Docstoc

presentation_nov10_trends_b_w

Document Sample
presentation_nov10_trends_b_w Powered By Docstoc
					                                                                   11/16/2010




      Trends in the Burden of
 Diabetes, High Blood Pressure, and
Cardiovascular Disease in Utah 2010
           MaryCatherine Jones, MPH
                 Epidemiologist
   Heart Disease & Stroke Prevention Program
           Utah Department of Health




                                  Yes, Virginia,
                                  this is a data
                                  presentation!




                                                   Slide 2 of 52




                                                                           1
                                                                                                                    11/16/2010




                                   Diabetes in Utah
                                                         67.3% have
                                                          high blood
                                                           pressure
                   7% smoke                                                          60.7% have
                   cigarettes                                                            high
                                                                                      cholesterol
                                                         Diabetes:
                                                           6.1%
                                                         UT adults
                43% report
                 that their
                   daily                                                             55.2%
                                                                                     55 2% are
                 activities                                                            obese
                                                        58% do not
                are limited                                meet
                                                          physical
                                                          activity
                                                         guidelines

Source: Utah Behavioral Risk Factor Surveillance System, 2009.                                      Slide 3 of 52




                Diabetes Prevalence: Utah
By Age and Sex
          25                                                               23.1
                                                                           23 1

          20                                                                          18.8
                                                                              16.7
                                                                                         15.5
          15                                                     14.4
Percent




                                                                    12.4
                                                                                                    Males
          10                                                                                        Females
                                                 7.0
                                                       5.4
          5                     3.3 3.2
                1.3 1.1
          0
                25-34           35-44           45-54            55-64     65-74       75+

Source: Utah Behavioral Risk Factor Surveillance System, 2009.
                                                                                                    Slide 4 of 52




                                                                                                                            2
                                                                                                                       11/16/2010




               Diabetes Prevalence: Utah
By Ethnicity
12%
                                                                             9.9%                  9.8%
10%

 8%
                    6.6%                        6.3%
 6%

 4%

 2%

 0%
                    Total                    White/NH                 Hispanic/Latino            Other, NH

Source: Utah Behavioral Risk Factor Surveillance System, 2005-2009 combined years.
                                                                                                       Slide 5 of 52




               Diabetes Prevalence: Utah
    By Race
     16%
     14%                                                                                       13.4%

     12%                                                                                                10.7%
     10%
                                                   8.3%
       8%
                   6.3%            6.3%
       6%                                                          4.9%
       4%
       2%
       0%
                   Total          White          African           Asian*            NH/PI**   AI/AN      Other
                                                American *
Source: Utah Behavioral Risk Factor Surveillance System, 2005-2009 combined years. Rate
for NH/PI suppressed due to RSE >0.5. Rates for African American and Asian populations                 Slide 6 of 52
have RSE >0 3 and should be interpreted with caution




                                                                                                                               3
                                                                                                                                    11/16/2010




                                                                                                                    RATE




Source: Utah Behavioral Risk Factor Surveillance System, 2007-2009. Age-adjusted to the 2000 U.S.
Standard Population
                                                                                                                   Slide 7 of 52




   Diabetes and Cardiovascular Disease



                                                                   For each 10 years of
         DM increases the risk of                                 DM, the relative risk of
          CVD by about 2.5x                                       CHD increases by1.5x




   Lloyd Jones D et al (2010). Heart Disease and Stroke Statistics—2010 Update: A Report from the American Heart Association.
   Circulation. 121. CHD refers to coronary heart disease., a subtype of cardiovascular disease.
                                                                                                                    Slide 8 of 52




                                                                                                                                            4
                                                                                                                                  11/16/2010




                 Utah Coronary Heart Disease Deaths,
                            1999-2009
                        140
                                                                                              Decreased by 44% in
                                                                                                         11 years
                        120

                              118.27
                        100
Rate per 100,000 Pop.




                         80


                         60                                                                                            66.34

                         40


                         20


                          0
                              1999     2000   2001   2002   2003   2004    2005      2006       2007      2008         2009


Source: Utah Death Certificate Database, ICD 10 Codes I20-I25, I11. Age-adjusted to the 2000 U.S Standard Population
                                                                                                                  Slide 9 of 52




                                              Utah Stroke Deaths,
                                                 1999-2009
                                                                                              Decreased by 41%
                                                                                                     in 11 years
                        70
                        60
                              61.32
Rat per 100,000 Pop.




