Sodium content of menu items in New York City chain restaurants following enforcement of the sodium warning icon rule, 2015-2017.

In 2016, New York City (NYC) began enforcing a sodium warning regulation at chain restaurants, requiring placement of an icon next to any menu item containing ≥2,300 mg sodium. As menu labeling may improve menu nutritional composition, we investigated whether sodium content of menu items changed following enforcement of the sodium warning icon. All menu offerings at 10 quick-service (QSR) and 3 full-service (FSR) chain restaurants were photographed in 2015 (baseline) and 2017 (follow-up) and matched to nutritional information from restaurant websites; items were categorized as being available at both baseline and follow-up, or at only one timepoint. Linear and logistic regression models, respectively, assessed changes in calculated mean sodium-per-serving per menu item and the odds of an item containing ≥2,300 mg sodium. At baseline, mean per-serving sodium content was 2,160 mg at FSR and 1,070 mg at QSR, and 40.6% of FSR items and 7.2% of QSR items contained ≥2,300 mg sodium per serving. Sodium content did not differ when comparing all items offered at follow-up to all offered at baseline (21 mg, 95% CI: -60,101), or when comparing new versus discontinued items (17 mg, 95% CI: -154, 187). At follow-up, there was no change in the overall likelihood of items requiring a warning icon (OR = 1.32, 95% CI: 0.97,1.79), or when comparing new versus discontinued items (OR = 2.08, 95% CI: 1.02,4.24) (p = 0.04, not significant following Bonferroni correction for multiple analyses). Our findings that the sodium content of menu items did not change following the sodium warning icon regulation underscore difficulties in reducing sodium levels in restaurants; however, our results may be limited by follow-up data collection occurring less than one year post-enforcement. It may take additional time and similar action from other jurisdictions for restaurants to reduce the sodium content of menu items.

Changes in Serving Size, Calories, and Sodium Content in Processed Foods From 2009 to 2015.

INTRODUCTION: Approximately 60% of the American diet comes from processed foods, which makes improving their nutritional quality important for Americans' health. The objective of this study was to measure changes in serving sizes, calories, and sodium in top-selling processed foods that were on the market in 2009 and 2015. METHODS: We analyzed products in the top 80% of sales in the 54 processed food categories with consistent serving sizes and sales metrics that were on the market in both 2009 and 2015. Mean serving size, calories (per serving and density), sodium (per serving and density), and sales were calculated for 2,979 branded processed food products. For each stratification of calorie density and sodium density (decreased, increased, or did not change), we calculated the mean serving size, calorie density, sodium density, and sales for each year. RESULTS: From 2009 to 2015, we found decreases in serving size (-2.3%, P < .001), calories per serving (-2.0%, P < .001), calorie density (-1.1%, P < .001), sodium per serving (-7.6%, P < .001), and sodium density (-6.0%, P < .001). A decrease in calorie density did not correspond to an increase in sodium density or vice versa. A decline in sales was observed regardless of whether calorie density or sodium density decreased, increased, or did not change. CONCLUSION: Reductions in calorie and sodium density occurred in tandem, suggesting that manufacturers reformulated for more than one health goal at the same time. Instead of unintended negative consequences of encouraging companies to reformulate for one nutrient, an overall net nutritional benefit occurred.

US Food Industry Progress During the National Salt Reduction Initiative: 2009-2014.

OBJECTIVES: To assess the US packaged food industry's progress from 2009 to 2014, when the National Salt Reduction Initiative had voluntary, category-specific sodium targets with the goal of reducing sodium in packaged and restaurant foods by 25% over 5 years. METHODS: Using the National Salt Reduction Initiative Packaged Food Database, we assessed target achievement and change in sales-weighted mean sodium density in top-selling products in 61 food categories in 2009 (n = 6336), 2012 (n = 6898), and 2014 (n = 7396). RESULTS: In 2009, when the targets were established, no categories met National Salt Reduction Initiative 2012 or 2014 targets. By 2014, 26% of categories met 2012 targets and 3% met 2014 targets. From 2009 to 2014, the sales-weighted mean sodium density declined significantly in almost half of all food categories (43%; 26/61 categories). Overall, sales-weighted mean sodium density declined significantly (by 6.8%; P < .001). CONCLUSIONS: National target setting with monitoring through a partnership of local, state, and national health organizations proved feasible, but industry progress was modest. PUBLIC HEALTH IMPLICATIONS: The US Food and Drug Administration's proposed voluntary targets will be an important step in achieving more substantial sodium reductions.