Infants in UK consuming too much salt

Cribb VL. Eur J Clin Nutr. 2011;doi:10.1038/ejcn.2011.137.

About 70% of 8-month-old infants have a salt intake higher than the recommended maximum level in the United Kingdom, according to results of a new study.

Researchers at the University of Bristol examined data on 1,178 participants in the Children of the 90s study. They then categorized the infants into four groups of increasing salt intake.

The researchers said most infants were first introduced to solids at about 3 to 4 months of age, with the mean salt intake for the highest group at 8 months that was more than double the maximum recommendation for that age group (400 mg sodium per day, up to 12 months).

Infants in this top group often consumed cows’ milk as a main drink, which has a higher sodium content, at 55 mg/100 g, than breast (15 mg per 100 g) or formula (15 mg to 30 mg per 100 g) milk. They also ate three times the amount of bread compared with the lowest group and were given salty flavorings such as yeast extract and gravy, the researchers said.

The said most of the salt consumed is added to food during manufacturing, with a relatively small proportion added during cooking or at the table, and current intakes in both children and adults are far higher than National Institute for Health and Clinical Excellence guidelines.

“Given that three-quarters of salt in the diet comes from processed adult foods, successful salt-reduction strategies can only be achieved with the cooperation of the food industry,” according to the study researchers. “Manufacturers have a responsibility to reduce the salt content of food products. This process has already started in the United Kingdom, but much more needs to be done. If this study were repeated today, it is likely that there would be some improvement but not enough to safeguard the health of all babies.”

The study researchers also said parents must be better informed about foods that are suitable for infants.

Disclosure: The researchers said although funding was obtained from Danone (Nutricia Ltd.), the work was carried out independently.

Nadim Kanafani

Although the infants they report on are now much older, these researchers from the UK highlight an important aspect of infant nutrition that receives little attention in the United States: sodium intake among infants. The US does not have a recommended maximum intake for children younger than 12 months of age. Rather the Institute of Medicine has set a recommended allowance for sodium of 370 mg in infants aged 6 to 12 months. Data on sodium intake among US children is similarly old, but these data do reveal that on average, infants in the US consume almost twice this recommended daily allowance. As is the case in the present study from the UK, sodium intake among infants is correlated with the amount of table food and regular milk the infants are consuming. The American Academy of Pediatrics recommends that solid foods not be given to infants until they are at least 4 months old. While many experts disagree on the optimal foods to give infants, there is definite consensus from nutrition and public health experts that many US infants are being fed high-sodium, high-fat foods based on refined grains early in their lives; I have personally witnessed infants in my clinic who cannot yet walk but are being fed French fries, sugary breakfast cereals, cookies, crackers and other high-sodium foods.

In light of these findings and concerns, pediatricians can give parents tips on what they can do to reduce sodium intake among infants and children:

• Choose breast-feeding above all other feeding methods;
• The best early infant foods include pureed fruits and vegetables and iron-fortified whole grain infant cereals with no added salt;
• As infants get bigger and acquire more oral motor skills and teeth, the focus should continue to be on fruits, vegetables, soft lean protein sources, whole grains, and age appropriate liquids like breast-milk or infant formula;
• Cow's milk should not be given to infants until at least 12 months of age; and
• Parents need to avoid giving infants processed foods, fast foods, frozen meals and should only be given table food if that food is low in sodium and not processed.

The important message to send parents on infant feeding is that lifelong eating habits are established during infancy. Paying attention to infant and child sodium intake now may have long-lasting effects on the risk for common health conditions like obesity and high blood pressure.

Nadim Kanafani, MD
Saint Louis University
Pediatric Endocrinology/Diabetes
SSM Cardinal Glennon Children's Hospital

Disclosures: Dr. Kanafani has no relevant financial disclosures.

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