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The relation of potassium and sodium intakes to diet cost among US adults



The 2010 Dietary Guidelines recommended that Americans increase potassium and decrease sodium intakes to reduce the burden of hypertension. One reason why so few Americans meet the recommended potassium or sodium goals may be perceived or actual food costs. This study explored the monetary costs associated with potassium and sodium intakes using national food prices and a representative sample of US adults. Dietary intake data from the 2001–2002 National Health and Nutrition Examination Survey were merged with a national food prices database. In a population of 4744 adults, the association between the energy-adjusted sodium and potassium intakes, and the sodium-to-potassium ratio (Na:K) and energy-adjusted diet cost was evaluated. Diets that were more potassium-rich or had lower Na:K ratios were associated with higher diet costs, while sodium intakes were not related to cost. The difference in diet cost between extreme quintiles of potassium intakes was $1.49 (95% confidence interval: 1.29, 1.69). A food-level analysis showed that beans, potatoes, coffee, milk, bananas, citrus juices and carrots are frequently consumed and low-cost sources of potassium. Based on existing dietary data and current American eating habits, a potassium-dense diet was associated with higher diet costs, while sodium was not. Price interventions may be an effective approach to improve potassium intakes and reduce the Na:K ratio of the diet. The present methods helped identify some alternative low-cost foods that were effective in increasing potassium intakes. The identification and promotion of lower-cost foods to help individuals meet targeted dietary recommendations could accompany future dietary guidelines.

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  1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859): 2224–2260.

    Article  Google Scholar 

  2. Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 2007; 334 (7599): 885–888.

    Article  Google Scholar 

  3. He FJ, MacGregor GA . Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev 2004; (4): CD004937.

  4. Appel LJ, Frohlich ED, Hall JE, Pearson TA, Sacco RL, Seals DR et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation 2011; 123 (10): 1138–1143.

    Article  Google Scholar 

  5. Cook NR, Obarzanek E, Cutler JA, Buring JE, Rexrode KM, Kumanyika SK et al. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch Int Med 2009; 169 (1): 32–40.

    Article  Google Scholar 

  6. Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D et al. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA 1997; 277 (20): 1624–1632.

    CAS  Article  Google Scholar 

  7. US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans 7th edn Washington, DC: US Government Printing Office, 2010.

  8. Centers for Disease C, Prevention. Usual sodium intakes compared with current dietary guidelines–United States, 2005–2008. MMWR Morb Mortal Wkly Rep 2011; 60 (41): 1413–1417.

    Google Scholar 

  9. Drewnowski A, Maillot M, Rehm C . Reducing the sodium-potassium ratio in the US diet: a challenge for public health. Am J Clin Nutr 2012; 96 (2): 439–444.

    CAS  Article  Google Scholar 

  10. IOM (Institute of Medicine). Strategies to Reduce Sodium Intake in the United States. The National Academies Press: Washington, DC, 2010.

  11. Anderson CA, Appel LJ, Okuda N, Brown IJ, Chan Q, Zhao L et al. Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study. J Am Diet Assoc 2010; 110 (5): 736–745.

    CAS  Article  Google Scholar 

  12. Brown IJ, Tzoulaki I, Candeias V, Elliott P . Salt intakes around the world: implications for public health. Int J Epidemiol 2009; 38 (3): 791–813.

    Article  Google Scholar 

  13. Beauchamp GK, Stein LJ . Salt Taste. In the Senses: A Comprehensive Reference, (ed Basbaum A.I.) 2008. Elsevier: New York, Vol. 4: 401–408.

    Book  Google Scholar 

  14. Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. US Department of Agriculture, Agricultural Research Service: Washington, DC, 2010.

  15. Drewnowski A . The cost of US foods as related to their nutritive value. Am J Clin Nutr 2010; 92 (5): 1181–1188.

    CAS  Article  Google Scholar 

  16. Monsivais P, Aggarwal A, Drewnowski A . Following federal guidelines to increase nutrient consumption may lead to higher food costs for consumers. Health Aff (Millwood) 2011; 30 (8): 1471–1477.

    Article  Google Scholar 

  17. Kaplan GA, Keil JE . Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 1993; 88 (4 Pt 1): 1973–1998.

    CAS  Article  Google Scholar 

  18. Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB . State of disparities in cardiovascular health in the United States. Circulation 2005; 111 (10): 1233–1241.

    Article  Google Scholar 

  19. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey. MEC In-person dietary interviewers procedures manual. January 2002. Accessed 15 February 2012.

