Sodium content of popular commercially processed and restaurant foods in the United States

Knowledge, attitudes, and practices related to dietary salt among older adults in Abha, Saudi Arabia

The need to foster successful aging has intensified with the aging of the global population. This study aimed to assess the knowledge, attitudes, and practices (KAP) concerning dietary salt consumption and to investigate the correlations between sociodemographic variables and salt-related KAP. A structured interview was administered to a cohort of 200 older adults in Abha City, Saudi Arabia, recruited through a convenience sampling approach. The evaluation of salt-related KAP revealed widespread low knowledge (91.5%) as participants scored less than 3, negative attitudes (85.5%) scored less than 12, and predominantly unsatisfactory practices (69.5%) with scores less than 26. Noteworthy differences emerged between participants with poor overall KAP (81.5%) and those with good KAP (18.5%). Significantly weak negative correlations were found between age (r=-0.212), marital status (-0.236), and body mass index (-0.243) with overall KAP. Further examination revealed a significantly weak positive correlation between attitude and practice (r = 0.141). KAP scores show a highly significant positive correlation with overall KAP scores (r = 0.169, 0.352, 0.969). The uncovered correlations contribute to a valuable understanding of the complex dynamics surrounding salt-related KAP. This understanding guides the design of targeted interventions, such as health education programs, promoting successful aging and public health outcomes.

Perspective: Human Milk Composition and Related Data for National Health and Nutrition Monitoring and Related Research

National health and nutrition monitoring is an important federal effort in the United States and Canada, and the basis for many of their nutrition and health policies. Understanding of child exposures through human milk (HM) remains out of reach due to lack of current and representative data on HM's composition and intake volume. This article provides an overview of the current national health and nutrition monitoring activities for HM-fed children, HM composition (HMC) and volume data used for exposure assessment, categories of potential measures in HM, and associated variability factors. In this Perspective, we advocate for a framework for collection and reporting of HMC data for national health and nutrition monitoring and programmatic needs, including a shared vision for a publicly available Human Milk Composition Data Repository (HMCD-R) to include essential metadata associated with HMC. HMCD-R can provide a central, integrated platform for researchers and public health officials for compiling, evaluating, and sharing HMC data. The compiled compositional and metadata in HMCD-R would provide pertinent measures of central tendency and variability and allow use of modeling techniques to approximate compositional profiles for subgroups, providing more accurate exposure assessments for purposes of monitoring and surveillance. HMC and related metadata could facilitate understanding the complexity and variability of HM composition, provide crucial data for assessment of infant and maternal nutritional needs, and inform public health policies, food and nutrition programs, and clinical practice guidelines.

Evaluation of the Mexican warning label nutrient profile on food products marketed in Mexico in 2016 and 2017: A cross-sectional analysis

BACKGROUND

Different nutrient profiles (NPs) have been developed in Latin America to assess the nutritional quality of packaged food products. Recently, the Mexican NP was developed as part of the new warning label regulation implemented in 2020, considering 5 warning octagons (calories, sugar, sodium, saturated fats, and trans fats) and 2 warning rectangles (caffeine and non-nutritive sweeteners). The objective of this cross-sectional study was to evaluate the Mexican NP and other NPs proposed or used in Latin America against the Pan American Health Organization (PAHO) model.

METHODS AND FINDINGS

Nutrition content data of 38,872 packaged food products available in the Mexican market were collected in 2016 and 2017. The evaluation of the Mexican NP, including its 3 implementation phases of increasing stringency (2020, 2023, and 2025), was conducted by comparing the percentage of products classified as "healthy" (without warnings) or "less healthy" (with 1 or more warnings), as well as the number and type of warnings assigned to food products, against the PAHO NP. Using the calibration method, we compared the classifications produced by the PAHO model against those produced by the NP models of Ecuador, Chile (3 phases), Peru (2 phases), Uruguay, and Brazil. Kappa coefficients and Pearson correlations were estimated, and proportion tests were performed. We found that the 3 implementation phases of the Mexican NP had near to perfect agreement in the classification of healthy foods (Mexico NP models: 19.1% to 23.8%; PAHO model: 19.7%) and a strong correlation (>91.9%) with the PAHO model. Other NPs with high agreement with the PAHO model were the Ecuador (89.8%), Uruguay (82.5%), Chile Phase 3 (82.3%), and Peru Phase 2 (84.2%) NPs. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models had the highest percentage of foods classified as healthy (49.2%, 47.1%, and 46.5%, respectively) and the lowest agreement with the PAHO model (69.9%, 69.3%, and 73%, respectively). Study limitations include that warnings considered by the Mexican NP models were evaluated as if all the warnings were octagon seals, while 2 out of the 7 were rectangular warnings (caffeine and non-nutritive sweeteners), and that our data are limited by the quality of the information reported in the list of ingredients and the nutrition facts table of the products.

