Wednesday, December 21, 2016

Some children at a higher risk for exposure to neurotoxic compounds


A class of flame retardants known as polybrominated diphenyl ethers (PBDEs) have been phased out of production in the U.S. out of concern for their potential neurotoxic effects, particularly in young children. But the compounds persist in older furniture, plastics and textiles, and in dust. Now a new report in the ACS journal Environmental Science & Technology examines the factors that help predict which children could be at a higher risk for exposure to these compounds.

Studies in animals and humans suggest that PBDEs, which are structurally similar to thyroid hormones, could have neurotoxic effects. As a result, various formulations of the flame retardants were phased out in the U.S. as far back as 2004. But the compounds had been added to products such as sofas that people keep for years. And PBDEs can continue to migrate into household dust from these items. Other studies have found that young children, who often put their hands and toys –and any dust that has settled on these items — in their mouths, tend to have the highest concentrations of PBDEs in their blood. Lyndsey Darrow and colleagues wanted to take a closer look to see whether particular groups of children might be affected more than others.

The researchers tested the blood levels of various PBDEs in 80 children between the ages of 1 and 5, all of whom were born after the U.S. phase-out in 2004 of two types of PBDE commercial formulations. Results showed that lower median income within a neighborhood, lower BMI and smoking in the household corresponded to higher PBDE levels. The researchers note that the socioeconomic disparity in PBDE exposure will likely increase over time as the more economically well-off continue to replace their older products with ones that don’t contain these flame retardants. The team speculates that lower BMI could lead to higher PBDE blood concentrations because the compounds accumulate in fat, which leaner kids have less of. However, it is unclear why smoking affects PBDE exposure.


Reducing antibiotic duration does more harm than good for ear infections in young children


In a landmark trial conducted at Children's Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine, researchers have demonstrated that when treating children between 9 and 23 months of age with antibiotics for ear infections, a shortened course has worse clinical outcomes without reducing the risk of antibiotic resistance or adverse events.

The results of the trial are published today in the New England Journal of Medicine and highlighted by an accompanying commentary.

Acute otitis media is a bacterial infection of the middle ear behind the ear drum which causes it to become painfully inflamed. Three out of four children experience this infection within their first year. Consequently, it is the most common reason why children are prescribed an antibiotic.

"Given significant concerns regarding overuse of antibiotics and increased antibiotic resistance, we conducted this trial to see if reducing the duration of antibiotic treatment would be equally effective along with decreased antibiotic resistance and fewer adverse reactions," said Alejandro Hoberman, M.D., chief, Division of General Academic Pediatrics at Children's, and the Jack L. Paradise Endowed Professor of Pediatric Research at Pitt's School of Medicine.

In the current trial, 520 children with acute otitis media were randomly assigned to either a standard 10-day regimen of the antibiotic amoxicillin-clavulanate or a shortened 5-day treatment followed by five days of placebo. Neither the study participants nor the physicians knew which group the participant was assigned to.

Children were followed starting in October through the rest of the annual respiratory-infection season, and had a final visit during the following September.

They found that the risk of treatment failure in the 5-day group (34 percent) was more than twice as much the risk in the 10-day group (16 percent). The results were significant when considering the trial design which was set up to find out whether the 5-day treatment would be as good as the 10-day regimen, Dr. Hoberman said. Instead, the results clearly showed that not only was their initial assumption proven wrong, but the 10-day treatment was far more effective.

When they tested the presence of antibiotic-resistant bacteria through nasopharyngeal (back of the nose) swabs, there was no decrease in the 5-day group as might have been expected with a shorter duration of antibiotics. Also, reduced-duration antibiotics did not decrease the risk of frequent adverse events like diarrhea or diaper rash.

When testing the risk of a recurrent infection, they found that it was higher when children were exposed to three or more children for 10 or more hours per week, such as in a day care setting, or if the initial infection occurred in both ears as opposed to just one ear.

Importantly, the study also showed for the first time that almost one in two children in whom residual fluid was observed in the middle ear after treatment had a recurring infection, a significantly higher percentage when compared to children without any residual fluid in the middle ear.

The marked superiority of the 10-day regimen over the 5-day regimen led the independent safety monitoring board overseeing the trial to conclude it prematurely as the primary end point was achieved.

