Advertisement
Research Original Research: Brief| Volume 118, ISSUE 5, P878-885, May 2018

Download started.

Ok

Sodium-Reduced Meat and Poultry Products Contain a Significant Amount of Potassium from Food Additives

Published:January 06, 2018DOI:https://doi.org/10.1016/j.jand.2017.10.025

      Abstract

      Background

      Sodium-reduced packaged food products are increasingly available to consumers; however, it is not clear whether they are suitable for inclusion in a potassium-reduced diet. For individuals with impaired renal potassium excretion caused by chronic kidney disease and for those taking certain medications that interfere with the rennin-angiotensin aldosterone axis, the need to limit dietary potassium is important in view of the risk for development of hyperkalemia and fatal cardiac arrhythmias.

      Objective

      The primary objective of this study was to determine the impact of the reduction of sodium in packaged meat and poultry products (MPPs) on the content of potassium and phosphorus from food additives.

      Design

      This was a cross-sectional study comparing chemically analyzed MPPs (n=38, n=19 original, n=19 sodium-reduced), selected from the top three grocery chains in Canada, based on market share sales. All MPPs with a package label containing a reduced sodium content claim together with their non-sodium-reduced packaged MPP counterparts were selected for analysis. The protein, sodium, phosphorus, and potassium contents of sodium-reduced MPPs and the non-sodium-reduced (original) MPP counterparts were chemically analyzed according to the Association of Analytical Communities official methods 992.15 and 984.27 and compared by using a paired t test. The frequency of phosphorus and potassium additives appearing on the product labels' ingredient lists were compared between groups by using McNemar’s test.

      Results

      Sodium-reduced MPPs (n=19) contained 44% more potassium (mg/100 g) than their non-sodium-reduced counterparts (n=19) (mean difference [95% CI): 184 [90-279]; P=0.001). The potassium content of sodium-reduced MPPs varied widely and ranged from 210 to 1,500 mg/100 g. Potassium-containing additives were found on the ingredient list in 63% of the sodium-reduced products and 26% of the non–sodium-reduced products (P=0.02). Sodium-reduced MPPs contained 38% less sodium (mg/100 g) than their non–sodium-reduced counterparts (mean difference [95% CI]: 486 [334-638]; P<0.001). The amounts of phosphorus and protein, as well as the frequency of phosphorus additives appearing on the product label ingredient list, did not significantly differ between the two groups.