CONCLUSIONS

The 3 implementation phases of the Mexican NP were useful to identify healthy food products. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models may have limited usefulness for the classification of foods according to the content of ingredients of concern. The results of this study may inform countries seeking to adapt and evaluate existing NP models for use in population-specific applications.

Salt intake and gastric cancer: a pooled analysis within the Stomach cancer Pooling (StoP) Project

PURPOSE

Previous studies show that consuming foods preserved by salting increases the risk of gastric cancer, while results on the association between total salt or added salt and gastric cancer are less consistent and vary with the exposure considered. This study aimed to quantify the association between dietary salt exposure and gastric cancer, using an individual participant data meta-analysis of studies participating in the Stomach cancer Pooling (StoP) Project.

METHODS

Data from 25 studies (10,283 cases and 24,643 controls) from the StoP Project with information on salt taste preference (tasteless, normal, salty), use of table salt (never, sometimes, always), total sodium intake (tertiles of grams/day), and high-salt and salt-preserved foods intake (tertiles of grams/day) were used. A two-stage approach based on random-effects models was used to pool study-specific adjusted (sex, age, and gastric cancer risk factors) odds ratios (aORs), and the corresponding 95% confidence intervals (95% CI).

RESULTS

Gastric cancer risk was higher for salty taste preference (aOR 1.59, 95% CI 1.25-2.03), always using table salt (aOR 1.33, 95% CI 1.16-1.54), and for the highest tertile of high-salt and salt-preserved foods intake (aOR 1.24, 95% CI 1.01-1.51) vs. the lowest tertile. No significant association was observed for the highest vs. the lowest tertile of total sodium intake (aOR 1.08, 95% CI 0.82-1.43). The results obtained were consistent across anatomic sites, strata of Helicobacter pylori infection, and sociodemographic, lifestyle and study characteristics.

CONCLUSION

Salty taste preference, always using table salt, and a greater high-salt and salt-preserved foods intake increased the risk of gastric cancer, though the association was less robust with total sodium intake.

Sodium content of restaurant dishes in China: a cross-sectional survey

Background

Sodium intake in China is extremely high and eating in restaurants is increasingly popular. Little research has explored the sodium level of restaurant dishes. The present study aims to assess the content and sources of sodium in Chinese restaurants.

Methods

Cross-sectional data were obtained from the baseline survey of the Restaurant-based Intervention Study (RIS) in 2019. A total of 8131 best-selling restaurant dishes with detailed recipes from 192 restaurants in China were included. Sodium content per 100 g and per serving were calculated according to the Chinese Food Composition Table. The proportion of restaurant dishes exceeding the daily sodium reference intake level in a single serving and the major sources of sodium were determined.

Results

Median sodium content in restaurant dishes were 487.3 mg per 100 g, 3.4 mg per kcal, and 2543.7 mg per serving. For a single serving, 74.9% of the dishes exceeded the Chinese adults’ daily adequate intake for sodium (AI, 1500 mg per day), and 62.6% of dishes exceeded the proposed intake for preventing non-communicable chronic diseases (PI, 2000 mg per day). Cooking salt was the leading source of sodium in Chinese restaurant dishes (45.8%), followed by monosodium glutamate (17.5%), food ingredients (17.1%), soy sauce (9.4%), and other condiments/seasonings (10.2%). More types of salted condiments/seasonings use were related to higher sodium level.