                        50
                        40
                        30                                                                                          36.01
  te




                        20
                        10
                         0
                              1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Source: Utah Death Certificate Database, ICD 10 Codes I60-I69. Age-adjusted to the 2000 U.S Standard Population




                                                                                                                                          5
                                                                                                                                                                 11/16/2010




                                                   Age-Adjusted Death Rates With CVD as Underlying Cause
                                                         Per 100,000 Utahns with Diabetes by Gender
                                                               Utah Death Records 2000-2008

                                         120
                                                                                                                                 Males

                                                     94.3
                                                     94 3                                                                        Females
                                         100
                                                                                                                                                  Decreased
                                                                                                                                                  by 25.4%
                      Rate per 100,000




                                             80    88.6
                                                                                                                                                  66.1

                                             60

                                             40                                                                                                 51.5

                                                                                                                                                  Decreased
                                             20                                                                                                   by 45.4%

                                             0
                                                    2000    2001       2002         2003        2004         2005        2006         2007        2008
                                                                                                 Year




                                                           Utah Hospital Discharges
                                                                                  1992-2008
                                                                                                                                           Stroke        CHD
                           70
                           7
                           60
                           50
                                                  54.22
Rate pe 10,000 Pop.




                                                                                                                                                51%  
                           40                                                                                                                   Decrease
                           30
                                                                                                                                             26.59
                           20
      er




                                                  16.83                                                                                      13.69
                           10
                                                                                                                                                 19% 
                                         0                                                                                                       Decrease




                                   Source: Utah Death Certificate Database, ICD 9 Codes 430-434, 436-438 (cerebrovascular disease), 410-414, 429.2 (CHD).
                                   Age-adjusted to the 2000 U.S Standard Population                                                             Slide 12 of 52




                                                                                                                                                                         6
                                                                                                             11/16/2010




                                    CVD Hospital Discharges
                           500
                                                                           456.3
                           450
Ra per 10,000 Population



                           400
                           350
                           300                                                            All Utah
                                                                262.8                     Adults
                           250
                           200                   169.1                  160.2             Utah Adults
                           150                                                            with
                                       78.1                                               Diabetes
 ate




                           100                               72.2
                            50     20.6       32.6
                             0
                                    Women       Men          Women        Men




                                                                                            Slide 13 of 52




                                                The Trends



                               Although
                                                                                 Prevalence
                                 CVD
                                                                                      of
                            mortality has             Prevalence
                                                                                obesity, HBP,
                            declined, DM                of DM
                                                                                  and high
                             continues to             increasing.
                                                                                cholesterol is
                            elevate CVD
                              l t
                                                                                 increasing.
                                  risk.




                                                                                            Slide 14 of 52




                                                                                                                     7
                                                                                                                         11/16/2010




              Diabetes Prevalence: Utah
                                                                                 Increased by 89.2% in years
8%
                                                                                                             7.00%
7%
6%
5%
4%
           3.70%
3%
2%
1%
0%




 Age-adjusted to 2000 U.S. Population. Source: Utah Behavioral Risk Factor Surveillance System
                                                                                                        Slide 15 of 52




                High Blood Pressure: Utah
                                                                              Increased by 22.4% in 14 years
30%

25%
                                                                                                        25.42%
20%
         20.76%

15%

10%

5%

0%
           1995          1997           1999           2001          2003           2005         2007   2009

 Age-adjusted to 2000 U.S. Population. Source: Utah Behavioral Risk Factor Surveillance System




                                                                                                                                 8
                                                                                                                                   11/16/2010




                      High Cholesterol: Utah
30%                                                                              Increased by 57.8% in 18 years

25%
                                                                                                                     25.88%

20%

15%      16.40%

10%

5%

0%
          1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

 Age-adjusted to 2000 U.S. Population. Source: Utah Behavioral Risk Factor Surveillance System
                                                                                                                  Slide 17 of 52




          Overweight or Obesity: Utah
                                                                                     Increased by 51.4% in 20
70%
                                                                                                       years
60%
                                                                                                                      59.50%

50%

40%        39.30%



30%

20%

10%

0%



               Years 1989-2009                                                        Years 1989-2008.