"The results of this study clearly show that for treating ear infections in children between 9 and 23 months of age, a 5-day course of antibiotic offers no benefit in terms of adverse events or antibiotic resistance. Though we should be rightly concerned about the emergence of resistance overall for this condition, the benefits of the 10-day regimen greatly outweigh the risks," said Dr. Hoberman.


Physical activity in week after concussion associated with reduced risk of persistent postconcussive


Among children and adolescents who experienced a concussion, physical activity within 7 days of injury compared with no physical activity was associated with reduced risk of persistent postconcussive symptoms at 28 days, according to a study appearing in the December 20 issue of JAMA.

Rest has long been considered the cornerstone of concussion management, and pediatric guidelines universally recommend an initial period of physical rest following a concussion until symptoms have resolved. No clear evidence has determined that avoiding physical activity expedites recovery. Roger Zemek, M.D., of Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada, and colleagues conducted a study that included 3,063 children and adolescents with acute concussion from 9 Pediatric Emergency Research Canada network emergency departments. Physical activity participation and postconcussive symptom severity were rated using standardized questionnaires in the emergency department and at days 7 and 28 postinjury. Persistent postconcussive symptoms (PPCS) were assessed at 28 days postenrollment.

The final study group included 2,413 participants, of whom PPCS at 28 days occurred in 733 (30 percent); 1,677 (70 percent) participated in physical activity within 7 days, primarily with light aerobic exercise. Of the patients who engaged in early physical activity, 31 percent were symptom free and 48 percent had at least 3 persistent or worsening postconcussive symptoms at day 7. Of those reporting engaging in no physical activity at day 7, 80 percent had at least 3 persistent or worsening postconcussive symptoms at day 7. Resumption of physical activity within 7 days postconcussion was associated with a lower risk of PPCS as compared with no physical activity. This finding was consistent across analytic approaches and intensity of exercise.

"Early physical activity could mitigate the undesired effects of physical and mental deconditioning associated with prolonged rest. Regardless of potential benefit, caution in the immediate postinjury period is prudent; participation in activities that might introduce risk for collision (e.g., resumption of contact sports) or falls (e.g., skiing, skating, bicycling) should remain prohibited until clearance by a health professional to reduce the risk for a potentially more serious second concussion during a period of increased vulnerability," the authors write.


   

Young children can choke to death on whole grapes


Very young children can choke to death on whole grapes, warn doctors writing in the Archives of Disease in Childhood.

Foodstuffs account for over half the episodes of fatal choking among the under 5s, with grapes the third most common cause of food related choking after hot dogs and sweets. But public awareness of this potential hazard is not widespread, they say.

They describe three cases of young children, all of whom required emergency treatment after eating whole grapes.

One case involved a 5 year old who started choking while eating whole grapes at an after school club. Prompt and appropriate attempts to dislodge the grape didn't work and the child went into cardiac arrest. The grape was later removed by paramedics, using specialist equipment, but the child died.

In the second case, a 17 month old boy was eating sandwiches and fruit with his family at home, when he choked on a grape. Attempts to try and dislodge it were unsuccessful and the emergency services were called. The grape was eventually removed by a paramedic but the child still died.

The third case involved a 2 year old who was snacking on grapes in the park when he started choking. Again, the grape proved impossible to dislodge, and an ambulance was called. Paramedics were on the scene within a minute and successfully cleared the airway.

The child suffered two seizures before reaching hospital and, on arrival, required emergency treatment to relieve swelling on his brain and to drain a build-up of watery fluid in his lungs. He spent five days in intensive care before making a full recovery.

The airways of young children are small; they don't have a full set of teeth to help them chew properly; their swallow reflex is underdeveloped; and they are easily distracted, all of which puts them at risk of choking, explain the authors.

Grapes tend to be larger than a young child's airway. And unlike small hard objects, such as nuts, the smooth soft surface of a grape enables it to form a tight seal in an airway, not only blocking this completely, but also making it more difficult to remove without specialist equipment, they emphasise.

"There is general awareness of the need to supervise young children when they are eating and to get small solid objects, and some foods such as nuts, promptly out of the mouths of small children; but knowledge of the dangers posed by grapes and other similar foods is not widespread," write the authors.

While there are plenty of warnings on the packaging of small toys about the potential choking hazard they represent, no such warnings are available on foodstuffs, such as grapes and cherry tomatoes, they point out.