Conclusions

The sodium levels in Chinese restaurant dishes are extremely high and variable. In addition to cooking salt, other salted condiments/seasonings also contribute a large proportion of sodium. Coordinated sodium reduction initiatives targeting the main sources of sodium in restaurant dishes are urgently needed.

Validation of an automated self-administered 24-hour dietary recall web application against urinary recovery biomarkers in a sample of French-speaking adults of the province of Québec, Canada

The objective of this study was to validate an automated self-administered 24-hour dietary recall web application (R24W) against recovery biomarkers for sodium, potassium and protein intakes and to identify individual characteristics associated with misreporting in a sample of 61 men and 69 women aged 20-65 years from Québec City, Canada. Each participant completed 3 dietary recalls using the R24W, provided two 24-hour urinary samples and completed questionnaires to document psychosocial factors. Mean reported intakes were 2.2%, 2.1% and 5.0% lower than the urinary reference values, respectively, for sodium, potassium and proteins (significant difference for proteins only (p = 0.04)). Deattenuated correlations between the self-reported intake and biomarkers were significant for sodium (r = 0.48), potassium (r = 0.56) and proteins (r = 0.68). Cross-classification showed that 39.7% (sodium), 42.9% (potassium) and 42.1% (proteins) of participants were ranked into the same quartile with both methods and only 4.8% (sodium), 3.2% (potassium) and 0.8% (proteins) were ranked in opposite quartiles. Lower body esteem related to appearance was associated with sodium underreporting in women (r = 0.33, p = 0.006). No other individual factor was found to be associated with misreporting. These results suggest that the R24W has a good validity for the assessment of sodium, potassium and protein intakes in a sample of French-speaking adults. Novelty: The validity of an automated self-administered 24-hour dietary recall web application named the R24W was tested using urinary biomarkers. According to 7 criteria, the R24W was found to have a good validity to assess self-reported intakes of sodium, potassium and proteins.

Strategic Sodium Reduction Initiative Reduces Sodium in Meals Served at Older Adult Congregate Meal Program Sites

Excessive sodium consumption is a public health issue and congregate meal programs provide a unique opportunity to reduce sodium served to a large, at-risk population. A Sodium Reduction Initiative (SRI) was implemented in a congregate meal program that serves over 3,000 older adults. Nutrient analyses conducted at baseline and post-intervention were used to calculate average sodium reduction and the number of low sodium foods; targeted foods were categorized by strategy. Customer satisfaction surveys were collected at baseline and 3- and 6-months post-intervention. Kruskal Wallis and analysis of variance were used to compare sodium reduction differences. Chi-square analysis determined associations among strategies. The SRI impacted 55 foods, low sodium foods increased by 22%, and the average sodium per menu cycle was reduced by 21%. Replacement with a lower sodium food was the most frequently used strategy and had the largest sodium reduction. Sauces and main entrees were most frequently impacted, and thirteen ingredients accounted for 75% of all reduced-sodium foods. Over 50% of the 1,424 survey respondents consumed the reduced-sodium foods and food satisfaction remained stable from baseline to post-intervention. Congregate meals programs that target commonly used foods and key ingredients can significantly reduce sodium served to older adults.

Systematic Review on International Salt Reduction Policy in Restaurants

As the catering sector has increasingly contributed to population-level salt intake, many countries have begun developing salt-reduction strategies for restaurants. This paper aims to provide an overview of global salt reduction policies in restaurants. Scientific papers and website materials were systematically searched from Web of Science, Science Direct, and PubMed, as well as official websites of government departments and organizations. A total of 78 full-text papers and grey literature works were included. From 58 countries and regions, 62 independent policies were identified, 27 of which were mandatory (3 with fines). The most common strategy was menu labeling, which was a component of 40 policies. Target setting (n = 23) and reformulation (n = 13) of dishes were also widely implemented. Other salt-reduction strategies included education campaign, chef training, toolkits delivery, table salt removal, media campaign, and government assistance such as free nutrition analysis and toolkits distribution. Most policies focused on chain restaurants. Evaluations of these policies were limited and showed inconsistent results, and more time is needed to demonstrate the clear long-term effects. Attention has been paid to salt reduction in restaurants around the world but is still at its early stage. The feasibility and effectiveness of the strategies need to be further explored.

