NWS-19 Reduce consumption of sodium in the population aged 2 years and older

National Data Source
National Health and Nutrition Examination Survey (NHANES); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch
No
Measure
milligrams (age adjusted—see Comments)
Baseline (Year)
3,640 (2003-2006)
Target
2,300
Target-Setting Method
Modeling
Numerator
Total one day intake of sodium (in mg) among persons aged 2 years and over
Denominator
Number of persons aged 2 years and over
Questions Used to Obtain the National Baseline Data

From the 2003-04 and 2005-06 National Health and Nutrition Examination Survey:

[NUMERATOR]

Foods:

The 2003-04 and 2005-06 NHANES included the collection of 1 day of dietary data for all respondents through in-person 24-hour recalls1 and collection of a 2nd day 24-hour recall by telephone. For these analyses, sodium intake from only the first 24 hour recall will be used. Each respondent was asked to recall the kinds and amounts of foods and beverages consumed at home and away from home during the previous day (midnight to midnight). Amounts of foods and beverages reported in household measures were then converted to gram amounts, and sodium intake from foods and beverages was estimated with the use of food composition files. Note: Estimates of sodium intake from salt added in cooking are included in these estimates. Additional questions used to assess total sodium intake include:

Dietary supplement use:

Has (Person) taken any vitamins or minerals in the past month? Please include those that are prescribed by a doctor or dentist and those that are not prescribed.

Has (Person) taken or used any medicines for which a doctor's or dentist's prescription is needed, in the past month? This includes any products which cannot be obtained without a doctor's or dentist's prescription. Include those medicines which you may have already mentioned.

[If yes:]

May I see the containers for all of the (vitamins and minerals/prescription medicines) (Person) took in the past month?

Enter complete name of vitamin/mineral from label, or probe respondent:

  1. Container seen
  2. Container not seen
  3. Product furnished by respondent
  4. Product name not on container

Enter manufacturer's or distributor's name and address (city and State)

How often did (Person) take (product) in the past month?

How much (product) did (Person) take each time (Person) took it?

Number of capsules, tablet/pills; teaspoons; tablespoons; fluid ounces/ounces; drops/droppers; packets/packs/packages; ml.; wafers; other

Antacid use:

Enter complete name of antacid from label or probe respondent:

  1. Antacid seen
  2. Antacid not seen. Product name furnished by respondent.
  3. How often did you take (antacid) in the past month?
  4. How much (antacid) did you take each time you took it?

Plain Drinking Water:

Plain drinking water intakes were collected directly as part of the dietary intake collection of foods and beverages beginning with the 2005-2006 NHANES. Thus, the dietary intake records from the 2005-2006 NHANES include the sodium provided by drinking water. The 2003-2004 NHANES collected plain drinking water intake through questions about the total amount of water drunk on the previous day (same period as the dietary intake). These amounts of water are provided in the NHANES dataset in gram units separately for tap and bottled water but the sodium from drinking water is not included in the dietary intake files.

Salt use at the table:

What type of salt (do you/does Person) usually add to (your/his/her) food at the table?

  1. None
  2. Ordinary salt
  3. Lite salt
  4. Salt substitute

How often (do you/does Person) add (type of salt) to (your/his/her) food at the table?

  1. Rarely
  2. Occasionally
  3. Very often
Data Collection Frequency
Periodic
Comparable Healthy People 2010 Objective
Adapted from HP2010 objective

Comments

Methodology Notes

Estimates include consideration of several sources of sodium intake: foods, dietary supplements, antacids, tap water, and salt use at the table.

Estimation of Sodium Intake from Salt Use at the Table:

Regarding salt use at the table, sea salt, flavored salts such as garlic, onion, and celery salt, and seasoning salts were counted as ordinary salts. Lite salt was labeled as such and has a reduced sodium content of at least 50%. Salt substitutes do not contain sodium. To obtain a daily amount for each person, the amount of sodium depending on salt type was multiplied by the frequency value. (Sodium in type of salt x frequency amount of sodium from table salt added per day. See table below).

Type of salt:

For “ordinary salt,” sodium intake from salt use at the table was estimated based on a 1991 study that estimated mean sodium intake for adults to be about 580 mg. Specifically, 580 mg of sodium (which is about 1500 mg or ¼ teaspoon of salt) for the “very often” code was assigned for persons aged 2 years and older. For “lite” salt which contains at least half the amount of sodium as “ordinary salt”, 290 mg of sodium was assigned. A zero sodium value was assigned for “salt substitute”, “other” or “don’t use”.

Frequency of salt use:

For “rarely”, the sodium value was multiplied by 0.25; for “occasionally,” the sodium value was multiplied by 0.50; for “very often,” the sodium value was multiplied by 1. The frequency question was not asked if response to type of salt was “don’t use” or “don’t know”. For “don’t use” responses, a zero value was assigned; for “don’t know” responses, ordinary salt was assumed and 290 mg of sodium was assigned based on an assumed frequency of “occasionally”.

The following table summarizes the amount of sodium added:

Assignment of Sodium Values

TypeRarelyOccasionallyVery oftenDK*Missing**
Ordinary145290580290--
Lite 73145290145--
Salt Substitute 0000--
Other145290580290--
Don't use00000
Don’t know0000290

* DK= Don’t Know
** Missing= Not Asked

Breast-feeding children aged 2 years and older are excluded from the analysis.

Age Adjustment

This Indicator uses Age-Adjustment Groups:

  • Total: 2-3, 4-8, 9-13, 14-18, 19-30, 31-50, 51-70, 71+
  • Sex: 2-3, 4-8, 9-13, 14-18, 19-30, 31-50, 51-70, 71+
  • Race/Ethnicity: 2-3, 4-8, 9-13, 14-18, 19-30, 31-50, 51-70, 71+
  • Education Level: 25-30, 31-50, 51-70, 71+
  • Family Income Level: 2-3, 4-8, 9-13, 14-18, 19-30, 31-50, 51-70, 71+
  • Country of Birth: 2-3, 4-8, 9-13, 14-18, 19-30, 31-50, 51-70, 71+
  • Disability Status: 20-30, 31-50, 51-70, 71+
  • Health Insurance Status: 2-3, 4-8, 9-13, 14-18, 19-30, 31-50, 51-64
  • Marital Status: 20-30, 31-50, 51-70, 71+
  • Veteran Status: 17-18, 19-30, 31-50, 51-70, 71+
  • Obesity Status, Adults: 20-30, 31-50, 51-70, 71+
Changes Between HP2010 and HP2020
Healthy People 2010 objective 19-10 assessed the proportion of the population who met a specific daily intake recommendation for sodium (i.e., less than 2400 mg based on the 2000 Dietary Guidelines for Americans, DGA), while Healthy People 2020 objective NWS-19 tracks the population's mean sodium daily intake so that the objective will not need to be modified with changes in the guidelines.

References and More Information

  1. Mattes RD, Donnelly D. Relative Contributions of Dietary Sodium Sources. J Amer College Nutr. 10 (4):383-393.1991.
  2. U.S. Code of Federal Regulations. 21 CFR § 101.56 (c)(1)(i).
  3. WWEIA, NHANES, and the MyPyramid Equivalents Database.
    http://www.ars.usda.gov/Services/docs.htm?docid=15044