains | 0–10 | ≥1.5 ounces equivalent/1000 kcal | No whole grains |
Dairy | 0–10 | ≥1.3 cup equivalent/1000 kcal | No dairy |
Total protein foods | 0–5 | ≥2.5 ounces equivalent/1000 kcal | No protein foods |
Seafood and plant proteins | 0–5 | ≥0.8 ounces equivalent/1000 kcal | No seafood or plant proteins |
Fatty Acids a | 0–10 | (PUFAs + MUFAs)/SFAs ≥ 2.5 | (PUFAs + MUFAs)/SFAs ≤ 1.2 |
Higher score indicates lower consumption | |||
Refined grains | 0–10 | ≤1.8 ounces equivalent/1000 kcal | ≥4.3 ounces equivalent/1000 kcal |
Sodium | 0–10 | ≤1.1 g/1000 kcal | ≥2.0 grams/1000 kcal |
Empty calories b | 0–20 | ≤19% of energy | ≥50% of energy |
Total HEI-2010 score | 0–100 | Sum of all components | |
Modified total HEI-2010 score c | 0–90 | Total HEI-2010 score without the sodium component |
Characteristics | All 24-h Diet Recalls | Total Daily Sodium a | |||
---|---|---|---|---|---|
Quartile 1 | Quartile 2 | Quartile 3 | Quartile 4 | ||
684–2295 mg | 2296–3189 mg | 3190–4366 mg | 4367–10,134 mg | ||
n = 10,142 | n = 2539 | n = 2532 | n = 2538 | n = 2533 | |
% (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | |
Gender * | |||||
Men | 49.3 (48.0, 50.6) | 30.2 (28.0, 32.6) | 40.0 (36.9, 43.2) | 51.0 (47.6, 54.3) | 73.6 (71.4, 75.7) |
Women | 50.7 (49.4, 52.0) | 69.8 (67.4, 72.0) | 60.0 (56.8, 63.1) | 49.0 (45.7, 52.4) | 26.4 (24.3, 28.6) |
Age group (years) * | |||||
18–44 | 46.5 (43.9, 49.1) | 38.7 (35.3, 42.3) | 42.3 (38.5, 46.1) | 47.5 (43.8, 51.1) | 56.5 (52.4, 60.5) |
45–64 | 35.8 (33.9, 37.7) | 37.1 (33.9, 40.4) | 37.1 (34.2, 40.1) | 35.5 (32.2, 39.1) | 33.6 (30.0, 37.4) |
65+ | 17.7 (16.5, 19.0) | 24.2 (21.6, 26.9) | 20.6 (18.0, 23.5) | 17.0 (15.1, 19.1) | 9.8 (8.4, 11.6) |
Race/Ethnicity | |||||
Non-Hispanic White | 65.8 (60.4, 70.7) | 63.9 (57.3, 70.1) | 67.1 (61.3, 72.4) | 66.9 (61.3, 72.1) | 65.0 (59.8, 69.8) |
Non-Hispanic Black | 11.5 (8.8, 14.9) | 13.0 (10.0, 16.9) | 10.4 (7.8, 13.6) | 11.4 (8.4, 15.2) | 11.5 (8.6, 15.0) |
Mexican American | 8.9 (6.6, 11.8) | 8.6 (6.3, 11.5) | 7.9 (5.4, 11.3) | 8.3 (6.3, 10.9) | 10.7 (7.7, 14.7) |
Other Hispanics | 5.9 (4.4, 7.9) | 7.0 (4.8, 10.0) | 6.2 (4.6, 8.4) | 5.5 (4.0, 7.6) | 5.1 (3.7, 6.9) |
Non-Hispanic Asian | 5.2 (4.2, 6.4) | 5.2 (4.0, 6.7) | 5.2 (4.3, 6.4) | 5.0 (3.8, 6.6) | 5.2 (4.0, 6.8) |
Other Race/Multi-Racial | 2.7 (2.1, 3.6) | 2.3 (1.7, 3.2) | 3.2 (2.2, 4.6) | 2.9 (1.9, 4.4) | 2.6 (1.7, 3.9) |
Family income to poverty ratio (IPR) * | |||||
<100% | 16.2 (13.7, 19.0) | 19.8 (16.5, 23.6) | 13.7 (11.6, 16.2) | 14.2 (11.7, 17.2) | 17.3 (13.1, 22.5) |
100–299% | 33.6 (31.0, 36.2) | 34.4 (30.3, 38.7) | 34.4 (30.9, 38.1) | 33.0 (29.7, 36.5) | 32.5 (29.1, 36.2) |
300–499% | 21.1 (18.9, 23.4) | 19.0 (16.6, 21.7) | 21.3 (17.7, 25.4) | 21.0 (18.6, 23.6) | 22.9 (19.2, 27.0) |
≥500% | 29.2 (26.1, 32.4) | 26.8 (23.1, 30.9) | 30.6 (26.6, 34.8) | 31.8 (28.0, 35.8) | 27.3 (23.0, 32.2) |
Education (among those aged 25 years or older) * | |||||
