Addressing Childhood Obesity for Type 2 Diabetes Prevention: Challenges and Opportunities.

IN BRIEF Addressing the problem of childhood obesity is an important component of preventing type 2 diabetes. Although children and their families ultimately make decisions about diet, physical activity, and obesity management, many groups have a role in making these choices easier. They do this by providing families with tools and resources and by implementing policies and practices that support a healthy diet and physical activity in the places where children and their families spend their time. Diabetes educators are an important part of the solution.

Physical Inactivity Among Adults Aged 50 Years and Older - United States, 2014.

Physical activity can help delay, prevent, or manage many of the chronic diseases for which adults aged ≥50 years are at risk (1-3). These diseases can impact the length and quality of life, as well as the long-term ability to live independently.* All adults aged ≥50 years, with or without chronic disease, gain health benefits by avoiding inactivity (2,3). To examine the prevalence of inactivity by selected demographic characteristics and chronic disease status in mid-life and older adults, CDC analyzed data on adults aged ≥50 years from the 2014 Behavioral Risk Factor Surveillance System (BRFSS). Overall, 27.5% of adults aged ≥50 years reported no physical activity outside of work during the past month. Inactivity prevalence significantly increased with increasing age and was 25.4% among adults aged 50-64 years, 26.9% among those aged 65-74 years, and 35.3% among those aged ≥75 years. Inactivity prevalence was significantly higher among women than men, among Hispanics and non-Hispanic blacks than among non-Hispanic whites, and among adults who reported ever having one or more of seven selected chronic diseases than among those not reporting one. Inactivity prevalence significantly increased with decreasing levels of education and increasing body mass index. To help adults with and without chronic disease start or maintain an active lifestyle, communities can implement evidence-based strategies, such as creating or enhancing access to places for physical activity, designing communities and streets to encourage physical activity, and offering programs that address specific barriers to physical activity.

Trends and determinants of discretionary salt use: National Health and Nutrition Examination Survey 2003-2012.

OBJECTIVE: To examine temporal trends and determinants of discretionary salt use in the USA. DESIGN: Multiple logistic regression was used to assess temporal trends in discretionary salt use at the table and during home cooking/preparation, adjusting for demographic characteristics, using data from the National Health and Nutrition Examination Survey 2003-2012. Prevalence and determinants of discretionary salt use in 2009-2012 were also examined. SETTING: Participants answered salt use questions after completing a 24 h dietary recall in a mobile examination centre. SUBJECTS: Nationally representative sample of non-institutionalized US children and adults, aged ≥2 years. RESULTS: From 2003 to 2012, the proportion of the population who reported using salt 'very often' declined; from 18 % to 12 % for use at the table (P<0·01) and from 42 % to 37 % during home cooking (P<0·02). While one-third of the population reported never adding salt at the table, most used it during home cooking/preparation (93 %). Use of discretionary salt was least commonly reported among young children and older adults and demographic and health subgroups at risk of CVD. CONCLUSIONS: While most people reported using salt during home cooking/preparation, a minority reported use at the table. Reported 'very often' discretionary salt use has declined. That discretionary salt use is less common among those at risk of CVD suggests awareness of messages to limit Na intake.

US consumer attitudes toward sodium in baby and toddler foods.

Dietary data from a nationally representative survey indicate about 80% of US toddlers aged 1-3 years consume too much dietary sodium, which can influence their preference for salty foods in later life. Information on consumer attitudes can inform strategies to reduce sodium in baby and toddler foods. Data were obtained from a 2012 online survey sent to a sample of 11636 US adults aged ≥18 years enrolled in a national probability-based consumer panel; 6378 completed the survey and had non-missing responses to the question of interest, "It is important for baby and toddler foods to be low in sodium." Prevalence of agreement was estimated. Logistic regression was used to describe associations of respondent characteristics with agreement. The majority of respondents were non-Hispanic white and had a household income ≥$60,000. About 7 in 10 (68%, 95% CI: 66%-70%) respondents agreed it is important for baby or toddler foods to be low in sodium. More than 6 of 10 respondents in most subgroups agreed. Among parents with a child currently aged <2 years (N = 390), 82% agreed (95% CI: 77%-87%); the highest agreement included parents who thought sodium was very harmful to their own health (92%, 95% CI: 85%-99%) or who were watching/reducing their own sodium intake (95%, 95% CI: 90%-100%). After adjusting for sex, age, race-ethnicity, agreement was most strongly associated with being a parent of a child <2 years, thinking sodium was harmful, and watching/reducing sodium intake (adjusted odds ratios ≥ 2.5, 95% CI's ≠1.0). The majority of respondents including most parents agreed it is important for baby and toddler foods to be low in sodium, suggesting wide consumer support for strategies to lower sodium in these foods.