As such, they advise that grapes and cherry tomatoes "should be chopped in half and ideally quartered before being given to young children (5 and under)," and emphasise "the importance of adult supervision of small children while they are eating."


Tuesday, December 6, 2016

Kids' restaurant menu items often include excess calories


Most kids' menu items offered by the nation's top 200 restaurant chains exceed the calorie counts recommended by nutrition experts, a new RAND Corporation study has found.

The findings highlight the importance of the upcoming rollout of calorie labeling on most restaurant menus, providing operators with an opportunity to reduce portion sizes so they are more appropriate to meet children's needs, according to researchers.

A panel convened to create guidelines for the calorie content of menus that cater to children's tastes found room for improvement. For example, a la carte items averaged 147 percent more calories than recommended by the expert panel.

The menu item that most often exceeded the calorie guidelines was fried potatoes. The study found that the average calorie count for the popular side dish was 287, nearly triple the recommended amount. McDonald's was the only chain in the study that served fried potatoes in the recommended 100-calorie portions. The findings are published online by the journal Nutrition Today.

"It's important to examine the caloric value of what kids are served because the chances are they will eat all or most of what they are served," said lead author Deborah Cohen, a senior natural scientist at RAND, a nonprofit research organization. "Overeating -- consuming more calories than are needed for normal growth and maintenance -- is a very common problem and a key contributing factor to childhood obesity."

A consensus of 15 child nutrition experts convened for the study recommended a maximum of 300 calories from main dishes for kids' meals. Other recommendations include 100 calories for a serving of fried potatoes, 150 calories for soups, appetizers and snacks, and 150 calories for vegetables and salads that included added sauces. No recommended limit was made for vegetables and fruits that have no added oils or sauces. Kids meals also should include no more than 110 calories of unflavored milk. The entire meal should not exceed 600 calories.

Using the expert guidelines, a burger or a serving of macaroni and cheese should have no more than 300 calories, but the study found that the average calorie content for those items in restaurants was 465 and 442, respectively.

What restaurants offer children is important because they eat out often. According to a study by the federal Centers for Disease Control and Prevention, on any given day 1 of 3 children and 41 percent of teenagers eat at fast-food outlets. The Economic Research Service of the U.S. Department of Agriculture reports that 50 percent of all food dollars are spent on meals away from home.

The study pointed out that appropriate calorie intake is challenging even when restaurants list the calorie counts for each menu item. Many adult consumers ignore or misunderstand the calorie information, and it is "unrealistic to expect that, if served too much, children younger than 12 years will be able to limit what they consume," the study said.

Furthermore, the average customer is ill-equipped to calculate how much of an oversized portion to leave behind or take home unless he or she has "a fluid knowledge of geometry" and brings a measuring cup or other tools, the study noted.

"The public may want to consider how they are at a disadvantage to prevent childhood obesity when so many food outlets serve foods in quantities that put their children at risk," Cohen said. "It is too difficult for children and their parents to limit consumption when they are served too much."

Cohen said the restaurant industry has an opportunity to embrace these calorie guidelines established by child nutrition experts by adjusting kids' menu offerings accordingly in support of promoting children's health and reducing childhood obesity. "Ultimately," she said, "this could mean good business for restaurants."

Wednesday, November 30, 2016

Sedentary lifestyle may impair academic performance in boys


A sedentary lifestyle is linked to poorer reading skills in the first three school years in 6-8 year old boys, according to a new study from Finland. The study conducted at the University of Eastern Finland in collaboration with the University of Jyväskylä and the University of Cambridge was recently published in the Journal of Science and Medicine and Sport.

"Low levels of moderate-to-vigorous physical activity and high levels of sedentary time in Grade 1 were related to better reading skills in Grades 1-3 among boys. We also observed that boys who had a combination of low levels of physical activity and high levels of sedentary time had the poorest reading skills through Grades 1-3," explains Eero Haapala, PhD, from the University of Eastern Finland and the University of Jyväskylä.

The study, constituting part of the Physical Activity and Nutrition in Children Study conducted at the University of Eastern Finland and part of the First Steps Study conducted at the University of Jyväskylä, investigated the longitudinal associations of physical activity and sedentary time with reading and arithmetic skills in 153 children aged 6-8 years old in Grades 1-3 of the primary school. Physical activity and sedentary time were measured objectively using a combined heart rate and movement sensor in Grade 1, and reading and arithmetic skills were assessed by standardised tests in Grades 1-3.