<High school diploma | 15.8 (13.5, 18.3) | 19.6 (16.3, 23.5) | 16.2 (13.4, 19.5) | 12.6 (10.7, 14.7) | 14.8 (12.3, 17.8) |
High school diploma | 21.0 (18.9, 23.2) | 22.8 (19.8, 26.2) | 19.9 (17.4, 22.8) | 19.6 (16.9, 22.6) | 21.7 (18.0, 25.9) |
Some college | 30.8 (29.0, 32.6) | 30.6 (27.6, 33.7) | 31.7 (28.5, 35.2) | 30.3 (27.1, 33.8) | 30.4 (27.5, 33.4) |
≥College degree | 32.5 (28.8, 36.4) | 27.0 (22.8, 31.6) | 32.1 (28.2, 36.3) | 37.5 (33.2, 42.0) | 33.1 (28.3, 38.2) |
BMI categories b | |||||
Underweight | 1.7 (1.3, 2.1) | 1.9 (1.3, 2.9) | 1.3 (0.8, 2.1) | 1.7 (1.2, 2.4) | 1.8 (1.3, 2.7) |
Normal | 30.1 (28.3, 32.0) | 32.0 (29.2, 35.0) | 31.2 (28.1, 34.5) | 30.4 (27.1, 33.9) | 27.1 (24.0, 30.4) |
Overweight | 32.5 (30.7, 34.4) | 30.9 (27.5, 34.5) | 31.1 (28.6, 33.7) | 33.3 (30.5, 36.2) | 34.6 (31.4, 37.9) |
Obese | 35.7 (33.9, 37.5) | 35.2 (32.2, 38.2) | 36.4 (33.3, 39.6) | 34.6 (31.4, 37.9) | 36.4 (33.1, 39.9) |
Self-reported hypertension * | 32.7 (30.7, 34.6) | 36.4 (34.0, 38.9) | 32.9 (30.0, 35.7) | 31.8 (28.6, 35.0) | 29.9 (27.5, 32.4) |
Self-reported diabetes * | 9.4 (8.7, 10.1) | 11.4 (10.0, 12.8) | 10.7 (8.8, 12.6) | 7.8 (6.3, 9.3) | 7.9 (6.6, 9.2) |
Total energy (kcal) quartiles *,c | |||||
1st quartile | 22.2 (21.2, 23.2) | 64.8 (62.2, 67.2) | 22.0 (19.8, 24.5) | 5.4 (4.3, 6.7) | 1.1 (0.6, 1.9) |
2nd quartile | 25.3 (23.9, 26.7) | 26.3 (24.3, 28.4) | 43.3 (40.6, 46.1) | 27.2 (24.6, 29.9) | 5.2 (4.2, 6.3) |
3rd quartile | 26.6 (25.2, 28.0) | 7.8 (6.1, 10.0) | 28.0 (25.5, 30.6) | 42.8 (39.4, 46.3) | 25.9 (23.8, 28.1) |
4th quartile | 26.0 (24.9, 27.0) | 1.1 (0.6, 2.1) | 6.7 (5.4, 8.3) | 24.7 (22.9, 26.6) | 67.8 (65.8, 69.8) |
Dependent Variables | Mean (95% CI) | Unadjusted Models | Adjusted Models a | ||
---|---|---|---|---|---|
Coefficient c (95% CI) | p-Value | Coefficient c (95% CI) | p-Value | ||
Macronutrients | |||||
Protein (g/1000 kcal) | 39.61 (39.02, 40.19) | 0.077 (0.055, 0.100) | <0.001 | 0.481 (0.439, 0.524) | <0.001 |
Carbohydrates (g/1000 kcal) | 121.22 (120.36, 122.08) | −0.352 (−0.399, −0.306) | <0.001 | −0.504 (−0.575, −0.434) | <0.001 |
Fiber (g/1000 kcal) | 8.46 (8.27, 8.66) | −0.033 (−0.042, −0.025) | <0.001 | 0.022 (0.007, 0.036) | 0.004 |
Total fat (g/1000 kcal) | 37.52 (37.21, 37.83) | 0.117 (0.104, 0.129) | <0.001 | 0.131 (0.094, 0.168) | <0.001 |
HEI-2010 components | |||||
Whole grains (oz/1000 kcal) | 0.46 (0.44, 0.49) | −0.005 (−0.006, −0.004) | <0.001 | −0.001 (−0.003, 0.001) | 0.290 |
Meat protein (oz/1000 kcal) | 3.00 (2.93, 3.07) | 0.009 (0.007, 0.012) | <0.001 | 0.047 (0.042, 0.053) | <0.001 |
Seafood and plant protein (oz/1000 kcal) | 0.77 (0.71, 0.82) | −0.002 (−0.004, 0.001) | 0.238 | −0.001 (−0.006, 0.003) | 0.586 |
Refined grains (oz/1000 kcal) | 2.61 (2.56, 2.66) | 0.011 (0.008, 0.013) | <0.001 | 0.025 (0.022, 0.029) | <0.001 |
Total vegetables (cups/1000 kcal) | 0.79 (0.76, 0.82) | −0.001 (−0.003, 0.0002) | 0.096 | 0.014 (0.012, 0.017) | <0.001 |