Restaurant interventions for salt reduction in China: protocol for a randomised controlled trial

INTRODUCTION

Salt intake in China is high, and most of it comes from that added by consumers. Nevertheless, recent years have seen a rapid increase in the frequency at which people eat out. The aim of this study is to evaluate the effectiveness of interventions designed for salt reduction in restaurants through a randomised controlled trial in China.

METHODS AND ANALYSIS

As a randomised controlled trial with restaurants as study subjects, we recruited 192 restaurants from 12 counties of 6 provinces in China. After the baseline survey, restaurants were randomly assigned to intervention or control group. Using social cognitive theory, comprehensive intervention activities were designed to encourage salt reduction in all restaurant foods, and at the same time, to encourage consumers to choose lower salt options when eating out. The interventions will be conducted only in restaurants of the intervention group during the first year. The follow-up assessment will be conducted at the end of the trial. The primary outcome is the change in the average salt content of the five best-selling dishes of the restaurant, as measured by laboratory tests. Secondary outcomes include differences in the monthly use of salt and salty condiments between intervention and control restaurants, and the knowledge, attitude and practice on salt among restaurant consumers.

ETHICS AND DISSEMINATION

The study was reviewed and approved by the Review Board of the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention and Queen Mary Research Ethics Committee. Results will be disseminated through presentations, publications and social media.

TRIAL REGISTRATION NUMBER

ChiCTR1800019694; Pre-results.

Policy Progress in Reducing Sodium in the American Diet, 2010–2019

Most Americans consume dietary sodium exceeding age-specific government-recommended targets of 1,500–2,300 mg/day per person. The majority (71%) of US dietary sodium comes from restaurant and packaged foods. Excess sodium intake contributes to hypertension and cardiovascular disease, which is the leading cause of death in the United States. This review summarizes evidence for policy progress to reduce sodium in the US food supply and the American diet. We provide a historical overview of US sodium-reduction policy (1969–2010), then examine progress toward implementing the 2010 National Academy of Medicine (NAM) sodium report's recommendations (2010–2019). Results suggest that the US Food and Drug Administration made no progress in setting mandatory sodium-reduction standards, industry made some progress in meeting voluntary targets, and other stakeholders made some progress on sodium-reduction actions. Insights from countries that have significantly reduced population sodium intake offer strategies to accelerate US progress toward implementing the NAM sodium-reduction recommendations in the future.

Progress Evaluation for Transnational Restaurant Chains to Reformulate Products and Standardize Portions to Meet Healthy Dietary Guidelines and Reduce Obesity and Non-Communicable Disease Risks, 2000-2018: A Scoping and Systematic Review to Inform Policy

Transnational restaurant chains sell food and beverage products in 75 to 139 countries worldwide linked to obesity and non-communicable diseases (NCDs). This study examined whether transnational restaurant chains reformulated products and standardized portions aligned with healthy dietary guidelines and criteria. Firstly, we describe the transnational restaurant industry structure and eating trends. Secondly, we summarize results from a scoping review of healthy dietary guidelines for restaurants. Thirdly, we describe a systematic review of five electronic databases (2000-2018) to identify studies on nutrient profile and portion size changes made by transnational restaurants over 18 years. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, identified 179 records, and included 50 studies conducted in 30 countries across six regions. The scoping review found a few expert-recommended targets for restaurants to improve offerings, but no internationally accepted standard for portions or serving sizes. The systematic review results showed no standardized assessment methods or metrics to evaluate transnational chain restaurants' practices to improve menu offerings. There was wide variation within and across countries, regions, firms, and chains to reduce energy, saturated and trans fats, sodium, and standardized portions. These results may inform future research and encourage transnational chain restaurants to offer healthy product profiles and standardized portions to reduce obesity and NCD risks worldwide.