 Age-adjusted to 2000 U.S. Population, adults 18+ only. Source: Utah Behavioral Risk Factor Surveillance System




                                                                                                                                           9
                                                                                                                          11/16/2010




                          Physical Activity: Utah
Recommended Physical Activity                                                             Increased 7.2% in 8 years
60%

                                                                                                          56.6%
50%          52.8%

40%

30%

20%

10%

 0%
                2001                    2003                    2005                    2007            2009


  Age-adjusted to 2000 U.S. Population. Source: Utah Behavioral Risk Factor Surveillance System
                                                                                                         Slide 19 of 52




                   Cigarette Smoking: Utah
                                                                                 Decreased by 41.3% in 19 years
18%
16%
14%    15.50%
12%
10%
8%                                                                                                            9.10%
6%
4%
2%
0%




  Age-adjusted to 2000 U.S. Population. Source: Utah Behavioral Risk Factor Surveillance System




                                                                                                                                 10
                                                                                                                                  11/16/2010




 “A Neglected Disease”

 THE INSTITUTE OF MEDICINE REPORT
 ON HYPERTENSION




                          High Blood Pressure
          Most common                                              Accounts for
          primary care                                                1 in 6
         diagnosis in US                                          US adult deaths

       65% of HBP pts                                                 $73.4B
       do not have HBP                                            direct indirect
                                                                  di t & i di t
        under control                                             costs, est. 2009

Source: IOM (Institute of Medicine). 2010. A Population-Based Policy and Systems Change Approach to Prevent and Control
Hypertension. Washington, DC: The National Academies Press.
                                                                                                                 Slide 22 of 52




                                                                                                                                         11
                                                                                                                                     11/16/2010




                       A “Neglected Disease”
         The health impact and cost of high blood
         pressure is well-documented.
         p


         The risk factors that contribute to HBP are
         highly prevalent.


         Evidence-based interventions to control HBP
         a e we es ab s ed a d e a ve y c eap.
         are well established and relatively cheap.

         We are failing to translate our public health
         and clinical knowledge into effective
         prevention, treatment, and control.
Source: IOM (Institute of Medicine). 2010. A Population-Based Policy and Systems Change Approach to Prevent and Control
Hypertension. Washington, DC: The National Academies Press.
                                                                                                                    Slide 23 of 52




           “Knowing is not enough; we must apply.
             Willing is not enough; we must do.”
                                                      -Goethe




                                                                                                                   Slide 24 of 52




                                                                                                                                            12
                                                                                                                          11/16/2010




                  Inadequate Primary Care
                                                       “Lack of physician adherence
                                                            to     t t      t id li
                                                            t HBP treatment guidelines
                                                            is a major problem and
                                                            significant reason for the lack of
                                                            awareness, lack of
                                                            pharmacological treatment, and
                                                                     yp
                                                            lack of hypertension control in
                                                            the United States.”



Source: IOM (Institute of Medicine). 2010. A Population-Based Policy and Systems Change Approach to Prevent and Control
Hypertension. Washington, DC: The National Academies Press.




                  Inadequate Primary Care
• Physicians are unlikely to
  treat or to intensify
                      y
  treatment for mild to
  moderate systolic HBP
  (<165mmHg) if the DBP
  <90mmHg
• Few physicians encourage
  patients to make lifestyle
  modifications that are
  known to be effective in
  controlling HBP.

Source: IOM (Institute of Medicine). 2010. A Population-Based Policy and Systems Change Approach to Prevent and Control
Hypertension. Washington, DC: The National Academies Press.




                                                                                                                                 13
                                                                                                                                     11/16/2010




              HBP Medication Compliance
                                                      • 50% of patients discontinue
                                                                                year.
                                                        drug treatment after 1 year
                                                      • Noncompliance with HBP meds
                                                        = increased hospital
                                                        admissions.
                                                      • Continuous HBP medications =
                                                        staying on meds costs less than
                                                        hospitalizing patients


Source: IOM (Institute of Medicine). 2010. A Population-Based Policy and Systems Change Approach to Prevent and Control
Hypertension. Washington, DC: The National Academies Press.




              HBP Medication Compliance
                                                                      Income and high out-
             92% of persons with                                        of-pocket costs =
              uncontrolled HBP                                           underuse of HBP
               have insurance.                                             medications



                                        Providers should work
                                       w pa e s o de y
                                       with patients to identify
                                       barriers to medication
                                             adherence.


