Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Review Article
Publication Acceptance Date: 7/24/2014
Publication Date: 10/6/2014
Publication URL: http://handle.nal.usda.gov/10113/60291
Citation: Sebastian, R.S., Enns, C.W., Goldman, J.D., Hoy, M.K., Moshfegh, A.J. 2015. Sandwiches are major contributors of sodium in the diets of American adults: Results from What We Eat in America, National Health and Nutrition Examination Survey 2009-2010. Journal of the Academy of Nutrition and Dietetics. 115(2):272-277.
Interpretive Summary: High sodium intake is a risk factor for high blood pressure and consequences such as heart failure and stroke. The majority of Americans have sodium intakes that are above the Tolerable Upper Intake Levels set by the Institute of Medicine. Identifying foods that contribute high proportions of sodium in diets of Americans is an important step toward reducing sodium intakes. Previous research underestimated sandwiches’ contributions to sodium intake through examining only sandwiches represented in the dietary data by one sandwich-specific food code (i.e., “single-code sandwiches,” such as “roast beef sandwich with cheese”) and not accounting for sandwiches coded using multiple food codes to identify individual components of the sandwich (e.g., bread, cheese, roast beef, mayonnaise). Using data from What We Eat in America (WWEIA), the dietary interview component of the National Health and Nutrition Examination Survey (NHANES) 2009-2010, we examined not only single-code sandwiches but also sandwiches that were represented in the dietary data by food codes linked together in “sandwich combinations.” We found that nearly half (49%) of adults age 20 years and older ate a sandwich on the intake day. Sandwiches contributed 19 percent of sodium intake in this age group, much higher than the 3.9 percent reported previously as being contributed by single-code sandwiches only. Even though much national attention is appropriately focused on how to reduce sodium in the food supply, consumer choices still play a vital role. This new information about the prominent role of sandwiches can alert not only food manufacturers and restaurants but also dietitians, nutritionists, and consumers to the importance of improving choices of sandwich ingredients in order to reduce sodium intake.
Technical Abstract: Efforts to sharpen the focus of sodium reduction strategies include identification of major food group contributors of sodium intake. Although sandwiches are a staple of the American diet, examinations of their contribution to sodium intake have been limited to “single-code” sandwiches. One day of dietary intake data from 5,762 adults age 20 years and over in What We Eat in America, NHANES 2009-2010 was analyzed. Sandwiches included both single-code sandwiches and sandwiches coded with multiple food codes linked together. Two-sided t-tests were used to compare percentages of men and women reporting sandwiches; contributions of sandwiches to energy and sodium intakes (amounts in kcal and mg, respectively, and % of daily totals) by gender; and total energy, total sodium, and sodium density by sandwich reporting status (reporter/nonreporter). On any given day, 49% of American adults ate sandwiches. A significantly higher percentage of men than women reported sandwiches (54 vs. 44%, respectively; p<0.001), and sandwiches accounted for higher percentages of men’s total energy and sodium intakes. Compared to individuals who did not report a sandwich on the intake day, sandwich reporters had significantly higher energy and sodium intakes; however, sodium density of the diet did not vary by sandwich reporting status. Even though much national attention is appropriately focused on how to reduce sodium in the food supply, consumer choices still play a vital role. Due to sandwiches’ high consumption and considerable contributions to sodium intake, making better choices of ingredients for sandwiches could significantly impact sodium intakes.