      Conclusions

      Potassium additives are frequently added to sodium-reduced MPPs in amounts that significantly contribute to the potassium load for patients with impaired renal handling of potassium caused by chronic kidney disease and certain medications. Patients requiring potassium restriction should be counseled to be cautious regarding the potassium content of sodium-reduced MPPs and encouraged to make food choices accordingly.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mohan S.
        • Campbell N.R.C.
        • Willis K.
        Effective population-wide public health interventions to promote sodium reduction.
        Can Med Assoc J. 2009; 181: 605-609
      1. Henney J.E. Taylor C.L. Boon C.S. NIH Sodium Reduction Strategy: Institute of Medicine (US) Committee on Strategies to Reduce Sodium Intake in the United States. The National Academies Press, Washington, DC2010
        • Sodium Working Group
        Sodium Reduction Strategy Recommendations from the Sodium Working Group.
        Canada: Health Canada, Ottawa, Ontario2010 (Accessed December 7, 2017)
        • Verma A.K.
        • Banerjee R.
        Low-sodium meat products: Retaining salty taste for sweet health.
        Crit Rev Food Sci Nutr. 2012; 52: 72-84
        • Kalantar-Zadeh K.
        • Gutekunst L.
        • Mehrotra R.
        • et al.
        Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.
        Clin J Am Soc Nephrol. 2010; 5: 519-530
        • Murphy-Gutekunst L.
        • Uribarri J.
        Hidden phosphorus-enhanced meats: Part 3.
        J Ren Nutr. 2005; 15: E1-E4
        • Benini O.
        • D’Alessandro C.
        • Gianfaldoni D.
        • Cupisti A.
        Extra-phosphate load from food additives in commonly eaten foods: A real insidious danger for renal patients.
        J Ren Nutr. 2011; 21: 303-308
        • Carrigan A.
        • Klinger A.
        • Choquette S.S.
        • et al.
        Contribution of food additives to sodium and phosphorus content of diets rich in processed foods.
        J Ren Nutr. 2014; 24: 13-19
        • Leon J.B.
        • Sullivan C.M.
        • Sehgal A.R.
        The prevalence of phosphorus-containing food additives in top-selling foods in grocery stores.
        J Ren Nutr. 2013; 23: 265-270
        • Sullivan C.M.
        • Leon J.B.
        • Sehgal A.R.
        Phosphorus-containing food additives and the accuracy of nutrient databases: Implications for renal patients.
        J Ren Nutr. 2007; 17: 350-354
        • Sherman R.A.
        • Mehta D.O.
        Dietary phosphorus restriction in dialysis patients: Potential impact of processed meat, poultry and fish products as protein sources.
        Am J Kidney Dis. 2009; 54: 18-23
        • Bell R.R.
        • Draper H.H.
        • Tzeng D.Y.M.
        • Shin H.K.
        • Schmidt G.R.
        Physiological responses of human adults to foods containing phosphorus additives.
        J Nutr. 1977; 107: 42-50
        • Chang A.R.
        • Lazo M.
        • Appel L.J.
        • Guiterrez O.M.
        • Grams M.E.
        High dietary phosphorus intake is associated with all-cause mortality: Results from NHANES III.
        Am J Clin Nutr. 2014; 99: 320-327
        • Dhingra R.
        • Sullivan L.M.
        • Fox C.S.
        • et al.
        Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community.
        Arch Intern Med. 2007; 167: 879-885
        • Tonelli M.
        • Sacks F.
        • Pfeffer M.
        • Gao Zhiwi
        • Curham G.
        Relation between serum phosphate and cardiovascular event rate in people with coronary disease.
        Circulation. 2005; 112: 2627-2633
        • Dotsch M.
        • Busch J.
        • Batenburg M.
        • et al.
        Strategies to reduce sodium consumption: A food industry perspective.
        Crit Rev Food Sci Nutr. 2009; 49: 841-851
        • Desmond E.
        Reducing salt: A challenge for the meat industry.
        Meat Sci. 2006; 74: 188-196
        • Ruusunen M.
        • Niemisto M.
        • Puolanne E.
        Sodium reduction in cooked meat products by using commercial potassium phosphate mixtures.
        J Agr Food Sci Finland. 2002; 11: 199-207
      2. Health Canada, Bureau of chemical safety. Health Canada’s proposal to enable the use of tripotassium phosphate (potassium phosphate, tribasic), potassium tripolyphosphate, sodium potassium tripolyphosphate, and sodium potassium hexametaphosphate in various standardized and unstandardized foods. http://www.hc-sc.gc.ca/fn-an/consult/nop-adm-0008/document-consultation-eng.php. Published September 11, 2014. Accessed September 21, 2017.

        • Sacks F.M.
        • Svetkey L.P.
        • Vollmer W.M.
        • et al.
        Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet.
        N Engl J Med. 2001; 344: 3-10
        • Salehi-Abargouei A.1
        • Maghsoudi Z.
        • Shirani F.
        • Azadbakht L.
        Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases–incidence: A systematic review and meta-analysis on observational prospective studies.
        Nutrition. 2013; 29: 611-618
        • Doorenbos C.J.
        • Vermeij C.G.
        Danger of salt substitutes that contain potassium in patients with renal failure.
        BMJ. 2003; 326: 35-36
        • John S.
        • Rangan Y.
        • Block C.
        • Koff M.
        Life-threatening hyperkalemia from nutritional supplements: Uncommon or undiagnosed?.
        Am J Emerg Med. 2011; 29: 1237.e1-1237.e2
        • Ray K.K.
        • Dorman S.
        • Watson R.D.S.
        Severe hyperkalemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: A potentially life threatening interaction.
        J Hum Hyperten. 1999; 13: 717-720
      3. NKF: National Kidney Foundation: Sodium and Your CKD Diet: How to Spice Up Your Cooking. https://www.kidney.org/atoz/content/sodiumckd Accessed September 21, 2017.

      4. Food and Drug Administration. Changes to the Nutrition Facts Label. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm. Revised June 19, 2017. Accessed August 16, 2017.

