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

doi:10.1016/j.jand.2017.10.025

Journal of the Academy of Nutrition and Dietetics

Volume 118, Issue 5, May 2018, Pages 878-885

https://doi.org/10.1016/j.jand.2017.10.025 Get rights and content

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.

Section snippets

Materials and Methods

This study utilized a cross-sectional design to examine chemical analysis of sodium, potassium, phosphorus, and protein in MPPs (n=38; n=19 original, n=19 sodium-reduced). Six grocery stores from the three largest grocery store chains in Canada by market share,²⁸ situated near St Michael’s Hospital in Toronto, were scanned for sodium-reduced MPPs in May 2014. An inclusive sample of sodium-reduced MPPs (n=19), each having a corresponding original non-sodium-reduced MPP counterpart (n=19), was

Results

Sodium-reduced MPPs (n=19) contained, on average, 44% more potassium (mg/100 g) than their original non–sodium-reduced counterparts (n=19), with an average difference of 184 mg/100 g (95% CI: 90 to 279; P=0.001) (Table 1). There was 38% less sodium in products that had been sodium reduced compared with original counterparts, with an average difference of 486 mg/100 g (95% CI: 334 to 638; P<0.001). Although the amounts of phosphorus and protein in the original MPPs and sodium-reduced MPPs did

Discussion

This study shows, for the first time to our knowledge, significantly greater amounts of chemically analyzed potassium in sodium-reduced meat and poultry foods, which may substantially contribute to the dietary potassium load. The higher potassium content in sodium- reduced MPPs is due to the increased prevalence of potassium additives, such as potassium chloride, potassium lactate, and potassium phosphate, which manufacturers are likely using as sodium replacements. There is a remarkably wide

Conclusion

In conclusion, potassium additives are frequently added to sodium-reduced MPPs in amounts that may significantly contribute to the potassium load for patients with chronic kidney disease and others with impaired renal excretion of potassium. Patients requiring a potassium restriction should be counseled regarding the potential for increased potassium content of sodium-reduced MPPs and should be encouraged to make food choices accordingly. The results of this study support the inclusion of

Acknowledgements

This study was presented in part at the ASN Kidney Week, Philadelphia, PA, November 11-16, 2014.

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

References (43)

O. Benini et al.
Extra-phosphate load from food additives in commonly eaten foods: A real insidious danger for renal patients
J Ren Nutr
(2011)
C.M. Sullivan et al.
Phosphorus-containing food additives and the accuracy of nutrient databases: Implications for renal patients
J Ren Nutr
(2007)
R.A. Sherman et al.
Dietary phosphorus restriction in dialysis patients: Potential impact of processed meat, poultry and fish products as protein sources
Am J Kidney Dis
(2009)
R.R. Bell et al.
Physiological responses of human adults to foods containing phosphorus additives
J Nutr
(1977)
A.R. Chang et al.
High dietary phosphorus intake is associated with all-cause mortality: Results from NHANES III
Am J Clin Nutr
(2014)
E. Desmond
Reducing salt: A challenge for the meat industry
Meat Sci
(2006)
A.1 Salehi-Abargouei et al.
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)
S. John et al.
Life-threatening hyperkalemia from nutritional supplements: Uncommon or undiagnosed?
Am J Emerg Med
(2011)
M. Allon et al.
Glucose modulation of the disposal of an acute potassium load in patients with end-stage renal disease
Am J Med
(1993)
N. Noori et al.
Dietary potassium intake and mortality in long term hemodialysis patients
Am J Kidney Dis
(2010)

J.B. Jaffery et al.

Conflicting dietary advice for adhering to low-sodium and low-phosphorus diet

J Ren Nutr

(2006)

J.K. Ahuja et al.

Sodium monitoring in commercially processed and restaurant foods

Am J Clin Nutr

(2015)

S. Mohan et al.

Effective population-wide public health interventions to promote sodium reduction

Can Med Assoc J

(2009)

Sodium Reduction Strategy Recommendations from the Sodium Working Group

(2010)

A.K. Verma et al.

Low-sodium meat products: Retaining salty taste for sweet health

Crit Rev Food Sci Nutr

(2012)

K. Kalantar-Zadeh et al.

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease

Clin J Am Soc Nephrol

(2010)

L. Murphy-Gutekunst et al.

Hidden phosphorus-enhanced meats: Part 3

J Ren Nutr

(2005)

A. Carrigan et al.

Contribution of food additives to sodium and phosphorus content of diets rich in processed foods

J Ren Nutr

(2014)

J.B. Leon et al.