Assessing Changes in Sodium Content of Selected Popular Commercially Processed and Restaurant Foods: Results from the USDA: CDC Sentinel Foods Surveillance Program

This report provides an update from the U.S. Department of Agriculture - Centers for Disease Control and Prevention Sentinel Foods Surveillance Program, exploring changes in sodium and related nutrients (energy, potassium, total and saturated fat, and total sugar) in popular, sodium-contributing, commercially processed and restaurant foods with added sodium. In 2010-2013, we obtained 3432 samples nationwide and chemically analyzed 1654 composites plus label information for 125 foods, to determine baseline laboratory and label sodium concentrations, respectively. In 2014-2017, we re-sampled and chemically analyzed 43 of the Sentinel Foods (1181 samples), tested for significant changes of at least ±10% (p < 0.05), in addition to tracking changes in labels for 108 Sentinel Foods. Our results show that the label sodium levels of a majority of the Sentinel Foods had not changed since baseline (~1/3rd of the products reported changes, with twice as many reductions as increases). Laboratory analyses of the 43 Sentinel Foods show that eight foods had significant changes (p < 0.05); sodium content continues to be high and variable, and there was no consistent pattern of changes in related nutrients. Comparisons of changes in labels and laboratory sodium shows consistency for 60% of the products, i.e., similar changes (or no changes) in laboratory and label sodium content. The data from this monitoring program may help public health officials to develop strategies to reduce and monitor sodium trends in the food supply.

Comparison of Label and Laboratory Sodium Values in Popular Sodium-Contributing Foods in the United States

BACKGROUND

Nutrition labels are important tools for consumers and for supporting public health strategies. Recent, published comparison of label and laboratory sodium values for US foods, and differences by brand type (national or private-label) or source (store or restaurant [fast-food and sit-down]) is unavailable.

OBJECTIVE

The objective was to compare label and laboratory values for sodium and related nutrients (ie, total sugars, total fat, and saturated fat) in popular, sodium-contributing foods, and examine whether there are differences by brand type, and source.

DESIGN

During 2010 to 2014, the Nutrient Data Laboratory of the US Department of Agriculture collected 3,432 samples nationwide of 125 foods, combined one or more samples of the same food (henceforth referred to as composites), and chemically analyzed them. For this comparative post hoc analysis, the Nutrient Data Laboratory linked laboratory values for 1,390 composites (consisting of one or more samples of the same food) of 114 foods to corresponding label or website (restaurant) nutrient values.

MAIN OUTCOME MEASURES

Label and laboratory values and their ratio for each composite, for each of the four nutrients (sodium, total fat, total sugars, and saturated fat).

STATISTICAL ANALYSES PERFORMED

Nutrient Data Laboratory analysis determined the ratio of laboratory to label value for each composite, and categorized them into six groups: ≥141%, 121% to 140%, 101% to 120%, 81% to 100%, 61% to 80%, and ≤60%. For sodium, the Nutrient Data Laboratory analysis determined the distribution of the ratios by food, food category, brand type, and source.

RESULTS

For sodium, 5% of the composites had ratios of laboratory to label values >120% and 14% had ratios ≤80%. Twenty-two percent of private-label brand composites had ratios ≤80%, compared with 12% of national brands. Only 3% of store composites had ratios >120% compared with 11% of restaurant composites. Ratios ≤80% were more prevalent among sit-down restaurants (37%) compared with fast-food restaurants (9%).

CONCLUSIONS

This study shows that a majority of label and laboratory values sampled agree and underdeclaration of label values is limited. However, there is some disagreement. Periodic monitoring of the nutrient content of foods through laboratory analyses establishes validity of the food labels and helps identify foods and food categories where the label and laboratory values do not compare well, and hence may need laboratory analyses to support accuracy of food composition data.

Differences in nutrient and energy contents of commonly consumed dishes prepared in restaurants v. at home in Hunan Province, China

OBJECTIVE

Eating away from home is associated with poor diet quality, in part due to less healthy food choices and larger portions. However, few studies account for the potential additional contribution of differences in food composition between restaurant- and home-prepared dishes. The present study aimed to investigate differences in nutrients of dishes prepared in restaurants v. at home.

