Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Maternal and pediatric nutrition

Blood pressure and sodium intake from snacks in adolescents

Abstract

Background/Objectives:

The relationship between sodium intake and arterial blood pressure (BP) values in adolescence is still controversial. The intake of high-sodium processed foods as snacks has gone up worldwide. The purpose of the present cross-sectional study was to analyze the association between BP values and sodium intake from snacks.

Subjects/Methods:

The mean weekly consumption of snacks was evaluated in 1200 randomly selected adolescents aged 11–13 years by a food-frequency questionnaire; their anthropometric and BP values were measured by trained researchers. A dietary 24-h food-recall questionnaire was randomly given to 400 of the 1200 adolescents.

Results:

Mean sodium intake from snacks was 1.4 g/day. Systolic and diastolic BP (SBP and DBP, respectively) significantly increased from the lower to the higher tertile of sodium from snacks and with increasing frequency of salty snacks consumption. In a multiple logistic regression model, both being in the highest SBP quartile and in the highest DBP quartile were significantly associated with the intake of sodium from snacks (odds ratio (OR)=1.48; 95% confidence interval (CI) 1.14–1.91 and OR=2.17; 95% CI 1.68–2.79, respectively), the consumption of >2/day salty snacks (OR=1.86; 95% CI 1.32–2.63 and OR=2.38; 95% CI 1.69–3.37, respectively) and body mass index (OR=1.26; 95% CI 1.22–1.31 and OR=1.14; 95% CI 1.10–1.18, respectively) but not with age, sex or exercise levels. In the 400 individuals, the average total sodium intake was 3.1 g/day and was significantly higher in individuals belonging to the highest quartile of SBP and DBP.

Conclusions:

Sodium intake from snacks was almost half of the average daily sodium consumption and was significantly associated with BP values in adolescents.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Sugiyama T, Xie D, Graham-Maar RC, Inoue K, Kobayashi Y, Stettler N . Dietary and lifestyle factors associated with blood pressure among U.S. adolescents. J Adolesc Health 2007; 40: 166–172.

    Article  PubMed  Google Scholar 

  2. Carretero OA, Oparil S . Essential hypertension. Circulation 2000; 37: 268–274.

    Google Scholar 

  3. Chen X, Wang Y . Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 2008; 117: 3171–3180.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Berenson GS . Childhood risk factors predict adult risk associated with subclinical cardiovascular disease. The Bogalusa Heart Study. Am J Cardiol 2002; 90: 3L–7L.

    Article  PubMed  Google Scholar 

  5. Sundström J, Neovius M, Tynelius P, Rasmussen F . Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts. BMJ 2011; 342: d643.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ . Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 2004; 113: 475–482.

    Article  PubMed  Google Scholar 

  7. McNiece KM, Poffenbarger TS, Turner JL . Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007; 150: 640–644.

    Article  PubMed  Google Scholar 

  8. Pileggi C, Carbone V, Nobile C, Pavia M . Blood pressure and related cardiovascular disease risk factors in 6–18 year-old students in Italy. J Paediatr Child Health 2005; 41: 347–352.

    Article  PubMed  Google Scholar 

  9. Spagnolo A, Giussani M, Ambruzzi AM, Bianchetti M, Maringhini S, Matteucci MC et al. Focus on prevention, diagnosis and treatment of hypertension in children and adolescents. Ital J Pediatr 2013; 39: 20.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yang Q, Zhang Z, Kuklina EV, Fang J, Ayala C, Hong Y et al. Sodium intake and blood pressure among US children and adolescents. Pediatrics 2012; 130: 611–619.

    Article  PubMed  Google Scholar 

  11. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24h urinary sodium and potassium excretion. BMJ 1988; 297: 319–328.

    Article  Google Scholar 

  12. Meneton P, Jeunemaitre X, de Wardener HE, MacGregor GA . Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev 2005; 85: 679–715.

    Article  CAS  PubMed  Google Scholar 

  13. Graudal NA, Hubeck-Graudal T, Jurgens G . Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst Rev 2011; (11): CD004022.

  14. Simons-Morton DG, Obarzanek E . Diet and blood pressure in children and adolescents. Pediatr Nephrol 1997; 11: 244–249.

    Article  CAS  PubMed  Google Scholar 

  15. He FJ, Mac Gregor GA . Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. Hypertension 2006; 48: 861–869.

    Article  CAS  PubMed  Google Scholar 

  16. Falkner B, Michel S . Blood pressure response to sodium in children and adolescents. Am J Clin Nutr 1997; 65: 618S–621S.

