In the JournalsPerspective

Significant sodium reductions achieved in US, but more progress needed

From 2000 and 2014, sodium consumed in United States households’ packaged food purchases was significantly reduced; however, a majority of households’ purchases contained sodium above the recommended density, suggesting that continued efforts are warranted to prevent excess sodium intake, according to findings published in JAMA Internal Medicine.

“Excessive dietary sodium intake has been established as a modifiable risk factor for hypertension and cardiovascular disease,” Jennifer M. Poti, PhD, from the department of nutrition at the University of North Carolina at Chapel Hill, and colleagues wrote. “However, 89% to 90% of U.S. children and adults exceeded the 2015 to 2020 Dietary Guidelines for Americans recommended limit for sodium intake in 2009 to 2012. To lower population-level sodium intake of Americans, the Institute of Medicine recommends that reducing sodium in packaged foods is essential because most sodium intake comes from store-bought foods and is added during industrial food processing.”

“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,” they added.

The researchers assessed changes in the amount of sodium that households in the United States acquire from packaged food purchases, the sodium content of purchases and the proportion of households that had purchases with optimal sodium density over the course of 15 years. They studied a nationwide, population-based sample of 172,042 United States households (754,608 year-level observations) from the 2000 to 2014 Nielsen Homescan Consumer Panel. To record all packaged foods purchased, household members used barcode scanners. Poti and colleagues also used time-varying brand- and product-specific nutrition information for approximately 1.5 million products.

Between 2000 and 2014, there was a significant decline in the amount of sodium that households acquired from packaged food and beverage purchases from 2,363 mg per day to 1,967 mg per day (–396 mg per day per capita; 95% CI, 407 to 385). The overall sodium content of households’ packaged food purchases significantly decreased by 49 mg per 100 g (95% CI, 50 to 48) — starting in 2005 and continuing through 2014 — indicating a 12% decline. The sodium content of households’ purchases for all top food sources of sodium also decreased significantly, with reductions of more than 100 mg per 100 g for condiments, sauces and dips (114 mg per 100 g; 95% CI, 117 to 111), as well as salty snacks (142 mg per 100 g; 95% CI, 144 to 141). Despite this progress, packaged food and beverage purchases with the recommended optimal sodium density of 1.1 mg/kcal or less were observed in less than 2% of households in the United States.

“The slow rate of decline in sodium from store-bought foods suggests that more concerted sodium reduction efforts are necessary in the United States,” Poti and colleagues concluded. “Future studies are needed to examine sodium trends by race/ethnicity and income to identify vulnerable subpopulations that further interventions should target.” – by Alaina Tedesco

Disclosure: The researchers report receiving support from the Robert Wood Johnson Foundation, NIH and the Carolina Population Center.

 

From 2000 and 2014, sodium consumed in United States households’ packaged food purchases was significantly reduced; however, a majority of households’ purchases contained sodium above the recommended density, suggesting that continued efforts are warranted to prevent excess sodium intake, according to findings published in JAMA Internal Medicine.

“Excessive dietary sodium intake has been established as a modifiable risk factor for hypertension and cardiovascular disease,” Jennifer M. Poti, PhD, from the department of nutrition at the University of North Carolina at Chapel Hill, and colleagues wrote. “However, 89% to 90% of U.S. children and adults exceeded the 2015 to 2020 Dietary Guidelines for Americans recommended limit for sodium intake in 2009 to 2012. To lower population-level sodium intake of Americans, the Institute of Medicine recommends that reducing sodium in packaged foods is essential because most sodium intake comes from store-bought foods and is added during industrial food processing.”

“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,” they added.

The researchers assessed changes in the amount of sodium that households in the United States acquire from packaged food purchases, the sodium content of purchases and the proportion of households that had purchases with optimal sodium density over the course of 15 years. They studied a nationwide, population-based sample of 172,042 United States households (754,608 year-level observations) from the 2000 to 2014 Nielsen Homescan Consumer Panel. To record all packaged foods purchased, household members used barcode scanners. Poti and colleagues also used time-varying brand- and product-specific nutrition information for approximately 1.5 million products.

Between 2000 and 2014, there was a significant decline in the amount of sodium that households acquired from packaged food and beverage purchases from 2,363 mg per day to 1,967 mg per day (–396 mg per day per capita; 95% CI, 407 to 385). The overall sodium content of households’ packaged food purchases significantly decreased by 49 mg per 100 g (95% CI, 50 to 48) — starting in 2005 and continuing through 2014 — indicating a 12% decline. The sodium content of households’ purchases for all top food sources of sodium also decreased significantly, with reductions of more than 100 mg per 100 g for condiments, sauces and dips (114 mg per 100 g; 95% CI, 117 to 111), as well as salty snacks (142 mg per 100 g; 95% CI, 144 to 141). Despite this progress, packaged food and beverage purchases with the recommended optimal sodium density of 1.1 mg/kcal or less were observed in less than 2% of households in the United States.

“The slow rate of decline in sodium from store-bought foods suggests that more concerted sodium reduction efforts are necessary in the United States,” Poti and colleagues concluded. “Future studies are needed to examine sodium trends by race/ethnicity and income to identify vulnerable subpopulations that further interventions should target.” – by Alaina Tedesco

Disclosure: The researchers report receiving support from the Robert Wood Johnson Foundation, NIH and the Carolina Population Center.

 

    Perspective

    Michael Miller

    Americans consume sodium in excess by approximately 1,000 mg per day (approximately 3,400 mg versus the recommended amount of 2,300 mg or 1 teaspoon of salt) in men and women younger than age 50 years and more than twice as much sodium than recommended (1,500 mg) for older men and women. Yet, despite promotional efforts by government agencies and the media to get this information out into the public domain, the progress made toward reducing the purchase of sodium-enriched products has not been well established. The new study examines the national trend in sodium reduction in U.S. households over a 15-year period by focusing on package foods and beverages, two of the richest sources of sodium consumed by Americans. 

    The study found average reductions in sodium of 12% from packaged goods purchased between 2000 and 2014. On the surface, this may seem like a significant improvement over the study period. However, the analysis did not include foods that did not contain a barcode, such as the popular, “grab-a-ticket” deli counters where lunchmeats are commonly seething with sodium. For example, one slice of deli ham often contains 300-400 mg of sodium. Because approximately one-half to one-third of daily sodium intake may be obtained from deli meats and popular store-prepared foods (also not assessed for sodium content), not having this information puts somewhat of a damper on an otherwise informative and interesting study. 

    • Michael Miller, MD
    • Professor of cardiovascular medicine, epidemiology and public health
      University of Maryland School of Medicine
      Director of the Center for Preventive Cardiology
      University of Maryland Medical Center

    Disclosures: Miller reports no relevant financial disclosures.