DESIGN

Eight commonly consumed dishes were collected in twenty of each of the following types of locations: small and large restaurants, and urban and rural households. In addition, two fast-food items were collected from ten KFC, McDonald's and food stalls. Five samples per dish were randomly pooled from every location. Nutrients were analysed and energy was calculated in composite samples. Differences in nutrients of dishes by preparation location were determined.

SETTING

Hunan Province, China.

SUBJECTS

Na, K, protein, total fat, fatty acids, carbohydrate and energy in dishes.

RESULTS

On average, both the absolute and relative fat contents, SFA and Na:K ratio were higher in dishes prepared in restaurants than households (P < 0·05). Protein was 15 % higher in animal food-based dishes prepared in households than restaurants (P<0·05). Quantile regression models found that, at the 90th quantile, restaurant preparation was consistently negatively associated with protein and positively associated with the percentage of energy from fat in all dishes. Moreover, restaurant preparation also positively influenced the SFA content in dishes, except at the highest quantiles.

CONCLUSIONS

These findings suggest that compared with home preparation, dishes prepared in restaurants in China may differ in concentrations of total fat, SFA, protein and Na:K ratio, which may further contribute, beyond food choices, to less healthy nutrient intakes linked to eating away from home.

Trends in Sodium Content of Menu Items in Large Chain Restaurants in the U.S

INTRODUCTION

Consuming too much sodium is associated with increased risk for cardiovascular disease, and restaurant foods are a primary source of sodium. This study assessed recent trends in sodium content of menu items in U.S. chain restaurants.

METHODS

Data from 21,557 menu items in 66 top-earning chain restaurants available from 2012 to 2016 were obtained from the MenuStat project and analyzed in 2017. Generalized linear models were used to examine changes in calorie-adjusted, per-item sodium content of menu items offered in all years (2012-2016) and items offered in 2012 only compared with items newly introduced in 2013, 2014, 2015, and 2016.

RESULTS

Overall, calorie-adjusted sodium content in newly introduced menu items declined by 104 mg from 2012 to 2016 (p<0.02). However, the magnitude and direction of these changes varied by menu category and restaurant type; sodium content, particularly for main course items, was high. Sodium declined by 83 mg in fast food restaurants, 19 mg in fast casual restaurants, and 163 mg in full service restaurants. Sodium in appetizer and side items newly introduced in 2016 increased by 266 mg compared with items on the menu in 2012 only (p<0.01). Sodium in main courses newly introduced in 2016 declined by 124 mg compared with items on the menu in 2012 only (p=0.01), with the greatest decline, 207 mg (p=0.03), among salads.

CONCLUSIONS

Average, adjusted, per-item sodium content was lower in newly introduced items in large chain restaurants. However, sodium content of core and new menu items remain high, and reductions are inconsistent across menu categories and restaurant types.

Progress Evaluation for the Restaurant Industry Assessed by a Voluntary Marketing-Mix and Choice-Architecture Framework That Offers Strategies to Nudge American Customers toward Healthy Food Environments, 2006-2017

Consumption of restaurant food and beverage products high in fat, sugar and sodium contribute to obesity and non-communicable diseases. We evaluated restaurant-sector progress to promote healthy food environments for Americans. We conducted a desk review of seven electronic databases (January 2006-January 2017) to examine restaurant strategies used to promote healthful options in the United States (U.S.). Evidence selection (n = 84) was guided by the LEAD principles (i.e., locate, evaluate, and assemble evidence to inform decisions) and verified by data and investigator triangulation. A marketing-mix and choice-architecture framework was used to examine eight voluntary strategies (i.e., place, profile, portion, pricing, promotion, healthy default picks, priming or prompting and proximity) to evaluate progress (i.e., no, limited, some or extensive) toward 12 performance metrics based on available published evidence. The U.S. restaurant sector has made limited progress to use pricing, profile (reformulation), healthy default picks (choices), promotion (responsible marketing) and priming and prompting (information and labeling); and some progress to reduce portions. No evidence was available to assess progress for place (ambience) and proximity (positioning) to promote healthy choices during the 10-year review period. Chain and non-chain restaurants can apply comprehensive marketing-mix and nudge strategies to promote healthy food environments for customers.