Greens and beans (cups/1000 kcal) | 0.11 (0.10, 0.12) | −0.0003 (−0.001, 0.0001) | 0.149 | 0.003 (0.002, 0.003) | <0.001 |
Total fruit (cups/1000 kcal) | 0.47 (0.44, 0.49) | −0.008 (−0.009, −0.007) | <0.001 | −0.007 (−0.008, −0.005) | <0.001 |
Whole fruit (cups/1000 kcal) | 0.34 (0.32, 0.36) | −0.007 (−0.008, −0.006) | <0.001 | −0.004 (−0.005, −0.003) | <0.001 |
Dairy (cups/1000 kcal) | 0.74 (0.72, 0.77) | 0.002 (0.001, 0.003) | 0.001 | 0.004 (0.002, 0.005) | <0.001 |
Empty calories (% of total kcal) d | 28.00 (27.47, 28.53) | 0.005 (−0.015, 0.026) | 0.597 | −0.241 (−0.278, −0.205) | <0.001 |
Modified total HEI-2010 score e | 47.12 (46.36, 47.88) | −0.061 (−0.086, −0.036) | <0.001 | 0.112 (0.074, 0.151) | <0.001 |
Stratification Characteristics | Sample Size | Modified Total HEI-2010 Score c Mean (95% CI) | Unadjusted Models | Adjusted Models a | Interaction p-Value e | ||
---|---|---|---|---|---|---|---|
Coefficient d (95% CI) | p−Value | Coefficient d (95% CI) | p-Value | ||||
All | 1,0142 | 47.12 (46.36, 47.89) | −0.061 (−0.086, −0.036) | <0.001 | 0.112 (0.074, 0.151) | <0.001 | n/a |
Age group (years) | |||||||
18–44 | 4698 | 44.38 (43.59, 45.16) | −0.023 (−0.052, 0.006) | 0.113 | 0.128 (0.079, 0.176) | <0.001 | ref |
45–64 | 3329 | 48.40 (47.38, 49.42) | −0.059 (−0.108, −0.011) | 0.019 | 0.096 (0.022, 0.171) | 0.013 | 0.051 |
65+ | 2115 | 51.75 (50.41, 53.08) | 0.001 (−0.075, 0.078) | 0.973 | 0.092 (−0.010, 0.194) | 0.076 | 0.875 |
Gender | |||||||
Men | 4989 | 46.13 (45.34, 46.93) | −0.052 (−0.078, −0.026) | <0.001 | 0.093 (0.048, 0.137) | <0.001 | ref |
Women | 5153 | 48.08 (47.18, 48.98) | −0.036 (−0.083, 0.012) | 0.138 | 0.150 (0.079, 0.222) | <0.001 | 0.497 |
Race/Ethnicity | |||||||
Non-Hispanic White | 4118 | 47.39 (46.33, 48.46) | −0.066 (−0.099, −0.033) | <0.001 | 0.120 (0.069, 0.172) | <0.001 | ref |
Non-Hispanic Black | 2364 | 44.25 (43.01, 45.49) | −0.016 (−0.056, 0.025) | 0.439 | 0.186 (0.117, 0.256) | <0.001 | 0.025 |
Mexican American | 1229 | 45.02 (43.76, 46.28) | −0.114 (−0.148, −0.079) | <0.001 | 0.003 (−0.073, 0.078) | 0.941 | 0.005 |
Other Hispanics | 957 | 47.49 (46.24, 48.74) | −0.048 (−0.093, −0.003) | 0.039 | 0.071 (−0.040, 0.181) | 0.201 | 0.545 |
Non-Hispanic Asian | 1160 | 54.45 (53.12, 55.78) | 0.009 (−0.051, 0.069) | 0.762 | 0.087 (0.002, 0.177) | 0.055 | 0.953 |
Other Race/Multi-Racial | 314 | 44.88 (41.98, 47.79) | −0.106 (−0.217, 0.006) | 0.062 | 0.197 (−0.061, 0.455) | 0.130 | 0.352 |
Total energy (kcal) quartiles | |||||||
first | 2495 | 48.91 (47.71, 50.11) | 0.285 (0.167, 0.403) | <0.001 | 0.292 (0.170, 0.414) | <0.001 | ref |
second | 2573 | 49.10 (47.93, 50.26) | 0.189 (0.080, 0.298) | 0.001 | 0.174 (0.077, 0.270) | 0.001 | 0.257 |
third | 2573 | 46.94 (46.13, 47.75) | 0.071 (0.001, 0.140) | 0.046 | 0.085 (0.026, 0.145) | 0.007 | 0.014 |