    Article  CAS  PubMed  Google Scholar 

  17. Leclercq C, Ferro-Luzzi A . Total and domestic consumption of salt and their determinants in three regions of Italy. Eur J Clin Nutr 1991; 45: 151–159.

    CAS  PubMed  Google Scholar 

  18. Società Italiana di Nutrizione Umana. http://www.sinu.it/html/pag/larn_minerali.asp#SODIO.

  19. Liem DG, Miremadi F, Keast RS . Reducing sodium in foods: the effect on flavor. Nutrients 2011; 3: 694–711.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Drewnowski A, Rehm CD . Sodium intakes of US children and adults from foods and beverages by location of origin and specific food source. Nutrients 2013; 5: 1840–1855.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Ovaskainen ML, Reinivuo H, Tapanainen H, Hannila ML, Korhonen T, Pakkala H . Snacks as an element of energy intake and food consumption. Eur J Clin Nutr 2006; 60: 494–501.

    Article  PubMed  Google Scholar 

  22. Larson N, Story M . A review of snacking patterns among children and adolescents: what are the implications of snacking for weight status? Child Obes 2013; 9: 104–115.

    Article  PubMed  Google Scholar 

  23. Bes-Rastrollo M, Sanchez-Villegas A, Basterra-Gortari FJ, Nunez-Cordoba JM, Toledo E, Serrano-Martinez M . Prospective study of self-reported usual snacking and weight gain in a Mediterranean cohort: the SUN project. Clin Nutr 2010; 29: 323–330.

    Article  PubMed  Google Scholar 

  24. Astrup A, Bovy MW, Nackenhorst K, Popova AE . Food for thought or thought for food?-A stakeholder dialogue around the role of the snacking industry in addressing the obesity epidemic. Obes Rev 2006; 7: 303–312.

    Article  CAS  PubMed  Google Scholar 

  25. Piernas C, Popkin BM . Trends in snacking among U.S. children. Health Aff (Millwood) 2010; 9: 398–404.

    Article  Google Scholar 

  26. Bo S, De Carli L, Venco E, Fanzola I, Maiandi M, De Michieli F et al. Impact of snacking pattern on overweight and obesity risk in a cohort of 11-13-y adolescents. J Pediatr Gatroenterol Nutr 2014; 59: 465–471.

    Article  Google Scholar 

  27. Cacciari E, Milani S, Balsamo A, Dammacco F, De Luca F, Chiarelli F et al. Italian cross-sectional growth charts for height, weight and BMI (6-20 y). Eur J Clin Nutr 2002; 56: 171–180.

    Article  CAS  PubMed  Google Scholar 

  28. Ainsworth BE, Haskell WL, Herrrmann SD, Meckes N, Bassett DR Jr, Tudor Locke C et al. Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 2011; 43: 1575–1581.

    Article  PubMed  Google Scholar 

  29. Pahkala K, Heinonen OJ, Lagström H, Hakala P, Sillanmäki L, Simell O . Leisure-time physical activity of 13-year-old adolescents. Scand J Med Sci Sports 2007; 17: 324–330.

    CAS  PubMed  Google Scholar 

  30. Bo S, Ciccone G, Durazzo M, Gambino R, Massarenti P, Baldi I et al. Efficacy of antioxidant treatment in reducing resistin serum levels: a randomized study. PLoS Clin Trials 2007; 2: e17.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bo S, Bertino E, Trapani A, Bagna R, De Michieli F, Gambino R et al. Magnesium intake, glucose and insulin serum levels in pre-school very-low-birth weight pre-term children. Nutr Metab Cardiovasc Dis 2007; 17: 741–747.

    Article  CAS  PubMed  Google Scholar 

  32. Hampl JS, Heaton CLB, Taylor CA . Snacking patterns influence energy and nutrient intakes but not body mass index. J Hum Nutr Dietet 2003; 16: 3–11.

    Article  CAS  Google Scholar 

  33. Schofield WN . Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 1985; 39: S5–S41.

    Google Scholar 

  34. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM . Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 1991; 45: 569–581.

    CAS  PubMed  Google Scholar 

  35. Biltoft-Jensen A, Fagt S, Groth MV, Matthiessen J, Wachmann HC, Christensen T . The intake of saturated fat and dietary fiber: a possible indicator of diet quality. Br J Nutr 2008; 100: 624–632.