Source: IOM (Institute of Medicine). 2010. A Population-Based Policy and Systems Change Approach to Prevent and Control
Hypertension. Washington, DC: The National Academies Press.
                                                                                                                    Slide 28 of 52




                                                                                                                                            14
                                                                                                                                     11/16/2010




   A Sentinel Indicator for Disparities
• Nationally, high blood pressure is associated
    ih     i l d h i health disparities.
  with racial and ethnic h l h di     ii
• These disparities occur along the entire
  spectrum from risk factors to the delivery of
  medical care.
• Targeting interventions toward a general
  population historically do not correct these
  inequities and can even worsen them.
Source: IOM (Institute of Medicine). 2010. A Population-Based Policy and Systems Change Approach to Prevent and Control
Hypertension. Washington, DC: The National Academies Press.
                                                                                                                    Slide 29 of 52




    HIGH BLOOD PRESSURE: THE
    BURDEN IN UTAH




                                                                                                                                            15
                                                                                                             11/16/2010




              High Blood Pressure Diagnoses
                                                             2009
           7,000

           6,000

           5,000

           4,000
   Count




           3,000

           2,000

           1,000

              0
                     Age <18            18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
                    Group

Source: Utah All-Payer Database, ICD 9 Codes 401-405
                                                                                            Slide 31 of 52




             High Blood Pressure Prevalence
                                               By Age and Sex, 2009
  70%
                                                                                                60%
  60%                                                                               55%
  50%
                                                                    40%
  40%                                                                       34%
  30%
                                              21%
  20%              14%                                    11%
  10%                           5%
    0%
                   M              F             M            F      M           F   M            F

                       18-34                         35-49              50-64             65+

Source: Utah Behavioral Risk Factor Surveillance Survey




                                                                                                                    16
                                                                                                                                 11/16/2010




          High Blood Pressure Prevalence
               By Education Level, 2009                                             By Income Level, 2009
       35%                     31%                                     35%          33%
                    29%
                     9%                    30%
       30%                                                                                      29%       28%
                                                                       30%
       25%                                            24%
                                                                       25%                                         23%
       20%
       15%                                                             20%
       10%                                                             15%
        5%
                                                                       10%
        0%
                                                                         5%
                                                                         0%




Source: Utah Behavioral Risk Factor Surveillance Survey. Age-adjusted to 2000 U.S. Standard Population.




          High Blood Pressure Prevalence
                                       By Ethnicity, 2005, 2007, 2009
   30%                                                                            27.7%
                                                                                  27 7%

   25%                                              22.4%                                                  23.1%
                       22.2%
   20%

   15%

   10%

     5%

     0%
               Hispanic or Latino White, non-Hispanic Other, non-Hispanic                                 All Utahns

Source: Utah Behavioral Risk Factor Surveillance Survey. Age-adjusted to 2000 U.S. Standard Population.
                                                                                                                Slide 34 of 52




                                                                                                                                        17
                                                                                                                                11/16/2010




          High Blood Pressure Prevalence
                                  By Race, 2003, 2005, 2007, 2009
 40%
                                                 34.6%
 35%
 30%                                                                26.7%
               25.3%            24.2%
 25%                                                                              22.3%                     22.3%
                                                                                                   21.4%
 20%
 15%
 10%
    5%
    0%
             Amer. Ind.          Asian            Black             Pac. Isl.      White            Other      Total

Source: Utah Behavioral Risk Factor Surveillance Survey. Age-adjusted to 2000 U.S. Standard Population.




                                               HBP in Utah
                                                                 2.1X
                                                               diabetes
                                                                 rate
                         15.1%                                                                    54.5% have
                         smoke                                                                        high
                       cigarettes                                                                  cholesterol
                                                               HBP:
                                                               23%
                                                             UT adults
                    33% report
                     that their                                                                   78.6% are
                       daily                                                                      overweight
                     activities                             50% are                                or obese
                    are limited                            not meeting
                                                             physical
                                                             activity
                                                            guidelines

   Source: Utah Behavioral Risk Factor Surveillance System, 2009.                                              Slide 36 of 52




                                                                                                                                       18
                                                                                                                            11/16/2010




     Taking Medication to Control HBP
                                    % Dr. Diagnosed HBP on meds
100%
 90%
 80%
 70%
 60%               54.5%                  52.2%                                          53.3%            54.3%
 50%                                                             44.9%
 40%
 30%
 20%
 10%
  0%
                    2001                   2003                   2005                    2007            2009


Source: Utah Behavioral Risk Factor Surveillance System. Age-adjusted to 2000 U.S. Standard Population.
                                                                                                           Slide 37 of 52




                     HBP in Utah: Conclusions
          Older, lower income, less educated, and racial and ethnic
                   minorities have a higher burden of HBP
                                       g




        HBP patients have a higher prevalence of CVD risk factors
                       than the general population.



