Salt To Go; U.S. Fast Food Contains Excessive Levels of Sodium

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Meals from fast-food chains in New York contain excessive amounts of salt, a new study has shown [1]. Over half of all purchases exceeded the 1500-mg daily limit of sodium advised for most Americans, and this rose to 84% of meals when only fried-chicken outlets were considered. Only one in 36 purchases met the FDA "healthy" sodium limit (600 mg) for meals.

"This study extends analyses of the nutritional content of fast food from calorie to sodium content and shows that fast food is high in sodium as well as calories," say Christine M Johnson (Cardiovascular Disease Prevention and Control Program, New York City Department of Health and Mental Hygiene) and colleagues in their report in the April 26, 2010 issue of the Archives of Internal Medicine.

The widespread consumption of fast food "contributes to current high levels of daily sodium intake in the US, higher blood pressure, and the resulting burden of cardiovascular disease," so reducing sodium levels in such foods is "a public-health priority," they urge.


Excess sodium not simply the result of large portions

In their study, Johnson et al collected data from noon to 2 pm on weekdays from March to June 2007; adults who bought a meal from one of 167 locations representing 11 fast-food chains across the five boroughs of New York City answered a brief survey and provided their purchase receipt in exchange for a $2 metro card. Nutrition information posted on company websites as of March 1, 2007 was used to determine sodium content.

The final sample size was just over 6500 meals; each meal contained, on average, 1751 mg of sodium; 20% had more than 2300 mg. Fried-chicken chains were the biggest culprits, with 55% of their meals containing more than 2300 mg.

And excess sodium was not simply the result of large portion size, say Johnson et al; they also calculated sodium density, defined as mg of sodium per 1000 cal. The sandwich and fried-chicken outlets and one pizza chain, Papa John's, were the worst culprits in terms of the sodium density of their foods.

Mean sodium, mean calories, and mean sodium density of meals at 11 New York City fast-food chains by collection of customer receipts

Fast-food chain
Mean sodium, mg
Mean cal
Mean sodium density, mg/1000 cal
Burger
     
Burger King
1685
1008
1727
McDonald's
1477
908
1782
Wendy's
1631
907
1885
Sandwich
     
Au Bon Pain
1553
608
2842
Subway
1883
768
2627
Fried chicken
     
Kentucky Fried Chicken
2397
958
2504
Popeye's
2497
1050
2418
Pizza
     
Domino's
2465
1550
1545
Papa John's
1561
652
2443
Pizza Hut
2272
1017
2233
Tex-Mex
     
Taco Bell
1849
909
2093
To download table as a slide, click on slide logo above

The researchers say the strengths of their study include the use of receipts of meals purchased, rather than reliance on patron self-report, and the large sample of patrons from randomly selected locations. Participants were not asked about salt added at the table, however, potentially underestimating the sodium content per meal.

"Our findings support the need for the fast-food industry to focus on reducing sodium levels across product lines," they conclude. "Government, public-health, and industry involvement to accelerate food reformulation will reduce blood pressure and save lives."

Asked to comment on the findings by heartwire, president of the American Society of Hypertension, Dr Henry Black (New York University Center for the Prevention of Cardiovascular Disease, NY) said: "I am not surprised. I don't think the public really knows how much salt is in these foods." And he agrees that urgent attempts should be made to reduce the sodium content in such foods. "Experience in the UK and other countries has shown that you can reduce the amount of salt in processed foods and restaurant foods without anybody complaining."


US facing up to high salt consumption

Johnson et al note that current US recommendations are for adults to limit sodium intake to less than 2300 mg per day, and several groups—blacks, middle-aged and older people, and those with hypertension, who together make up 69% of the adult population—are advised to cap intake at 1500 mg per day. Despite these suggestions, most adults consume an average of 3500 mg of sodium per day, with more than 75% of dietary sodium coming from packaged and restaurant foods.

Black cautions that it will be important as things move forward on this issue in the US to avoid confusion among the public between salt and sodium. "Is the limit 6000 mg of salt a day, is it 2300 mg of sodium? We have to be careful of this, and maybe the people who make recommendations should select one or the other. Perhaps it's better for the public to call it salt?"

Moves are now afoot in the US to emulate the efforts of other countries, which have successfully reduced the amount of salt in processed foods by working together with the food and beverage industries.

Just last week, as reported by heartwire, the Institute of Medicine issued a report advising the FDA that it should set stricter federal standards for the amount of salt that food manufacturers, restaurants, and food-service companies can add to their products, and New York City has been at the forefront of a countrywide campaign—the National Salt Reduction Initiative—which aims to cut the salt content in bought foods by 25% over five years. The American Medical Association has also called on industry to reduce the sodium content of processed products by 50%; such a reduction would save "tens of thousands of lives each year" and save almost $20 billion in healthcare costs annually, say Johnson et al.

And there are already signs that food manufacturers are beginning to take notice; as part of the National Salt Reduction Initiative, 16 companies pledged earlier this week to cut levels of salt in their products [2]. Two of those included chains examined by Johnson et al—Au Bon Pain and Subway.


Submitted by DMorgan on Sun, 05/02/2010 - 8:34pm.