Screening for Social Determinants of Health-Reply.
Screening for Social Determinants of Health-Reply.
复制标题
筛选健康回复的社会决定因素。
DOI：
10.1001/jama.2016.16925
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
P. Dworkin
中科院分区：
文献类型：
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作者：
A. Garg;Renée Boynton;P. Dworkin
从 2005 年到 2006 年以及 2014 年，钠摄入量呈显着下降 11% 的趋势。2014 年，平均每日钠摄入量为 3200 毫克，显着低于美国摄入量。4 TOHP II 调查人员指出，由于美国食品中的钠含量，即使是积极主动的参与者也很难减少钠摄入量：“最大的困难是避免加工或餐饮食品中添加钠，而不是改变随意加盐的方法。”行为......”5 这一观察结果进一步支持了减少家庭外准备的食物中钠含量的必要性。与必需营养素水平低相关的不利影响通常在极低的水平下发生。钠的生理需要量约为 500 毫克/天；足够的摄入量保守地设定为 1500 毫克/天。在随机临床试验中，干预措施（膳食钠）是暴露，每个个体根据与结果相关的意向治疗进行分类。在观察性研究中，不提供干预措施，只有多次 24 小时尿液采集才能准确评估个体钠摄入量与健康结果的关系。高质量证据支持在整个日常摄入量范围内，钠减少与血压之间存在线性剂量反应关系，但不支持低钠摄入量与 CVD 风险增加之间的关联。 6 美国个人摄入过多钠，但无法减少摄入量，因为加工食品和餐馆食品中添加了大量钠。过量的钠会导致高血压和心血管疾病；逐渐减少钠摄入量会降低血压以及相关的心肌梗塞、中风和其他并发症。减少钠含量是可能的——世界其他地方和美国的一些食品制造商已经做到了这一点。鉴于压倒性的科学证据，自愿减少食品供应中的钠含量是必要的，也是早就应该的。 FDA 拟议的自愿指南草案将鼓励制造商逐步减少加工和预制食品中添加的钠，并将选择权交给消费者。
significant downward trend in sodium intake of 11% from 2005 through 2006 and in 2014. In 2014, average daily sodium intake was 3200 mg, significantly lower than US intake.4 The TOHP II investigators noted that it was challenging for even highly motivated participants to reduce sodium intake because of the amounts in US foods: “The greatest difficulty is encountered in avoiding sodium that has already been added to processed or catered foods rather than changing discretionary salting behaviors....”5 This observation further supports the need to reduce the amount of sodium in foods prepared outside of the home. Adverse effects associated with low levels of an essential nutrient typically occur at extremely low values. Physiologic need for sodium is approximately 500 mg/d; adequate intake is set conservatively at 1500 mg/d. In randomized clinical trials, the intervention (dietary sodium) is the exposure, and each individual is classified according to intention-to-treat in relation to outcome. In observational studies, no intervention is provided and only multiple 24-hour urine collections can accurately assess individual sodium intake in relation to health outcomes. High-quality evidence supports a linear, doseresponse relationship between sodium reduction and blood pressure throughout the range of usual intake and does not support an association between low sodium intake and increased CVD risk.6 Individuals in the United States consume too much sodium yet are unable to reduce intake because large amounts are added to processed and restaurant foods. Excess sodium causes high blood pressure and CVD; reducing sodium gradually will reduce blood pressure and associated myocardial infarctions, strokes, and other complications. Sodium reduction is possible—it has been done elsewhere in the world and by some US food manufacturers. Given the overwhelming scientific evidence, pursuing voluntary reductions of sodium in the food supply is warranted and overdue. The FDA’s proposed draft voluntary guidance will encourage manufacturers to gradually reduce sodium added to processed and prepared foods and put choice where it belongs, in the consumer’s hands.