           Provider adherence to JNC-7 guidelines, which includes
        lifestyle counseling and medical management of HBP could
                  help to control HBP and other risk factors.

                                                                                                           Slide 38 of 52




                                                                                                                                   19
                                                                                                                   11/16/2010




      THE INSTITUTE OF MEDICINE
      REPORT ON SODIUM 2010
From Centers for Disease and Control (2010). Sodium Reduction Awareness Tool.
                                                                                                              39




 Sodium Reduction: A Public Health Imperative

                                                       • Excess sodium intake is a primary
                                                         risk factor for high blood pressure.
                                                             h d           k l       k
                                                         High sodium intake also makes it
                                                         hard to control high blood pressure.
                                                       • Most of the sodium in our food
                                                         supply is invisible in processed and
                                                         restaurant foods. Consumers have
                                                         little control over the amount of
                                                         sodium in their diet.
                                                       • It can be difficult for even the most
                                                         motivated consumer to reduce
                                                         sodium intake.


   IOM (Institute of Medicine). 2005. Dietary Reference Intakes for Water, Potassium, Sodium Chloride, and 
                                                                                                              40
   Sulfate. Washington, DC: The National Academies Press. 




                                                                                                                          20
                                                                                                                             11/16/2010




                                       Sources of Sodium

                                                                              Food processing
                                                                                   77%



                                                                                          Naturally
                                                                                          occurring
                                                                                            12%



                                                                                         At the table
                                                                                              6%

                                                                                  During cooking
                                                                                       5%




    Mattes RD, Donnelly, D. Relative contributions of dietary‐sodium sources. J Am Coll Nutr. 1991                       4
                                                                                                                         1
    Aug;10(4):383‐93.




                     Sodium Intake Recommendations

• The 2005 Dietary Guidelines
  for Americans recommend
  less than 2,300 mg per day
  for the general population.
       – For specific populations—70
         percent of U.S. adults—limit
         intake to 1,500 mg per day.

• Average daily sodium intake
  for U.S. adults is more than
  3,400 mg per day.
IOM (Institute of Medicine). 2005. Dietary Reference Intakes for Water, Potassium, Sodium Chloride, and Sulfate.
Washington, DC: The National Academies Press. Centers for Disease Control and Prevention. Application of lower sodium
intake recommendations to adults—United States,1999–2006. MMWR. 2009;58(11):281–3. U.S. Department of Agriculture.
What we eat in America. Available from http://www.ars.usda.gov/service/docs.htm?docid=15044                             42




                                                                                                                                    21
                                                                                                                                    11/16/2010




        Estimated Effects on HBP Prevalence
      and Related Costs from Sodium Reduction
 Reducing avg. population sodium
           2 300mg/day
 intake to 2,300mg/day would


           Reduce cases of HBP by 11 million


                     Save $18 billion in health care
                     spending
   Even fewer cases of HBP and more dollars saved if intake was reduced to 1,500
   mg per day (recommended maximum level for “specific populations”).
   Palar K, Sturm R. Potential societal savings from reduced sodium consumption in the U.S. adult population. Am J
   Health Promot. 2009 Sep-Oct;24(1):49-57.                                                                        43




                         What Has Been Done to Reform
                              the Norm Abroad?
       Several countries have taken action on sodium reduction.
       •    Finland: Significant decrease i average population salt i t k
            Fi l d Si ifi t d             in            l ti     lt intake.

       •    United Kingdom: Reduced average sodium intake by 360 mg.

       •    Canada: Sodium Working Group formed in 2007.