The study showed that high levels of moderate-to-vigorous physical activity, low levels of sedentary time, and particularly their combination in Grade 1 were related to better reading skills in Grades 1-3 in boys. High levels of physical activity and low levels of sedentary time were also associated with better arithmetic skills in Grade 1 only in boys. In girls, there were no strong and consistent associations of physical activity and sedentary time with reading or arithmetic skills.

Promoting physically active lifestyle may kick-start boys' school performance

The results of the study suggest that a combination of low levels of moderate-to-vigorous physical activity and high levels of sedentary time might be particularly harmful for the development of academic skills in boys, and that increasing physical activity, reducing sedentary time, and especially their combination may improve academic achievement.

Monday, November 21, 2016

Early childhood household smoke exposure predicts later delinquency and dropout risk at age 12


Results of a new study led by Professor Linda Pagani of the University of Montreal's School of Psycho-Education show that the more children are exposed to household tobacco smoke in early childhood, the greater their risk of adopting antisocial behavior toward others, engaging in proactive and reactive aggression, having conduct problems at school, and dropping out at age 12.



"Young children have little control over their exposure to household tobacco smoke, which is considered toxic to the brain at a time when its development is exponential," said Pagani.
"The detection of early environmental factors that influence later child well-being represents an important target for individual and community health. Parents who smoke near where their children live and play often inadvertently expose them to second and third hand smoke. It was already known that environmental smoke places children at risk of short- and long-term health problems. However, now for the first time, we have compelling evidence which suggests other dangers to developing brain systems that govern behavioural decisions, social and emotional life, and cognitive functioning," she added. 
Pagani, her graduate student François Lévesque-Seck, and fellow Professors Isabelle Archambault and Michel Janosz, came to their conclusions after examining data from a longitudinal birth cohort of Quebec boys and girls born in 1997 and 1998. The Quebec Longitudinal Study of Child Development is a public database administered and coordinated by the Institut de la statistique du Québec. Every year, parents of 1,035 children from the longitudinal study reported whether anyone smoked at home when their children were aged 1.5 to 7.5 years. At age 12, their children self-reported their antisocial behaviour and academic characteristics. Overall, 60 percent of families reported never being exposed to tobacco smoke, while 27 percent reported intermittent exposure, and 13 percent reported chronic exposure. Pagani's team then analyzed the data to identify whether there was a significant link between early household smoke exposure and later signs of child deviance. This was done while eliminating the influence of numerous confounding factors such as exposure to tobacco smoke, drugs, and alcohol during pregnancy, and other parental and family characteristics that could have explained the observed link between early household smoke and later child deviance.
"Our goal was to eliminate any pre-existing conditions of the children or families that could shed a different light on our results or serve as alternative explanations," said the researcher.
Animal studies have suggested that exposure to tobacco smoke is toxic to the developing brain at a time when it is most vulnerable to environment input. Abnormal brain development can result from chronic or transient exposure to toxic chemicals and gases in second hand tobacco smoke. These compounds eventually solidify and create third hand smoke. Antisocial behavior is characterized by proactive intent to harm others, lack prosocial feelings, and violate social norms. Such behaviors include aggression, criminal offenses, theft, refusal to comply with authority, and destruction of property. In later childhood, antisocial behavior is often associated with academic problems, as highlighted in the study. Deviance and dropout risk are costly to society as a whole.
"These long-term associations should encourage policy-makers and public health professionals to raise awareness among parents about the developmental risks of second hand smoke exposure. In addition, schools could incorporate this knowledge into curricula at all grade levels in an effort to prevent further exposure to neurotoxins," she concluded.


Tuesday, November 15, 2016

Skipping breakfast and not enough sleep can make children overweight


FULL STORY

Mothers smoking in pregnancy, children skipping breakfast and not having a regular bedtime or sufficient sleep all appear to be important factors in predicting whether a child will become overweight or obese, according to new research led by UCL.

