Monitoring Changes in Sodium Intake for the US Population between 2007 and 2012: A Novel Approach Using a Crosswalk between Nutrition Label Data and Dietary Recalls

Abstract

BackgroundPrevious studies examining trends in sodium intake have been limited by lack of up‐to‐date, product‐specific food composition data necessary to accurately monitor the diverse array of products in the US food supply and continual product reformulations. Further, many US food manufacturers and retailers have pledged to reduce the sodium content of their packaged food products, yet reductions in the sodium content of store‐bought foods consumed by Americans and corresponding declines in sodium intake from stores have not been evaluated.ObjectiveThis cross‐sectional study aimed to identify major contributors to sodium intake from stores among US children and adults, to evaluate whether the sodium content of these foods declined between 2007 and 2012, and to determine whether sodium intake from stores changed during this time span.MethodsThis study used 24‐hour dietary recall data for a nationally representative US sample of 8,974 children 2–18y and 16,267 adults >18y from the 2007–2008, 2009–2010, and 2011–2012 National Health and Nutrition Examination Survey (NHANES). To enhance standard food composition data with time‐varying product‐specific nutritional information for packaged food products, we linked Nutrition Facts Panel data from barcoded foods (168,077 to 193,195 per survey cycle) to codes for packaged foods consumed from stores by NHANES participants. We generated sales‐weighted mean nutrient content for each food item reported in each survey cycle, with weighting derived from purchases by households in the nationwide Nielsen Homescan Consumer Panel in the corresponding period. Survey‐weighted mean sodium content (mg/100g) and sodium intake (mg/d) from foods consumed from stores were determined in each time point, overall and by food group.ResultsThe sodium content of foods consumed by US children and adults from stores decreased significantly between 2007–2008 and 2011–2012 for 5 of 12 major sources of sodium: breads and tortillas (−6.9%), ready‐to‐eat cereal (−7.5%), salty snacks (−7.7%), pasta and pasta dishes (−10.3%), and rice and rice dishes (−22.3%). However, sodium content increased significantly for poultry (+10.4%), meat (+13.6%), and sandwiches (+14.1%). Among adults, mean sodium intake from stores exceeded the IOM recommended upper limit for total daily intake in all years and did not significantly change between 2007–2008 and 2011–2012 (−30 mg/d; 95% CI: −199, 139 mg/d). Among children, sodium intake from stores increased significantly between 2007–2008 and 2009–2010 by +172 mg/d (95% CI: 57, 287 mg/d), then decreased significantly between 2009–2010 and 2011–2012 by −209 mg/d (95% CI: −323, −96 mg/d); however, the net change between 2007 and 2012 was not significant.ConclusionsDespite significant declines between 2007 and 2012 in the sodium content of store‐bought foods consumed by Americans, sodium intake remains high. Findings support the need for more concerted sodium reduction efforts for packaged foods in the US and highlight the importance of monitoring industry pledges.Support or Funding InformationThis work was supported by the Robert Wood Johnson Foundation (67506, 68793, 70017, 71837), NIH (R01DK098072, DK56350) and the Carolina Population Center and its NIH center grant (P2C HD050924). E Dunford is supported by a National Health and Medical Research Council of Australia Early Career Fellowship (APP1088673).