Vital Signs: Food Categories Contributing the Most to Sodium Consumption — United States, 2007–2008

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On February 7, 2012, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).
Abstract
Background: Most of the U.S. population consumes sodium in excess of daily guidelines (<2,300 mg overall and 1,500 mg for specific populations). Excessive sodium consumption raises blood pressure, which is a major risk factor for heart disease and stroke, the nation's first and fourth leading causes of death. Identifying food categories contributing the most to daily sodium consumption can help reduction.

Methods: Population proportions of sodium consumption from specific food categories and sources were estimated among 7,227 participants aged ≥2 years in the What We Eat in America, National Health and Nutrition Examination Survey, 2007–2008.
Results: Mean daily sodium consumption was 3,266 mg, excluding salt added at the table. Forty-four percent of sodium consumed came from 10 food categories: bread and rolls, cold cuts/cured meats, pizza, poultry, soups, sandwiches, cheese, pasta mixed dishes, meat mixed dishes, and savory snacks. For most of these categories, >70% of the sodium consumed came from foods obtained at a store. For pizza and poultry, respectively, 51% and 27% of sodium consumed came from foods obtained at fast food/pizza restaurants. Mean sodium consumption per calorie consumed was significantly greater for foods and beverages obtained from fast food/pizza or other restaurants versus stores.
Implications for Public Health Practice: Average sodium consumption is too high, reinforcing the importance of implementing strategies to reduce U.S. sodium intake. Nationwide, food manufacturers and restaurants can strive to reduce excess sodium added to foods before purchase. States and localities can implement policies to reduce sodium in foods served in institutional settings (e.g., schools, child care settings, and government cafeterias). Clinicians can counsel most patients to check food labels and select foods lower in sodium.
Introduction
High sodium consumption is related to high blood pressure, or hypertension, which in 2008 was reported as a primary or contributing cause of approximately 348,000 U.S. deaths (1). Thirty-one percent of adults in the United States have hypertension, and fewer than half of them have their blood pressure under control (2). Reducing the average daily population sodium consumption by about one third is projected to reduce blood pressure and decrease the number of new and recurrent cases of heart attack and stroke, averting up to 81,000 deaths, and saving $20 billion health-care dollars annually (3).
Excess sodium consumption is common and can be reduced through modifications to the food environment (4). Average daily sodium consumption during 2007–2008 was 3,266 mg among persons aged ≥2 years in the United States, well above the current Dietary Guidelines for Americans recommendations of <2,300 mg overall and 1,500 mg for specific at-risk populations comprising about half of the population (5). Approximately 88% of persons aged ≥2 years who should consume <2,300 mg daily and 99% of persons who should consume 1,500 mg daily consume more than these levels (6). Meeting these recommendations might be challenging, because >75% of sodium consumed is estimated to come from sodium added to restaurant and processed foods before purchase, whereas only 5%–6% is added at home during cooking and 5%–6% at the table (4,7). The Institute of Medicine (IOM) recently recommended populationwide strategies, including mandatory reductions in sodium in processed and restaurant foods with interim voluntary reductions from food manufacturers (4).
Identifying the major food sources of sodium is important to reducing sodium consumption. This report describes the sources of dietary sodium consumption, both specific food categories and where they were obtained among the U.S. population aged ≥2 years, overall, and by age and other demographic characteristics. February 10, 2012 / 61(05);92-98