      5. Health Canada. Food Labelling Changes. https://www.canada.ca/en/health-canada/services/food-nutrition/food-labelling/nutrition-labelling/regulations-compliance.html Revised April 25, 2017. Accessed August 16, 2017.

      6. Mintel International. Global Market Navigator Database. [database online]. Chicago, IL: Mintel Group Ltd; 2013.

        • K/DOQI: National Kidney Foundation Kidney Disease Outcomes Quality Initiative
        Clinical practice guidelines for bone metabolism and disease in chronic kidney disease.
        Am J Kidney Dis. 2003; 42: S1-S201
      7. IBM SPSS Statistics for Windows [computer program]. Version 22.0. Armonk, NY: IBM Corp; 2013.

        • Nelms M.N.
        • Sucher K.P.
        • Lacey K.
        • Roth S.L.
        Nutrition Therapy & Pathophysiology.
        2nd ed. Wadsworth Centgage Learning, Belmont, CA2007: 797
        • K/DOQI: National Kidney Foundation Kidney Disease Quality Outcomes Initiative
        Clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Guideline 12: Use of diuretics in CKD.
        Am J Kidney Dis. 2004; 43: S206-S222
        • Allon M.
        • Dansby L.
        • Shanklin N.
        Glucose modulation of the disposal of an acute potassium load in patients with end-stage renal disease.
        Am J Med. 1993; 94: 475-482
        • Fernandez J.
        • Oster J.F.
        • Perez G.O.
        Impaired extrarenal disposal of an acute oral potassium load in patients with end-stage renal disease on chronic hemodialysis.
        Miner Electrolye Metab. 1986; 12: 125-129
        • Sanghavi S.
        • Whiting S.
        • Uribarri J.
        Potassium balance in dialysis patients.
        Semin Dial. 2013; 26: 597-603
        • Noori N.
        • Kalantar-Zadeh K.
        • Kovesdy C.P.
        • et al.
        Dietary potassium intake and mortality in long term hemodialysis patients.
        Am J Kidney Dis. 2010; 56: 338-347
        • Curtis J.C.
        • Niederman S.A.
        • Kansagra S.M.
        Availability of potassium on the nutrition facts panel of US packaged foods.
        JAMA Intern Med. 2013; 173: 828-829
        • Webster J.
        • Trieu K.
        • Dunford E.
        • Hawkes C.
        Target Salt 2025: A global overview of national programs to encourage the food industry to reduce salt in foods.
        Nutrients. 2014; 6: 3274-3287
        • Doyle M.E.
        • Glass K.A.
        Sodium reduction and its effect on food safety, food quality and human health.
        Compr Rev Food Sci Food Saf. 2010; 9: 44-56
        • Uribarri J.
        • Calvo M.S.
        Hidden sources of phosphorus in the typical American diet: Does it matter in nephrology?.
        Semin Dial. 2003; 16: 186-188
        • Sherman R.A.
        • Mehta D.O.
        Phosphorus and potassium content of enhanced meat and poultry products: Implications for patients who receive dialysis.
        Clin J Am Soc Nephrol. 2009; 4: 1370-1373
        • Jaffery J.B.
        • Hood V.L.
        Conflicting dietary advice for adhering to low-sodium and low-phosphorus diet.
        J Ren Nutr. 2006; 16: 332-336
        • Ahuja J.K.
        • Pehrsson P.R.
        • Haytowitz D.B.
        • et al.
        Sodium monitoring in commercially processed and restaurant foods.
        Am J Clin Nutr. 2015; 101: 622-631

      Biography

      A. S. Parpia is a hemodialysis dietitian, Diabetes Comprehensive Care Program, St Michael’s Hospital, Toronto, Ontario, Canada.

      Biography

      M. B. Goldstein is an emeritus professor, University of Toronto, and the medical director of hemodialysis, St Michael’s Hospital, Toronto, Ontario, Canada.

      Biography

      J. Arcand is an assistant professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Toronto, Ontario, Canada.

      Biography

      F. Cho is a technical manager, Scientific Services, Maxxam Analytics, Mississauga, Ontario, Canada.

      Biography

      M. R. L’Abbé is the chair, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

      Biography

      P. B. Darling is an assistant professor, School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.