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Lower-Income Americans at Higher Risk of Death From Excess Salt



April 2, 2024 – Eating food with high amounts of salt has long been linked to a greater risk of high blood pressure and heart disease. But much of the research on salt’s effects have been with middle- and upper-income populations. 

A study says large portion of low-income African Americans and White Americans exceed the current recommended sodium intake level. So why is this population getting too much salt? 

“In this marginalized group, it is almost always consistent with food access,” said Lena Beal, a registered dietitian nutritionist and a spokesperson for the Academy of Nutrition and Dietetics. Lower access to healthier food involves few options outside of convenience foods, a lack of education about healthier food choices, and problems being able to afford quality food, she said

Salt is a necessary nutrient, but a diet with too much of this good thing is linked to death from heart disease.

A large portion of low-income African Americans and White Americas exceeded the current recommended sodium intake level in the new study, “which may have contributed to their high cardiovascular disease mortality rate,” said senior author Xiao-Ou Shu, MD, PhD, a researcher in the Department of Medicine, Division of Epidemiology at Vanderbilt University Medical Center in Nashville. Cardiovascular disease is a term for problems with your heart and blood vessels.

About 80% of the 65,000 people in the study got more than the daily recommended amount of salt (or sodium) in their diet. The federal government recommends 2,300 milligrams or less per day. In contrast, Black Americans consumed an average of 4,512 milligrams of sodium in their diet per day, while low-income White Americans consumed an average of 4,041 milligrams daily. 

Overall, having too much sodium in their diet was linked about 10% to 30% of cardiovascular disease deaths in the study, which was published online March 26 in the journal JAMA Network Open. 

Barriers to Healthier Foods

“It’s a solid study. We see this often in our everyday practice, so it’s good to have a study that supports it,” said Beal, who was not involved in the research. 

“We have our urban food deserts in Atlanta, where there’s no grocery store within walking distance or one easily accessible using public transit, so people end up shopping at the proverbial corner store,” said Beal, a cardiac dietitian at Piedmont Atlanta Hospital.

“The barriers for that population are very real and palpable when you’re dealing with them every single day,” she said.

According to the city of Atlanta, just 52% of city residents lived within a half-mile of fresh food in 2015, a figure that increased to 75% by 2020. The city has set a goal of upping that to 85% by 2025. 

Moving forward, Beal would like to see more action. “We have got to put some muscle time, energy, research dollars, and resources into these communities to increase their access to wholesome, healthful choices at affordable prices.”

Excess Salt, Excess Death Risk

Shu and colleagues examined patients a median of 14 years after they entered the Southern Community Cohort Study. People ages 40 to 79 were enrolled in the study between 2002 and 2009, mostly from health centers serving underserved Americans in one of 12 Southern states. They were 72% Black and 28% White, and about 83% lived in households with an annual income below $25,000.

After controlling for other things that can increase heart disease risk, the researchers found that every 1,000-milligram increase in salt over the recommended 2,300 milligrams per day was tied to a greater risk of death.

For example, among Black patients, this added a 3% increased risk of dying from any reason, 7% higher risk from total cardiovascular disease, and an 8% higher chance of dying from congestive heart disease. Among White patients, the risks were even greater – an added 8% likelihood of dying from total cardiovascular disease and a 13% higher risk of death from congestive heart disease. This group also was 55% more likely to die from heart failure. 

And the issue is not just among Americans with lower socioeconomic status. Americans overall consume high levels of dietary salt – an average of 3,400 milligrams a day. 

Myths and Potential Solutions

People have multiple misperceptions about excess salt, Beal said. On the medical side, they tend to misunderstand “the strong correlation with heart disease, and on the diet side, people misunderstand how simple it is to address.” 

Avoiding excess salt does not mean eating food with no taste. Rather than sprinkling on the salt, add herbs and spices, Beal suggested. For example, instead of eating rice that comes in a box with a seasoning packet that you boil and serve, choose rice in a bag that you boil and season yourself.

Shu said that “a special program aiming to educate the health risk of high sodium intake and promote healthy diet among these vulnerable populations should be a public health priority.”

Beal encourages people to change their lifestyle in two ways, even if they are financially restrained. “It’s going to be how much or how often you do something – the amount or the frequency.”

The “how much” means portion control. The “how often” means the number of times you eat prepackaged products, convenience foods, or processed foods. Restaurant food can include unknown amounts of salt, too, especially fast food.

Choose to buy 100% fruit drinks instead of dark sodas, Beal suggested. Opt for smaller bottles – buy a drink that is 8 ounces instead of 20 ounces. Buy ramen noodles and drain the liquid off before eating. In addition, limit condiments and sauces like barbecue sauce, ketchup, and mayonnaise, which “have all the excess sodium and sugar.”

Study Limitations and Strengths

Shu and colleagues calculated salt in the diet based on what people reported at one time, when they entered the Southern Community Cohort Study. So any changes over time could not be considered. Also, self-reporting salt in the diet might be less accurate than testing blood or urine samples. 