The prevalence of phosphorus-containing food additives in top-selling foods in grocery stores

J Ren Nutr

(2013)

R. Dhingra et al.

Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community

Arch Intern Med

(2007)

Cited by (25)

New Insights Into Dietary Approaches to Potassium Management in Chronic Kidney Disease
2023, Journal of Renal Nutrition
Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD.
Association between ultrapocessed food and chronic kidney disease
2021, Nefrologia
Citation Excerpt :
It is calculated that potassium intake would increase 453–674 mg/day if it replaces 20 or 50% of the sodium chloride in the diet.88 Parpia et al.89 find 40% more potassium in meat products in which sodium chloride has been replaced by additives containing potassium. As with phosphoric salts, the percentage of absorbed potassium is much higher in additives.
The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25%–35% of phosphorus, 12%–18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies.
La alimentación moderna está estrechamente vinculada al consumo de alimentos procesados, originando un aumento en la ingesta de sal, azúcares simples, fósforo y potasio añadidos. Este aporte excesivo se asocia a un mayor riesgo de obesidad, diabetes, hipertensión y enfermedad renal crónica (ERC). La ERC, que según datos del estudio ENRICA afecta al 15% de la población, magnifica su repercusión por la mayor prevalencia de diabetes e hipertensión y por las limitaciones en el manejo del sodio y fósforo. La ingesta de estos productos supera ampliamente las recomendaciones establecidas, suponiendo un 72% del sodio total, un 25%–35% del fósforo, un 12%–18% de potasio y más del 10% del aporte calórico en azúcares simples. Son necesarias medidas para disminuir su aporte a través de consejo nutricional, revisión del etiquetado, campañas de educación en hábitos saludables, tasas y actuaciones institucionales que impliquen a las agencias de seguridad alimentaria, industria, distribución y sociedades científicas.
High pressure processing improves the sensory quality of sodium-reduced chicken sausage formulated with three anion types of potassium salt
2021, Food Control
Citation Excerpt :
Potassium (K+) has been viewed as the most similar cation to Na+ when considering its physicochemical properties (Armenteros, Aristoy, Barat, & Toldrá, 2009). In addition to its salt taste, K+ plays a role in blood pressure regulation which makes it an even more desirable ingredient (Parpia et al., 2018). In meat processing, potassium chloride (KCl) is a great candidate as it presents a similar function to NaCl in the extraction of myofibrillar proteins and contributes to maintaining functional properties of meat products, but its use is limited due to KCl-induced bitterness, metallic-taste and off-flavors (Stanley, Bower, & Sullivan, 2017).
Sodium reduction has been recognised by the meat industry as an important driver for consumers. The objective of this study was to investigate the effects of high pressure processing (HPP, 200 MPa, 10 min) on the sensory quality of sodium-reduced chicken sausages formulated with three anion types of potassium salts (K-salts; potassium chloride, potassium lactate and potassium citrate). Partial replacement of 25% sodium chloride (NaCl) with K-salts did not affect the textural properties. Applying HPP before cooking, sausages were more compact and continuous with a uniform gel-matrix than sausages that had not been HPP. HPP contributed to an increased firmness and decreased cook loss of chicken sausages. Colour parameters (L*, a*, b*) were lower in HPP sausages. Moreover, the textural properties and colour were maintained over a 40-day chilled storage period. Sensory evaluation showed that the use of K-salts at the concentrations used in this study had no negative effects on the sensory properties and that HPP improved the texture of sausages. However, HPP treatment in combination with K-lactate or K-citrate reduced the perceived saltiness of the sausages. We conclude that the HPP in combination with K-salts can increase the textural attributes of sodium-reduced chicken sausages. Therefore, the HPP in combination with K-salts might be used as a strategy to reduce NaCl in emulsion-type meat products without compromising consumer preference in textural properties.
Handouts for Low-Potassium Diets Disproportionately Restrict Fruits and Vegetables
2021, Journal of Renal Nutrition
Citation Excerpt :
Parts per million does not easily translate into units (i.e., mg) used for dietary recommendations, making use of these regulations difficult to apply in clinical practice. Evidence from smaller studies has found that when potassium chloride, potassium lactate, and potassium phosphate are used, there are significant increases in potassium content.18,19 For example, Parpia et al.19 described the potassium content of 19 original and 19 low-sodium meat and poultry products.
Several recent publications, including an expert summary on hyperkalemia management, have encouraged plant-based foods for patients with chronic kidney disease (CKD) and highlighted the impact of potassium additives on total potassium intake. The aim of this research brief was to investigate if and/or how current recommendations for low-potassium diet may incorporate these new recommendations.
Using a geographical approach, each province's and territory's government health and renal program (where applicable) website was reviewed for resources on dietary potassium restriction. All handouts/booklets/printable webpages were obtained and reviewed.
Eighteen resources from 6 provincial health agencies in Canada were included. Six additional resources from national agencies were also included, 4 from Canada and 2 from the United States. The 5 most commonly restricted foods were bananas, potatoes, oranges, cantaloupe, and avocados. All resources recommended restriction of fruits and vegetables, 67% recommended restriction of dairy products, 57% recommended restriction of whole grain products, 62% recommended restrictions of plant-based proteins, and 67% mentioned restriction of other foods (such as coffee, tea, and chocolate), 28% mentioned restriction of potassium additives in ultraprocessed foods.
Low-potassium diets primarily restrict fruits and vegetables while the least common restriction is ultraprocessed food. Several recent publics have recommended a greater focus on ultraprocessed versus unprocessed food for hyperkalemia management. These new recommendations differ from current teaching materials that predominately restrict plant-based foods to manage hyperkalemia in CKD. Updates will likely be needed to current resources to reflect new recommendations.
Management of potassium in chronic kidney disease and acute kidney injury
2021, Nutritional Management of Renal Disease, Fourth Edition
People with kidney disease are at increased risk of developing potassium disorders, which can result in serious, sometimes fatal cardiotoxicity. In this chapter, we provide an overview of potassium homeostasis and balance in health and kidney disease and summarize nutrition assessment components and dietary intervention strategies for managing potassium disorders in this population. At the end of the chapter, we present a clinical case study of a patient with hyperkalemia.
The Macronutrient Content of Sodium-Modified Foods Is Unchanged Compared with Regular Counterparts: An Evaluation of Select Categories of Packaged Foods in the United States, 2018
2020, Journal of the Academy of Nutrition and Dietetics
Lowering excess sodium in packaged foods is part of a public health strategy to reduce cardiovascular disease risk. Sales of foods with labeled sodium claims increased during the past decade. Yet, it is unclear whether sugars or fats were added during the reformulation of foods that might counter the benefits of sodium reduction.
It was hypothesized that the nutrient content of packaged foods with lower sodium label claims (ie, sodium-modified) would differ from their regular (ie, unmodified) counterparts.
This cross-sectional study compared label data of 153 sodium-modified foods and 141 regular, matched counterparts within four food categories: soups, processed meats, vegetables, and savory snacks. Foods were identified by searching manufacturer websites of the top-10 brands in each category. Sodium, calories, total carbohydrate, sugar, protein, total fat, saturated fat, and potassium (when reported) were compared by labeled serving and per 100 g food.
The average amount in milligrams of sodium per serving in regular foods ranged from 162 mg for savory snacks to 782 mg for soups. Compared with regular foods, the matched lower sodium foods had significantly less sodium per serving (–95 to –387 mg) and per 100 g (–184 to –462 mg) (P<0.01 for all comparisons), except for soups per 100 g (P = 0.166), and were similar to their regular counterparts in calories, total carbohydrate, sugar, protein, total fat, and saturated fat (P>0.05 for all comparisons). Of the soups that reported potassium on the label, potassium was 244 mg/serving (P=0.004) and 139 mg/100 g (P=0.002) higher among matched lower sodium soups.
The similarity in macronutrient contents on the labels for sodium-modified foods and their regular counterparts suggests that reformulation did not include the addition of significant amounts of sugars, fats, or other macronutrients among major food brands in the selected categories. Potassium content and additional food categories deserve further investigation.