  20. Rehm CD, Monsivais P, Drewnowski A . The quality and monetary value of diets consumed by adults in the United States. Am J Clin Nutr 2011; 94 (5): 1333–1339.

    CAS  Article  Google Scholar 

  21. Carlson A, Lino M, Juan WY, Marcoe K, Bente L, Hiza HAB, Guenther PM, Leibtag E . Development of the CNPP Prices Database. Center for Nutrition Policy and Promotion, US Dept of Agriculture: Washington, DC, 2008.

    Google Scholar 

  22. National Cancer Institute. Risk Factor Monitorting and Methods Figure 1. List of specific foods: Result of grouping like foods reported in 2003–2006 NHANES. 2011.

  23. Hoffmann K, Schulze MB, Schienkiewitz A, Nothlings U, Boeing H . Application of a new statistical method to derive dietary patterns in nutritional epidemiology. Am J Epidemiol 2004; 159 (10): 935–944.

    Article  Google Scholar 

  24. Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH et al. Sodium and potassium intakes among US adults: NHANES 2003–2008. Am J Clin Nutr 2012; 96 (3): 647–657.

    CAS  Article  Google Scholar 

  25. Monsivais P, Rehm CD, Drewnowski A . The DASH diet and diet costs among ethnic and racial groups in the United States. JAMA Int Med 2013; 173 (20): 1922–1924.

    Article  Google Scholar 

  26. American Heart Association. Potassium and High Blood Pressure. 2012.

  27. Monsivais P, Perrigue MM, Adams SL, Drewnowski A . Measuring diet cost at the individual level: a comparison of three methods. Eur J Clin Nutr 2013; 67 (11): 1220–1225.

    CAS  Article  Google Scholar 

  28. Glanz K, Basil M, Maibach E, Goldberg J, Snyder D . Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. J Am Diet Assoc 1998; 98 (10): 1118–1126.

    CAS  Article  Google Scholar 

  29. Waterlander WE, Steenhuis IH, de Boer MR, Schuit AJ, Seidell JC . The effects of a 25% discount on fruits and vegetables: results of a randomized trial in a three-dimensional web-based supermarket. Int J Behav Nutr Phys Activity 2012; 9: 11.

    Article  Google Scholar 

  30. Ni Mhurchu C, Blakely T, Jiang Y, Eyles HC, Rodgers A . Effects of price discounts and tailored nutrition education on supermarket purchases: a randomized controlled trial. Am J Clin Nutr 2010; 91 (3): 736–747.

    Article  Google Scholar 

  31. Geliebter A, Ang IY, Bernales-Korins M, Hernandez D, Ochner CN, Ungredda T et al. Supermarket discounts of low-energy density foods: effects on purchasing, food intake, and body weight. Obesity 2013; 21 (12): E542–E548.

    Article  Google Scholar 

  32. Griffith R, O’Connell M, Smith K Food expenditure and nutritional quality over the great recession. IFS Briefing Note, Institute for Fiscal Studies, London, document number BN1 43.

  33. Bernstein AM, Bloom DE, Rosner BA, Franz M, Willett WC . Relation of food cost to healthfulness of diet among US women. Am J Clin Nutr 2010; 92 (5): 1197–1203.

    CAS  Article  Google Scholar 

  34. Townsend MS, Aaron GJ, Monsivais P, Keim NL, Drewnowski A . Less-energy-dense diets of low-income women in California are associated with higher energy-adjusted diet costs. Am J Clin Nutr 2009; 89 (4): 1220–1226.

    CAS  Article  Google Scholar 

  35. Monsivais P, Aggarwal A, Drewnowski A . Are socio-economic disparities in diet quality explained by diet cost? J Epidemiol Commun Health 2012; 66 (6): 530–535.

    Article  Google Scholar 

  36. Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, Franch HA et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation 2012; 126 (12): 1514–1563.

    Article  Google Scholar 

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This study was supported by NIH grants R21 DK085406 and R01 DK 076608.

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Correspondence to A Drewnowski.

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The authors declare no conflict of interest.

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Author Contributions

AD, CR and PM designed and conducted the research. CR analyzed the data and MM modeled the indicator foods. AD, CR, MM and PM wrote the paper. AD and CR had primary responsibility for final content. All authors read and approved the final manuscript.

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Drewnowski, A., Rehm, C., Maillot, M. et al. The relation of potassium and sodium intakes to diet cost among US adults. J Hum Hypertens 29, 14–21 (2015).

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