From Centers for Disease and Control (2010). Sodium Reduction Awareness Tool. Image from http://www.thediabetesclub.com/the- 44
worst-high-blood-pressure-foods-you-can-eat-2/                                                                     Slide 44 of 52




                                                                                                                                           22
                                                                                                                    11/16/2010




                        International: Product Variability

         Burger King Double Whopper                                              Kellogg’s Special K

                       Sodium per           Sodium per                             Sodium per    Sodium per
                       serving              100 gm                                 serving       100 gm
    Brazil             1,300 mg             349 mg                      Canada     270 mg        931 mg
    Australia          1,153 mg             321 mg                      Mexico     260 mg        867 mg
    US                 1,090 mg             291 mg                      US         220 mg        710 mg
    Germany            1,010 mg             285 mg                      France     200 mg        450 mg
    Canada             980 mg               263 mg                      Italy      200 mg        450 mg
    UK                 875 mg               246 mg                      UK         100 mg        450 mg
    Italy              819 mg               231 mg                      Turkey     200 mg        400 mg




                                                                                                              45
       World Action on Salt and Health.




                        National Salt Reduction Initiative

                                                • New York City DOH launched a nationwide
                                                  effort to reduce the level of salt in processed
                                                                   foods.
                                                  and restaurant foods
                                                    – Includes more than 40 cities, states, and
                                                       public health organizations.
                                                    – Works with food industry representatives
                                                       voluntarily to reduce the salt in their
                                                       products.
                                                • Initial sodium reduction benchmarks have
                                                  been set for 61 categories of packaged
                                                  foods and 25 categories of restaurant foods.

                                                • UDOH is in the process of getting approval to
                                                  join this effort.

From Centers for Disease and Control (2010). Sodium Reduction Awareness Tool.                                  46
                                                                                                   Slide 46 of 52




                                                                                                                           23
                                                                                                                     11/16/2010




                     Potential State and Local Strategies




 Procurement                                                                           Consumer
    policies                   Labeling                 Venue-based                               Letter writing
                                                                                      awareness
(state, local, o          requirements                  approaches                    campaigns    campaigns
rganizational)




 From Centers for Disease and Control (2010). Sodium Reduction Awareness Tool. Image from:
 http://www.weblo.com/asset_image/455928/60232/Morton_Salt/
                                                                                                    Slide 47 of 52




                             Healthier Food Environment =
                                 Healthier Population
        Changing the food environment gives consumers a broader range of healthful foods
                                     from which to choose.



        Policy and environment strategies are effective at the state and local level and help
                                 drive demand for federal action.



             Lowering sodium content of processed and restaurant foods is one of the most
             promising strategies to decrease the prevalence of heart disease and stroke.



                                    Sodium reduction will benefit most Americans.


 From Centers for Disease and Control (2010). Sodium Reduction Awareness Tool.
                                                                                                                48
                                                                                                    Slide 48 of 52




                                                                                                                            24
                                                             11/16/2010




            Counseling Patients
• Educate patients about sodium and high blood
  pressure
   – Foods high in sodium do not necessarily taste
     “salty.”
   – Foods labeled “heart healthy” do not
                                   content.
     necessarily have low sodium content
   – Reading nutritional labels is key to
     identifying high sodium products.

                                            Slide 49 of 52




            Counseling Patients
• Follow up with patients by asking what they are
  doing l         h i di i k
  d i to lower their sodium intake.
• Work with patients to set goals around healthy
  diet and choosing low sodium foods.




                                            Slide 50 of 52




                                                                    25
                                                                                                 11/16/2010




                                       Additional Resources

   • CDC’s Division for Heart Disease and Stroke Prevention
     Salt Web page
     http://www.cdc.gov/salt

   • Institute of Medicine, Strategies to Reduce Sodium in the United
     States http://www.iom.edu/sodiumstrategies
   • Institute of Medicine, A Population-Based Policy and Systems
     Change Approach to Prevent and Control Hypertension
           //             /         /      /A
     http://www.iom.edu/Reports/2010/A-Population-Based-
     Policy-and-Systems-Change-Approach-to-Prevent-and-
     Control-Hypertension.aspx

From Centers for Disease and Control (2010). Sodium Reduction Awareness Tool.
                                                                                            51
                                                                                Slide 51 of 52




      MaryCatherine Jones, MPH
      Heart Disease & Stroke Prevention Program
      Utah Department of Health
      (801) 538-6536
      mcjones@utah.gov

      THANK YOU!




                                                                                                        26

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:0
posted:6/6/2013
language:English
pages:26
About