View all citing articles on Scopus

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

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

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

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

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

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

: STATEMENT OF POTENTIAL CONFLICT OF INTEREST F. Cho is an employee at Maxxam Analytics and has no financial interest in this research. No potential conflict of interest was reported by the other authors. The food products were chosen by the principal investigators at the University of Ottawa and Toronto.

: FUNDING/SUPPORT Funding for this research was provided by a research grant from the Canadian Foundation of Dietetic Research.

^∗: RD=accredited practicing dietitian certified in Canada.

View full text

ResearchOriginal Research: BriefSodium-Reduced Meat and Poultry Products Contain a Significant Amount of Potassium from Food Additives

Abstract

Background

Objective

Design

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Conclusion

Acknowledgements

J Ren Nutr

J Ren Nutr

Am J Kidney Dis

J Nutr

Am J Clin Nutr

Meat Sci

Nutrition

Am J Emerg Med

Am J Med

Am J Kidney Dis

J Ren Nutr

Am J Clin Nutr

Effective population-wide public health interventions to promote sodium reduction

Can Med Assoc J

Sodium Reduction Strategy Recommendations from the Sodium Working Group

Low-sodium meat products: Retaining salty taste for sweet health

Crit Rev Food Sci Nutr

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease

Clin J Am Soc Nephrol

Hidden phosphorus-enhanced meats: Part 3

J Ren Nutr

Contribution of food additives to sodium and phosphorus content of diets rich in processed foods

J Ren Nutr

The prevalence of phosphorus-containing food additives in top-selling foods in grocery stores

J Ren Nutr

Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community

Arch Intern Med

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