fourth | 2501 | 43.86 (42.80, 44.91) | −0.035 (−0.085, 0.014) | 0.157 | −0.031 (−0.084, 0.023) | 0.254 | <0.001 |
24-h Diet Recalls | ||||||
---|---|---|---|---|---|---|
Component (Maximum Score) | Total Daily Sodium Intake b <2300 mg (n = 2551) | Total Daily Sodium Intake b ≥2300 mg (n = 7591) | Adjusted Score Difference c (95% CI) | p-Value for Difference | ||
Mean Score (95% CI) | % w/max Score | Mean Score (95% CI) | % w/max Score | |||
Total vegetables (5) | 2.78 (2.69, 2.88) | 25% | 2.92 (2.85, 3.00) | 22% | 0.54 (0.41, 0.66) | <0.001 |
Greens and beans (5) | 1.08 (0.97, 1.19) | 17% | 1.28 (1.21, 1.35) | 18% | 0.37 (0.24, 0.50) | <0.001 |
Total fruit (5) | 2.37 (2.24, 2.51) | 32% | 1.92 (1.87, 2.06) | 19% | −0.27 (−0.45, −0.08) | 0.006 |
Whole fruit (5) | 2.27 (2.10, 2.44) | 38% | 1.96 (1.87, 2.05) | 27% | −0.11 (−0.31, 0.09) | 0.256 |
Whole grains (10) | 2.89 (2.67, 3.10) | 12% | 2.58 (2.42, 2.75) | 8% | 0.16 (−0.11, 0.43) | 0.234 |
Dairy (10) | 4.68 (4.52, 4.84) | 17% | 5.24 (5.10, 5.38) | 16% | 0.49 (0.30, 0.67) | <0.001 |
Total protein foods (5) | 3.83 (3.75, 3.90) | 49% | 4.25 (4.20, 4.30) | 59% | 0.60 (0.50, 0.69) | <0.001 |
Seafood and plant protein (5) | 1.97 (1.83, 2.11) | 29% | 2.07 (1.96, 2.18) | 29% | −0.002 (−0.20, 0.20) | 0.982 |
Fatty acid ratio (10) | 5.45 (5.22, 5.68) | 30% | 5.14 (5.02, 5.25) | 21% | −0.08 (−0.38, 0.23) | 0.613 |
Sodium (10) | 6.32 (6.14, 6.50) | 26% | 3.70 (3.60, 3.80) | 5% | −4.48 (−4.66, −4.30) | <0.001 |
Refined grains (10) | 6.90 (6.70, 7.10) | 42% | 6.11 (5.97, 6.25) | 28% | −1.05 (−1.31, −0.79) | <0.001 |
Empty calories (20) d | 13.03 (12.53, 13.52) | 26% | 13.61 (13.35, 13.87) | 21% | 2.45 (1.92, 2.98) | <0.001 |
Modified total HEI-2010 score (90) a | 47.24 (46.08, 48.41) | 0.1% | 47.08 (46.34, 47.82) | 0% | 3.08 (1.86, 4.31) | <0.001 |
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Mercado, C.I.; Cogswell, M.E.; Perrine, C.G.; Gillespie, C. Diet Quality Associated with Total Sodium Intake among US Adults Aged ?18 Years—National Health and Nutrition Examination Survey, 2009–2012. Nutrients 2017, 9, 1164. https://doi.org/10.3390/nu9111164
Mercado CI, Cogswell ME, Perrine CG, Gillespie C. Diet Quality Associated with Total Sodium Intake among US Adults Aged ?18 Years—National Health and Nutrition Examination Survey, 2009–2012. Nutrients. 2017; 9(11):1164. https://doi.org/10.3390/nu9111164
Chicago/Turabian StyleMercado, Carla I., Mary E. Cogswell, Cria G. Perrine, and Cathleen Gillespie. 2017. "Diet Quality Associated with Total Sodium Intake among US Adults Aged ?18 Years—National Health and Nutrition Examination Survey, 2009–2012" Nutrients 9, no. 11: 1164. https://doi.org/10.3390/nu9111164
APA StyleMercado, C. I., Cogswell, M. E., Perrine, C. G., & Gillespie, C. (2017). Diet Quality Associated with Total Sodium Intake among US Adults Aged ?18 Years—National Health and Nutrition Examination Survey, 2009–2012. Nutrients, 9(11), 1164. https://doi.org/10.3390/nu9111164