Racial and Ethnic Differences in Sodium Sources and Sodium Reduction Behaviors among US Adults: NHANES 2017-2020 pre pandemic

BackgroundNearly all US adults exceed sodium recommendations, which increases cardiovascular risk. Understanding racial and ethnic differences in sodium sources and behaviors could lead to nuanced public health messaging, dietary interventions, and clinical guidance to more equitably achieve population-level sodium reduction. MethodsUsing National Health and Nutrition Examination Survey 2017-2020 pre-pandemic data, racial and ethnic differences in sodium sources and sodium-related behaviors (e.g., salt use at the table and in food preparation, doctor advice to reduce sodium, attempts to reduce sodium, and label reading) were assessed using weighted chi-square. Given the nutrient databases assumption that rice is salted may be inappropriate for some ethnic groups, we conducted a secondary analysis altering this assumption. ResultsPizza, soup, and chicken were top sources of sodium across racial and ethnic groups. For Asian Americans, 4 top sources were unique (e.g., soy-based condiments). Black adults reported the highest rates of reducing sodium (67% vs. 44% among White adults) and receiving physician sodium reduction advice (35% vs.18% among Asian Americans). Asian Americans were the most likely to frequently use salt during food preparation (66% vs. Other Race adults 32%) but reported not using salt at the table (43% vs. 23% among Other Race adults). Assuming rice is unsalted reduces Asian American sodium intake estimates by [~]325 mg/day. ConclusionsWhile product reformulation targets and front-of-pack nutrition labeling may help reduce sodium intake across groups, to equitably address sodium intake, culturally appropriate advice on sources of sodium and salt usage may be needed, particularly for Asian Americans. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSO_LIAmong the top 10 sources of Asian American adult sodium intake, 4 sources accounted for over 14% of sodium intake and were not shared with other racial and ethnic groups (e.g., soy-based condiments, fish, fried rice/lo mein, and stir-fry and soy-based sauce mixtures) while few unique sources were identified for other racial and ethnic groups. C_LIO_LIBlack adults reported the highest rates of reducing sodium and receiving physician sodium reduction advice, and Asian Americans were the most likely to frequently use salt during food prep but least likely to use salt at the table. C_LIO_LICompared to estimates derived under the Food and Nutrient Database for Dietary Studies (FNDDS) assumption that rice is salted, applying the assumption that rice is unsalted lowers Asian American sodium intake estimates by about 325 mg/day. C_LI What Are the Clinical Implications?O_LIBecause of different top sources of sodium, public health messaging, clinical guidance, and product reformulation efforts will need to focus on multiple food products used across racial and ethnic groups. C_LIO_LITailored advice on salt usage and culturally and linguistically appropriate patient education may support physician advice to reduce sodium while front of pack nutrition labelling may improve label reading across racial and ethnic groups. C_LIO_LITo improve sodium surveillance in the US, both salted and unsalted rice should be included in dietary databases and assessment of sodium intake using a less biased measure (e.g., 24-hour urinary sodium excretion) should be considered. C_LI