Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/18/2016
Publication Date: 5/18/2016
Citation: Quader, Z.S., Gillespie, C., Sliwa, S.A., Mugavero, K., Gunn, J.P., Ahuja, J.K., Pehrsson, P.R., Moshfegh, A.J., Burdg, J.P., Cogswell, M.E. 2016. Sodium intake among U.S. school-age children: National Health and Nutrition Examination Survey, 2011-2012. Journal of the Academy of Nutrition and Dietetics. 64(22):4531-4535.

Interpretive Summary: About 90% of U.S. children consume excess dietary sodium and one in 9 children ages 8-17 years have blood pressure above the normal range for their age, gender, and height, which increases their risk of high blood pressure as adults. Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake. This report describes major food sources, places obtained, and eating occasions contributing to sodium intake among U.S. school-aged children using 24-hour dietary recall data from a nationally representative sample of 2,142 U.S. children aged 6-18 years in the 2011-12 What We Eat In America, National Health and Nutrition Examination Survey. Average daily sodium intake was highest among adolescents 14-18 years and lowest among girls. Ten food categories contributed to almost half of U.S. school-aged children’s sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. Foods obtained from grocery stores contributed 58% of sodium intake. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of population-wide strategies to reduce sodium intake. This information will help health and nutrition professionals, educators, and policy officials in developing education programs and policy initiatives to lower sodium intake, and for monitoring changes in sodium intakes.

Technical Abstract: Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake which occurs among 90% of U.S. school-aged children. We conducted a cross-sectional analysis of 24-hour dietary recall data from a nationally representative sample of 2,142 U.S. children aged 6-18 years in the 2011-12 National Health and Nutrition Examination Survey (NHANES), to describe major food sources, places obtained, and eating occasions contributing to sodium intake among U.S. school-aged children. We determined population proportions of sodium intake from major food categories, places, and eating occasions. T-tests were used to examine differences between subgroups. Average daily sodium intake was highest among adolescents 14-18 years (3,565 ± 120 mg), lowest among girls (2,919 ± 74 mg). Little variation was seen in average intakes or the top 5 sodium contributors by sociodemographic characteristics or weight status. Ten food categories contributed to almost half (48%) of U.S. school-aged children’s sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. Over 80 food categories contributed to the other half of children’s sodium intake. Foods obtained from grocery stores contributed 58% of sodium intake; fast/food pizza restaurants, 16%; school cafeterias, 10%. Thirty-nine percent of sodium intake was consumed at dinner, 31% at lunch, 16% at snacks, and 14% at breakfast. With the exception of plain milk, which naturally contains sodium, the top 10 food categories contributing to U.S. school children’s sodium intake in 2011-12 comprised foods in which sodium is added during processing or preparation. Since sodium is consumed throughout the day, from multiple foods and locations, no single target for sodium reduction emerges, highlighting the importance of sodium reduction across the U.S. food supply.