Sodium Reduction in US Households' Packaged Food and Beverage Purchases, 2000 to 2014

Importance

Initiatives to reduce sodium in packaged foods have been launched in the United States, yet corresponding changes in the amount of sodium that US households obtain from packaged foods have not been evaluated, to our knowledge.

Objective

To assess 15-year changes in the amount of sodium that US households acquire from packaged food purchases, the sodium content of purchases, and the proportion of households that have purchases with optimal sodium density.

Design, Setting, and Participants

Longitudinal study of US households in the 2000 to 2014 Nielsen Homescan Consumer Panel, a population-based sample of households that used barcode scanners to record all packaged foods purchased throughout the year. Time-varying brand- and product-specific nutrition information was used for 1 490 141 products.

Main Outcomes and Measures

Sociodemographic-adjusted changes in mean sodium per capita (mg/d) and sodium content (mg/100 g), overall and for top food group sources of sodium, and the proportion of households that have total purchases with sodium density of 1.1 mg/kcal or less.

Results

In a nationwide sample of 172 042 US households (754 608 year-level observations), the amount of sodium that households acquired from packaged food and beverage purchases decreased significantly between 2000 and 2014 by 396 mg/d (95% CI, -407 to -385 mg/d) per capita. The sodium content of households' packaged food purchases decreased significantly during this 15-year period by 49 mg/100 g (95% CI, -50 to -48 mg/100 g), a 12.0% decline; decreases began in 2005 and continued through 2014. Moreover, the sodium content of households' purchases decreased significantly for all top food sources of sodium between 2000 and 2014, including declines of more than 100 mg/100 g for condiments, sauces, and dips (-114 mg/100 g; 95% CI, -117 to -111 mg/100 g) and salty snacks (-142 mg/100 g; 95% CI, -144 to -141 mg/100 g). However, in all years, less than 2% of US households had packaged food and beverage purchases with sodium density of 1.1 mg/kcal or less.

Conclusions and Relevance

In this nationwide study, significant reductions in sodium from packaged food purchases were achieved in the past 15 years. Nonetheless, most US households had food and beverage purchases with excessive sodium density. Findings suggest that more concerted sodium reduction efforts are needed in the United States.

Descriptive Epidemiology of Hypertension and Its Association With Obesity: Based on the WHO STEPwise Approach to Surveillance in Palau

The rise of noncommunicable diseases is a serious health burden for Palau. This study described the prevalence of hypertension, and assessed its association with obesity. Surveys following the WHO STEPwise approach to surveillance were conducted in 2529 adults. Multivariate prevalence ratios (PR) of hypertension for body mass index (BMI) categories were calculated by logistic regression models using conditional standardization procedure. Age- and sex-specified analyses were performed. Overall prevalence of obesity and hypertension were 40.4% and 46.8%, respectively. Prevalence of hypertension was positively associated with BMI. However, overweight men had as high prevalence of hypertension as the obese (multivariable-adjusted PR was 1.84 for overweight and 1.91 for obese compared with nonoverweight). The association between hypertension and BMI was similar across age groups. The prevalence of hypertension in women increased gradually with the increase of BMI whereas that in men reached a plateau already in the overweight.

Personal characteristics, cooking at home and shopping frequency influence consumption

This study examines how the consumption of fruits and vegetables is affected by home cooking habits and shopping patterns, including distance to patronized stores and frequency of shopping, in two low-income predominantly African American urban neighborhoods in New Orleans, Louisiana.

In-person interviews were conducted in 2013 with 901 adult residents who identified themselves as the primary household shopper. Respondents were asked where and how often they shopped and answered a food frequency questionnaire. Addresses were geocoded and distances to the stores where respondents shopped were calculated. Multivariable logistic regression was used to examine the relationship between food consumption and personal factors, neighborhood factors and shopping habits.