All three are early life factors which can be modified and the research highlights the possibility that prompt intervention could have an impact in curbing the growth in childhood overweight and obesity.
The paper, which was published in US journal Pediatrics, is the first research in the UK to look at the patterns of body mass index (BMI) weight development in the first 10 years of a child's life and to examine the lifestyle factors that appear to predict weight gain.

Being overweight or obese is linked to a child having poorer mental health, which can extend into adolescence and adulthood. This poorer psychosocial well-being includes low self-esteem, unhappiness as well as risky behaviours such as cigarette smoking and alcohol consumption.

The research is based on the Millennium Cohort Study, a study of children born into 19,244 families in the UK between September 2000 and January 2002. Data on weight and height was collected when the children were 3, 5, 7 and 11.

This research used observational information which does not allow firm cause and effect conclusions to be drawn. However the results are based on data from thousands of children and the researchers were able to take account of many of the influences on the development of a child's weight.

"It is well known that children of overweight or obese mothers are more likely to be overweight themselves, probably reflecting the 'obesogenic' environment and perhaps a genetic predisposition to gain weight," said Professor Yvonne Kelly (UCL Epidemiology and Public Health), who led the research.

"This study shows that disrupted routines, exemplified by irregular sleeping patterns and skipping breakfast, could influence weight gain through increased appetite and the consumption of energy-dense foods. These findings support the need for intervention strategies aimed at multiple spheres of influence on BMI growth."

Smoking in pregnancy has been linked to a higher risk of a child being overweight, possibly due to a link between fetal tobacco exposure and infant motor co-ordination which could be a developmental pathway to BMI growth.

The study identified four patterns of weight development. The large majority of children, 83.3%, had a stable non-overweight BMI, while 13.1% had moderate increasing BMIs while 2.5% had steeply increasing BMIs. The smallest group, 0.6%, had BMIs in the obese range at the age of 3 but were similar to the stable group by the age of 7.

Girls were more likely to be in the "moderately increasing" group while Pakistani, Black Caribbean and Black African children were more likely to belong to the "high increasing" group.

The research also looked at other factors to see what influence, if any, they had on children's weight.
After taking account of background factors, breastfeeding and the early introduction of solid food were not associated with children's weight. Likewise, sugary drink consumption, fruit intake, TV viewing and sports participation were not strong predictors of unhealthy weight gain.


Friday, November 4, 2016

Music therapy reduces depression in children and adolescents


Researchers at Bournemouth University and Queen's University Belfast have discovered that music therapy reduces depression in children and adolescents with behavioural and emotional problems.

In partnership with Every Day Harmony (the brand name for Northern Ireland Music Therapy Trust), the researchers found that children and young people, aged 8 -- 16 years old, who received music therapy had significantly improved self-esteem and significantly reduced depression compared with those who received treatment without music therapy.

The study, which was funded by the Big Lottery Fund, also found that young people aged 13 and over who received music therapy had improved communicative and interactive skills, compared to those who received usual care options alone. Music therapy also improved social functioning over time in all age groups.

In the largest ever study of its kind, 251 children and young people were involved in the study which took place between March 2011 and May 2014. They were divided into two groups -- 128 underwent the usual care options, while 123 were assigned to music therapy in addition to usual care. All were being treated for emotional, developmental or behavioural problems.

Professor Sam Porter of the Department of Social Sciences and Social Work at Bournemouth University, who led the study, said: "This study is hugely significant in terms of determining effective treatments for children and young people with behavioural problems and mental health needs. The findings contained in our report should be considered by healthcare providers and commissioners when making decisions about the sort of care for young people that they wish to support."

Dr Valerie Holmes, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast and co-researcher, added: "This is the largest study ever to be carried out looking at music therapy's ability to help this very vulnerable group."

Ciara Reilly, Chief Executive of Every Day Harmony, the music therapy charity that was a partner in the research, said: "Music therapy has often been used with children and young people with particular mental health needs, but this is the first time its effectiveness has been shown by a definitive randomised controlled trail in a clinical setting. The findings are dramatic and underscore the need for music therapy to be made available as a mainstream treatment option. For a long time we have relied on anecdotal evidence and small-scale research findings about how well music therapy works. Now we have robust clinical evidence to show its beneficial effects. I would like to record my gratefulness to the Big Lottery Fund for its vision in providing the resources for this research to be carried out."

The research team will now look at the data to establish how cost-effective music therapy is in relation to other treatments.