In terms of strengths, Beal cited the large sample size and the focus on underserved communities.

Asked about next steps, Shu said their plans include looking into how genes affect the way sodium impacts health.

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5 Family and Community Engagement Strategies to Improve Student Outcomes



Strong school-family-community partnerships bring exceptional value to children’s education. A recent book by Karen L. Mapp, a senior lecturer at the Harvard Graduate School of Education, and four other co-collaborators synthesizes the available research to explain who benefits from these partnerships and the many advantages of family and community engagement.

Everyone Wins! The Evidence for Family-School Partnerships & Implications for Practice (Scholastic, 2022) cites various research to demonstrate how family-community-school partnerships benefit all stakeholder groups when they’re approached effectively:

  • Students have higher grades, better attendance, deeper engagement in school, greater self-esteem, and higher rates of graduation and college attainment.
  • Educators enjoy better job satisfaction, better success motivating students from different backgrounds, more family support, and an improved mindset about students and their families.
  • Families have stronger relationships with their children and better rapport with educators. They can navigate school policies and advocate for their children more effectively.
  • Schools enjoy a better climate, more support from their community, and improved staff morale—leading to better teacher retention.
  • School districts and communities become better places to live and raise children. They experience fewer disciplinary problems, greater participation in afterschool programs, and more family and student involvement in decision-making.
community members talking and hugging in matching green volunteer t-shirts in front of an outdoor mural

What elements make school-family-community partnerships particularly effective? Here are five tips for how school systems can successfully promote family and community engagement in education and drive better student outcomes.

1. Successful Family Engagement Requires Intentional Leadership

Engaging with families has to be a core activity and not just an afterthought. It requires a total commitment by school and district leaders, and this commitment must include investing in the tools and training needed to help educators effectively engage with families from all backgrounds. It must be a real and intentional focus, and as Mapp says: “It’s real when I see it on your budget sheets.”

2. Teachers and Administrators Must Communicate Clearly and Consistently

To encourage family involvement in their children’s education, educators must interact with families frequently—and in many ways. For instance, teachers and administrators might engage with families in person during school drop-off and pick-up periods, set up a Family Information Board in the school’s lobby, write and distribute regular newsletters or blog posts, and/or send emails or text messages to parents.

Communicating effectively is one of the National PTA’s “National Standards for Family-School Partnerships,” which guides how schools and families should work together to support student success. Teachers and administrators should learn about and meet families’ preferred methods of communication, and families should be able to share and receive information in culturally and linguistically relevant ways.

3. Develop Healthy, Positive Relationships Based on Mutual Trust and Respect

Interactions between educators and families should be positive and reciprocal, with families feeling valued and supported. Educators can establish trust and encourage healthy, two-way communications with families by sharing information about their children’s positive behaviors and accomplishments and which skills may need work. Listen to all parents and provide opportunities for shared decision-making.

4. Be Mindful of Diversity, Equity, and Inclusion

Welcoming all families and fostering a sense of belonging is another National PTA standard. When families engage with your school, do they feel respected, understood, and connected to the school community?

To ensure equity and inclusion, learn about the families you serve and their unique needs and challenges. Use culturally responsive engagement practices. Create opportunities for connection, especially with historically marginalized families and students. Learn about and seek to remove barriers for families to participate fully in their children’s education.

5. Help Families Support and Extend the Learning at Home

Students learn more effectively when they have opportunities at home to practice, reinforce, or extend the skills and lessons they’ve learned in school. Educators can facilitate this process by giving families specific ideas for expanding their children’s learning at home, such as by incorporating core math and literacy concepts into everyday routines.

Schools can also make instructional resources such as take-home packs, activity sets, and other materials available to families to support their children’s education.

How School Specialty® Can Help

School Specialty has more than six decades of experience in providing tools, resources, and strategies that promote successful education both in school and at home. We offer arts and crafts, early childhood, ELA, math, science, STEM/STEAM, physical education, special needs, and social emotional learning resources for families, as well as games, puzzles, and general supplies.

How do you promote family engagement in your classroom and community? Let us know in the comments!

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Preteens and skincare: What parents should know – CHOC




Published on: April 16, 2024
Last updated: April 9, 2024

Should teens and preteens be using so many skincare products with fancy ingredients? A pediatric dermatologist answers parents’ questions.


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Living With Crohn’s: My Daily Routine



By Michelle Pickens, as told to Danny Bonvissuto

As early as I can remember, I’ve had issues with my health. When I was little, I had severe constipation, nausea, vomiting, and food sensitivities.

As I got older, those symptoms transitioned into diarrhea, irregular bowel movements, and pain. I was always very fatigued and my immune system was weak: The second someone in my class had the cold or flu, I’d get it, too. Looking back, it was a sign.

From a mental perspective, my anxiety was high. What if I need to find a bathroom? What if I’m nauseous? Doctors would say, “Oh, you’ll grow out of it. It’s just your anxiety.”