Consumption of daily servings of fresh produce increased by 3% for each additional trip to a grocery store, by 76% for shopping at a farmer's market, and by 38% for preparing food at home. Each additional trip to a convenience store increased the frequency of consumption of chips, candy and pastries by 3%. The distance from residence to the type of store patronized was not associated with consumption of produce or chips, candy or pastries.

Shopping at full-service grocery stores, farmer's markets and cooking at home were positively associated with the consumption of fresh produce while shopping at convenience stores was associated with increased consumption of chips, candy and pastries. These findings are useful for designing programmatic interventions to increase fresh fruit and vegetable consumption among residents in low-income urban communities.

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Shopping frequency and store type influence consumption of food.

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Distance to patronized store was not associated with consumption.

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Food prepared at home is associated with increased consumption of produce.

A Comparison of Concentrations of Sodium and Related Nutrients (Potassium, Total Dietary Fiber, Total and Saturated Fat, and Total Sugar) in Private-Label and National Brands of Popular, Sodium-Contributing, Commercially Packaged Foods in the United States

BACKGROUND

Private-label brands account for about one in four foods sold in US supermarkets. They provide value to consumers due to their low cost. We know of no US studies comparing the nutrition content of private-label products with corresponding national brand products.

OBJECTIVE

The objective was to compare concentrations of sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar) in popular sodium-contributing, commercially packaged foods by brand type (national or private-label brand).

DESIGN

During 2010 to 2014, the Nutrient Data Laboratory of the US Department of Agriculture obtained 1,706 samples of private-label and national brand products from up to 12 locations nationwide and chemically analyzed 937 composites for sodium and related nutrients. The samples came from 61 sodium-contributing, commercially packaged food products for which both private-label and national brands were among the top 75% to 80% of brands for US unit sales. In this post hoc comparative analysis, the authors assigned a variable brand type (national or private label) to each composite and determined mean nutrient contents by brand type overall and by food product and type.

STATISTICAL ANALYSES PERFORMED

The authors tested for significant differences (P<0.05) by brand type using independent sample t tests or Mann-Whitney U tests when appropriate.

RESULTS

Overall for all foods sampled, differences between brand types were not statistically significant for any of the nutrients studied. However, differences in both directions exist for a few individual food products and food categories.

CONCLUSIONS

Concentrations of sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar) do not differ systematically between private-label and national brands, suggesting that brand type is not a consideration for nutritional quality of foods in the United States. The study data provide public health officials with baseline nutrient content by brand type to help focus US sodium-reduction efforts.

Sodium Intake among US School-Aged Children: National Health and Nutrition Examination Survey, 2011-2012

BACKGROUND

Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake, which occurs among 90% of US school-aged children.

OBJECTIVE

To describe major food sources, places obtained, and eating occasions contributing to sodium intake among US school-aged children.

DESIGN

Cross-sectional analysis of data from the 2011-2012 National Health and Nutrition Examination Survey.

PARTICIPANTS/SETTING

A nationally representative sample of 2,142 US children aged 6 to 18 years who completed a 24-hour dietary recall.

MAIN OUTCOME MEASURES

Population proportions of sodium intake from major food categories, places, and eating occasions.

STATISTICAL ANALYSES PERFORMED

Statistical analyses accounted for the complex survey design and sampling. Wald F tests and t tests were used to examine differences between subgroups.

RESULTS

Average daily sodium intake was highest among adolescents aged 14 to 18 years (3,565±120 mg), lowest among girls (2,919±74 mg). Little variation was seen in average intakes or the top five sodium contributors by sociodemographic characteristics or weight status. Ten food categories contributed to almost half (48%) of US school-aged children's sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. More than 80 food categories contributed to the other half of children's sodium intake. Foods obtained from stores contributed 58% of sodium intake, fast-food/pizza restaurants contributed 16%, and school cafeterias contributed 10%. Thirty-nine percent of sodium intake was consumed at dinner, 31% at lunch, 16% from snacks, and 14% at breakfast.

CONCLUSIONS

With the exception of plain milk, which naturally contains sodium, the top 10 food categories contributing to US schoolchildren's sodium intake during 2011-2012 comprised foods in which sodium is added during processing or preparation. Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the US food supply.