    Article  CAS  PubMed  Google Scholar 

  36. Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C . Sources of energy from meals versus snacks in 220 people in four age groups. Eur J Clin Nutr 1995; 49: 33–41.

    CAS  PubMed  Google Scholar 

  37. He FJ, Marrero NM, MacGregor GA . Salt and blood pressure in children and adolescents. J Hum Hypertens 2008; 22: 4–11.

    Article  CAS  PubMed  Google Scholar 

  38. Howe PRC, Cobiac L, Smith RM . Lack of effect of short-term changes in sodium intake on blood pressure in adolescent school children. J Hypertens 1991; 9: 181–186.

    Article  CAS  PubMed  Google Scholar 

  39. Cooper R, Von Horn L, Liuk A . Randomized trial on the effect of decreased dietary sodium intake on blood pressure in adolescents. J Hypertens 1984; 2: 36.

    Google Scholar 

  40. Tu W, Eckert GJ, DiMeglio LA, Yu Z, Jung J, Pratt JH . Intensified effect of adiposity on blood pressure in overweight and obese children. Hypertension 2011; 58: 818–824.

    Article  CAS  PubMed  Google Scholar 

  41. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS . The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999; 103: 1175–1182.

    Article  CAS  PubMed  Google Scholar 

  42. Francis LA, Lee Y, Birch LL . Parental weight status and girls’ television viewing, snacking, and body mass indexes. Obes Res 2003; 11: 143–151.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Collison KS, Zaidi MZ, Subhani SN, Al-Rubeaan K, Shoukri M, Al-Mohanna FA . Sugar-sweetened carbonated beverage consumption correlates with BMI, waist circumference, and poor dietary choices in school children. BMC Public Health 2010; 10: 234.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Grimes CA, Wright JD, Liu K, Nowson CA, Loria CM . Dietary sodium intake is associated with total fluid and sugar-sweetened beverage consumption in US children and adolescents aged 2-18 y: NHANES 2005-2008. Am J Clin Nutr 2013; 98: 189–196.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Bandini LG, Vu D, Must A, Cyr H, Goldberg A, Dietz WH . Comparison of high-calorie, low-nutrient-dense food consumption among obese and non-obese adolescents. Obes Res 2000; 7: 438–443.

    Article  Google Scholar 

  46. Phillips SM, Baldini LG, Naumova EN, Cyr H, Colclough S, Dietz WH et al. Energy-dense snack food intake in adolescence: longitudinal relationship to weight and fatness. Obes Res 2004; 12: 461–472.

    Article  PubMed  Google Scholar 

  47. Keast DR, Nicklas TA, O'Neil CE . Snacking is associated with reduced risk of overweight and reduced abdominal obesity in adolescents: National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Clin Nutr 2010; 92: 428–435.

    Article  CAS  PubMed  Google Scholar 

  48. Keast DR, Nicklas TA, O’Neil CE . Snacking is associated with reduced risk of overweight and reduced abdominal obesity in adolescents: National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Clin Nutr 2010; 92: 428–435.

    Article  CAS  PubMed  Google Scholar 

  49. Slining MM, Mathias KC, Popkin BM . Trends in food and beverage source among US children and adolescents: 1989-2010. J Acad Nutr Diet 2013; 113: 1683–1694.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S Bo.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Author Contributions

Valentina Ponzo participated in the conception and design of the study, supervision of data collection, data analysis, interpretation of the findings of the study, manuscript writing and revision. Gian Pasquale Ganzit participated in the data analysis, interpretation of the findings, manuscript writing and revision. Laura Soldati participated in the data collection, interpretation of the findings and manuscript revision. Luca De Carli and Marilena Durazzo participated in the data analysis, interpretation of the findings of the study and manuscript revision. Ilaria Fanzola and Maria Maiandi participated in the data collection, interpretation of the findings of the study and manuscript revision. Simona Bo participated in the conception and design of the study, interpretation of the findings of the study, manuscript writing and revision. All authors have read and approved the final manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ponzo, V., Ganzit, G., Soldati, L. et al. Blood pressure and sodium intake from snacks in adolescents. Eur J Clin Nutr 69, 681–686 (2015). https://doi.org/10.1038/ejcn.2015.9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.9

This article is cited by

Search

Quick links