Assessing The Sodium Situation: The Consumer's Perspective

The topic of sodium consumption has received increased attention and stimulated much debate among the scientific and public health communities recently due to its effect on blood pressure and the increasing prevalence of hypertension in the U.S. population. Various studies have examined many aspects of sodium and official reports with sodium recommendations are not lacking either. In 2010, the Institute of Medicine (IOM) released its report, Strategies to Reduce Sodium Intake in the US 2010, estimating that population-wide reductions in sodium could prevent more than 100,000 deaths annually. In January 2011, the US Department of Agriculture (USDA) and Department of Health and Human Services (HHS) released the much anticipated Dietary Guidelines for Americans, 2010. Among the key recommendations outlined in the 2010 Dietary Guidelines is to “reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.”

According to the 2010 Dietary Guidelines, “The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.” Currently, Americans’ average intake of sodium is approximately 3,400 mg/day.  Additionally, 2010 Centers for Disease Control and Prevention (CDC) data suggest that only 5.5 percent of adults consume less-than or equal-to the 1,500 mg per day recommendation, and only 18.8 percent of all other adults consumed less than 2,300 mg per day, and overall, only 9.6 percent of all adults stayed within their applicable recommended limit. Given the disparity between sodium recommendations and average intake, it’s not surprising that the CDC has reported such low adherence to official recommendations.

Earlier this year, the International Food Information Council (IFIC) surveyed the American public to gauge consumers’ attitudes and behaviors related to their own sodium intake. This is the second survey focusing on sodium and compares findings from the original IFIC Consumer Sodium Research conducted in 2009 to understand whether consumer concerns, perceptions, and actions related to sodium have changed during this time.  Where changes did occur, this survey also evaluates which subpopulations have experienced the most significant changes. It is well documented that intakes are above recommended levels and the 2011 IFIC Consumer Sodium Research gives some insight into why.  In light of the increased focus on sodium reduction, this research also sheds light on ways that consumers may find success in managing their blood pressure beyond just sodium reduction.

Sodium: Not my concern, but others should be concerned 

There is a low level of concern regarding sodium intake by individuals.  In 2011, IFIC asked consumers how concerned they are with their personal sodium consumption and the majority of Americans reported not being concerned (59 percent)—this level of concern is consistent with our 2009 data (60 percent). However, while most Americans are not highly concerned personally about sodium intake, a strong majority (83 percent) feel that certain other people should be, namely those with or those concerned about high blood pressure and those with weight issues.

There are an abundance of factors that consumers believe contribute to a healthy diet.  Increasing fruits and vegetables (70 percent) is by far the consumers’ top choice when rating the three most important elements of a healthful diet.  However, only 38 percent rated limiting sodium as one of the top three important factors. While limiting sodium remains middle-of-the-pack in the eyes of consumers, limiting sugar (48 percent) and monitoring calories (45 percent) increased from 2009 (44 percent and 32 percent respectively). There are a variety of factors and approaches that contribute to a healthful diet, but it is not surprising that limiting sodium is trumped by other dietary factors that may have received more attention of late. But perhaps this isn’t a new phenomenon.  As fad diets touting or targeting the “nutrient of the day” have come and gone, sodium intake has been reported to be fairly constant since the 1950’s. \[Bernstein and Willet: AJCN 2010;92:1172-80\].

Assaulted with numbers, consumers remember few

Lack of awareness about sodium guidelines may also be playing a role. When consumers were asked how much sodium is recommended to consume per day, almost half (46 percent) responded that they didn’t know.  Moreover, only 30 percent identified either of the sodium values established in 2010 Dietary Guidelines recommendations (1,500 or 2,300 mg).  Federal dietary guidance on sodium is tailored to specific segments of the population (based on age, race, and specific health conditions), which serves to target advice to specific groups, but varying recommendations may also result in confusion for the public.

Consumers are hearing messages about lowering their sodium; however, recommendations about specific numbers and thresholds do not appear to be resonating with consumers. Even with all the media attention around the release of the 2010 Dietary Guidelines, almost 2 in 3 Americans (62 percent) remain unaware of any government recommendations regarding sodium.  In terms of personal intake, over half (57 percent) of all consumers surveyed don’t know how much sodium they consume per day and almost 6 in 10 (59 percent) of those with high blood pressure also reported not knowing.  In other words, certain populations (i.e., those with hypertension) that are recommended to decrease their sodium intake even further than the general population may not be any more aware of recommendations or personal consumption levels.

Taste always trumps health

Let’s not forget about one of the most important factors in food—taste. Data from IFIC Foundation’s 2011 Food & Health Survey continue to show that taste is the biggest driver of purchasing decisions regarding foods and beverages.  Taste is also a factor in reducing sodium consumption.  Nearly 4 in 10 (39 percent) Americans believe low- or reduced-sodium products don’t taste as good.  Currently, 58 percent of consumers are not trying to limit sodium in their diet and the top three reasons cited are 1) being in good overall health (44 percent), 2) taste (36 percent), and 3) not being convinced of the need to reduce sodium (31 percent).

Conclusion

Despite an increased focus on sodium for its effect on blood pressure and recent dietary recommendations, a comparison of the IFIC 2009 and 2011 sodium surveys shows that general concern and awareness of intake and official recommendations remain low.  Taste is also a barrier as many consumers have yet to fully embrace the taste of low or reduced sodium products and view limiting sodium as just one of the many contributing factors in a healthful diet. Nevertheless, they do acknowledge the beneficial role of increasing fruits and vegetables—a critical component to blood pressure management because of the relatively low sodium content and high potassium content of these foods. 

The good news is that the majority of American consumers feel that they can be successful in a variety of lifestyle modifications that are proven to have a direct effect on blood pressure, such as weight loss and increased physical activity, as well as reducing sodium.  While sodium reduction is an important piece to the puzzle, it is not the only piece.  Due to the multifactorial nature of blood pressure, it is important for health professionals to communicate simple, positive messages about the multiple lifestyle strategies that can aid consumers in lowering blood pressure while government, public health organizations, food industry, and consumers work together to reduce sodium intakes.

For more information:

2011 IFIC Consumer Sodium Research:  Concern, Perceptions, and Action     

2011 IFIC Sodium Research Executive Summary: Is Sodium on American Plates and Minds? An Assessment of Consumer Attitudes and Behavior with Respect to Dietary Sodium

National Institutes of Health: Your Guide to Lowering Your Blood Pressure with DASH