Kids consume too much salt


Cardiovascular disease, including heart disease and stroke, kills more than 800,000 Americans each year. We know that too much salt may contribute to high blood pressure and increased cardiovascular risk. According to a new study in the Journal of the Academy of Nutrition and Dietetics, American children are consuming sodium at levels that far exceed the daily recommended limit. Taste preferences for high sodium foods, formed as children, follow individuals into adulthood and put them at increased risk for developing cardiovascular problems later in life.

"Sodium reduction is considered a key public health strategy to reduce the risk of cardiovascular diseases nationwide and this study is the latest in ongoing CDC efforts to monitor U.S. sodium intake," explained lead author Zerleen S. Quader, MPH, a data analyst with the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention. "We already know that nearly all Americans regardless of age, race, and gender consume more sodium than is recommended for a healthy diet and the excess intake is of great concern among particular youths."

Using data from the 2011-2012 National Health and Nutrition Examination Survey (NHANES), CDC researchers looked at the eating habits of 2,142 children between the ages of 6 and 18 years. They found that the average sodium intake for kids was 3,256 milligrams per day, not including any salt added at the table. The recommended intake for children varies from 1,900 mg/day to 2,300 mg/day depending on age. Nearly 90% of the children surveyed exceeded the upper level of sodium recommended for their age group and previous evidence suggests that one in nine children ages 8-17 years already has blood pressure above the normal range for their age, sex, and height, which increases their risk of high blood pressure as adults.

The study also found that high levels of sodium were being consumed throughout the day and from a variety of different sources. For example, they found 39% of sodium was consumed at dinner, 31% came from lunch, 16% from snacks, and 14% at breakfast. Researchers discovered that only 10 types of food made up almost 50% of kids' sodium intake. These included pizza, Mexican mixed dishes, sandwiches (including burgers), breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry.

Looking at where sodium-laden foods were purchased, researchers found that foods from the grocery store accounted for a substantial 58% of daily sodium intake, while fast-food/pizza contributed 16%, and the school cafeteria 10%. "With the exception of plain milk, which naturally contains sodium, the top ten food categories contributing to U.S. school children's sodium intake in 2011-2012 comprised foods in which sodium is added during processing or preparation," said Quader. "Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the U.S. food supply."

While sodium intake exceeded daily recommended levels across the board, the study found that average levels were even higher for teens ages 14-18 years (3,565 mg/day vs. 3,256 mg/day for all ages) and that girls had significantly lower daily intake than boys (2,919 mg/day for girls vs. 3,584 mg/day for boys); however, no significant differences in mean sodium intake were observed by race/ethnic group, household income, or child weight status.

This new study illustrates why identifying targets for sodium intervention can be tricky, since salt is ubiquitous in children's diets. It's also hard to pinpoint problem foods, since the sodium content of dishes can vary significantly according to how they are made and prepared. "It's surprising how much sodium content for the same food type can vary by product," described Quader. "The best way to reduce sodium intake from these products is to check the Nutrition Facts panel on packages and look for no-salt-added or lower-sodium versions."

The investigators have identified some important tips for parents and caregivers looking to help cut down sodium in kids' diets:

· Feed your children a diet rich in fresh fruits and vegetables without added sodium or sauces.

· Read nutrition labels. When shopping at the grocery store, look for the lowest sodium options for your child's favorite foods. An easy way to assess sodium in a food is to focus on the amount of sodium per serving. Those foods with less than 140 mg per serving are considered low in sodium.

· Request nutritional information at restaurants to find healthier options. Speak with your local grocer about stocking lower-sodium versions of foods.

While more attention is being paid to fostering good food habits early, salt could prove to be a challenging opponent. Researchers hope that this study can serve as a benchmark as more measures are put into place to reduce the amount of sodium kids consume. "The results support the need to reduce sodium content across the U.S. food supply rather than in a single type of food or venue," concluded Quader. "These data provide baseline information on sources of sodium intake among U.S. school-aged children that can be used to monitor changes in the food supply over time."

For more information on the role sodium plays in heart health, please visit http://www.cdc.gov/salt. For heart-healthy, low-sodium recipes and other eating tips, visit the Million Hearts Healthy Eating and Lifestyle Resource Center at http://www.recipes.millionhearts.hhs.gov.