Finally, a Diagnosis

After years of misdiagnosis, I was finally diagnosed with Crohn’s disease in 2015. I was 23 and had just finished up college while working full time. My symptoms were getting worse. I had a lot of vomiting and pain. The fatigue was at the point where it was difficult for me to work or even get out of bed some days.

It was so bad it pushed me to seek additional care. I took a couple months off, looked for another job, and went through all the doctor appointments it took to get the diagnosis.

There’s no blood test for Crohn’s. No way to prove what you’re feeling. Eventually I saw the right doctor, who did a test with a pill camera called a small bowel capsule. (This is a pill-sized camera that you swallow, allowing doctors to see inside your digestive system.) It tracked my intestines and was able to get into a blind spot where neither a colonoscopy nor endoscopy can see inflammation. 

It was such a relief to get the diagnosis because it made me feel like I wasn’t crazy. For so many years I knew something was wrong and couldn’t name it. I also felt hopeful. Once I knew what I was dealing with, I knew I could work to get to a better place.

Sharing My Story

In 2016, I started a blog called Crohnically Blonde as an outlet to connect with people as I go through the stages of dealing with Crohn’s. When I first started to share, there weren’t as many people talking about it.

I’ve been able to form relationships in an online community through shared experiences. I hope someone can see my story and feel that, if they’re at the beginning of their journey, there’s a way to get through.

Managing My Medication

At first, I was on a lot of medication that wasn’t working well and was a huge imposition on my schedule. Now I get infusions of an immunosuppressive drug every 7 weeks.

It means being away from my family and job for 4-5 hours, and managing child-care coverage during the treatment and the weekend after, because I feel almost flu-like. The extra help allows me to rest and fuel back up after the treatment.

I have the option to be on more medications to control my symptoms. But I try to shy away from those and manage it on my own because I don’t want to be on medicine for every single thing.

Before I had my son, I was more willing to try different medications. But while I was pregnant, I could barely be on any of the Crohn’s medicines. After I had him, it didn’t make sense to be reliant on them.

Crohn’s, Pregnancy, and Motherhood

Crohn’s affected me throughout my pregnancy. I got very sick in my third trimester because I went off my immunosuppressive drug to avoid passing any on to the baby. I ended up having to be induced early so I could get back on the medication as soon as possible.

My son, Maddox, is 1 now. Crohn’s changed my expectation of what I thought motherhood would be.

I’ve learned that I’d rather be present and able to enjoy him in the good moments than push it when I’m sick. It’s been difficult. But if I’m not well, I can’t be there for my child. I try to be with him as much as I can, but there are times when I need to step back and take an hourlong nap.

I have a great support system: My husband, mom, or mother-in-law can step in and help out for a little while, and when I feel better, I can be a better mom. There are also days when I don’t have accessible help. In those situations, I’ll do lower-key activities that I can enjoy with him but that aren’t physically demanding on me.

Schedule and Adjust

Right now I’m in a pretty good spot. I work from home now, as a recruiter for a tech company, and that makes a huge difference. A lot of my anxiety in the past was around being in an office and being sick. Now that I can work remotely, it’s such a game changer.

But Crohn’s still affects my day-to-day. I have days where I’m feeling sick, and need to rest and change my plans so I’m home and not out somewhere.

No matter how planned-out I have my day or week, if I’m not feeling well that takes precedence. I like to be a very scheduled person. But I have to roll with the punches and have a plan B.

The biggest challenge is managing my sleep and stress. They’re both very influential in symptom flare-ups. I have to get at least 8 hours of sleep, no matter what. And I try to incorporate time to de-stress, like reading a book or relaxing at the end of the day.

Going to therapy helps offset stress as well, and is now part of my ingrained self-care schedule.

Social Life Strategies

My co-workers, family, and friends are very understanding. But that wasn’t the case at first. The more open I’ve been about Crohn’s, the more people understand that I’m not flaking out if I have to change plans; there’s an underlying reason.

I only have a certain amount of energy, so now I pick and choose. I know I need to work and be with my family, which means I have less energy to put into social situations.

I plan out what I’m comfortable doing, but have also become comfortable with changing plans. Even if I’m excited to go out to dinner with a friend, I don’t push it if I feel terrible that day.

Food in Flux

I’ve followed a gluten-free diet for years. I started with an elimination diet and realized that gluten was bothering me.

Other foods aren’t as black and white. I can eat a salad one day and it’s fine, and eat the same salad the next day and it makes me sick. I repeat the safe foods that don’t make me sick and stick to a general schedule of three meals a day that are pretty much all gluten free.

Sometimes the timing matters: I’ll wake up and feel nauseated and need a starchy food like dry cereal. If I’m going on a road trip, or have a big event, like a wedding, I plan it out and try to be careful about what I eat leading up to it because I don’t want to be sick. But it’s hard because you never really know. It’s kind of a gamble.

Flexibility Is Key

I’ve learned to be as flexible as possible. I never know what each day is going to bring, I just have to trust that my body is telling what it needs for that specific day. That’s my priority, and everything else can wait.


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