Vital signs: sodium intake among U.S. school-aged children - 2009-2010.

BACKGROUND: A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts. METHODS: Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6­18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009­2010. RESULTS: U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school­aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14­18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6­10 years or 11­13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%). IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%­50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75­150 mg per day and about 220­440 mg on days children consume school meals.

Monitoring the sodium content of restaurant foods: public health challenges and opportunities.

We reviewed methods of studies assessing restaurant foods' sodium content and nutrition databases. We systematically searched the 1964-2012 literature and manually examined references in selected articles and studies. Twenty-six (5.2%) of the 499 articles we found met the inclusion criteria and were abstracted. Five were conducted nationally. Sodium content determination methods included laboratory analysis (n = 15), point-of-purchase nutrition information or restaurants' Web sites (n = 8), and menu analysis with a nutrient database (n = 3). There is no comprehensive data system that provides all information needed to monitor changes in sodium or other nutrients among restaurant foods. Combining information from different sources and methods may help inform a comprehensive system to monitor sodium content reduction efforts in the US food supply and to develop future strategies.

Meeting the Healthy People 2030 Added Sugars Target.

INTRODUCTION: Many Americans exceed the dietary recommendations for added sugars. Healthy People 2030 set a population target mean of 11.5% calories from added sugars for persons aged ≥2 years. This paper describes the reductions needed in population groups with varying added sugars intake to meet this target using four different public health approaches. METHODS: Data from the 2015-2018 National Health and Nutrition Examination Survey (n=15,038) and the National Cancer Institute method were used to estimate the usual percentage calories from added sugars. Four approaches investigated lowering intake among (1) the general U.S. population, (2) people exceeding the 2020-2025 Dietary Guidelines for Americans recommendation for added sugars (≥10% calories/day), (3) high consumers of added sugars (≥15% calories/day), or (4) people exceeding the Dietary Guidelines for Americans recommendation for added sugars with two different reductions on the basis of added sugars intake. Added sugars intake was examined before and after reduction by sociodemographic characteristics. RESULTS: To meet the Healthy People 2030 target using the 4 approaches, added sugars intake needs to decrease by an average of (1) 13.7 calories/day for the general population; (2) 22.0 calories/day for people exceeding the Dietary Guidelines for Americans recommendation; (3) 56.6 calories/day for high consumers; or (4) 13.9 and 32.3 calories/day for people consuming 10 to <15% and ≥15% calories from added sugars, respectively. Differences in added sugars intake were observed before and after reduction by race/ethnicity, age, and income. CONCLUSIONS: The Healthy People 2030 added sugars target is achievable with modest reductions in added sugars intake, ranging from 14 to 57 calories/day depending on the approach.

The Macronutrient Content of Sodium-Modified Foods Is Unchanged Compared with Regular Counterparts: An Evaluation of Select Categories of Packaged Foods in the United States, 2018.

BACKGROUND: Lowering excess sodium in packaged foods is part of a public health strategy to reduce cardiovascular disease risk. Sales of foods with labeled sodium claims increased during the past decade. Yet, it is unclear whether sugars or fats were added during the reformulation of foods that might counter the benefits of sodium reduction. OBJECTIVE: It was hypothesized that the nutrient content of packaged foods with lower sodium label claims (ie, sodium-modified) would differ from their regular (ie, unmodified) counterparts. DESIGN: This cross-sectional study compared label data of 153 sodium-modified foods and 141 regular, matched counterparts within four food categories: soups, processed meats, vegetables, and savory snacks. Foods were identified by searching manufacturer websites of the top-10 brands in each category. Sodium, calories, total carbohydrate, sugar, protein, total fat, saturated fat, and potassium (when reported) were compared by labeled serving and per 100 g food. RESULTS: The average amount in milligrams of sodium per serving in regular foods ranged from 162 mg for savory snacks to 782 mg for soups. Compared with regular foods, the matched lower sodium foods had significantly less sodium per serving (-95 to -387 mg) and per 100 g (-184 to -462 mg) (P<0.01 for all comparisons), except for soups per 100 g (P = 0.166), and were similar to their regular counterparts in calories, total carbohydrate, sugar, protein, total fat, and saturated fat (P>0.05 for all comparisons). Of the soups that reported potassium on the label, potassium was 244 mg/serving (P=0.004) and 139 mg/100 g (P=0.002) higher among matched lower sodium soups. CONCLUSIONS: The similarity in macronutrient contents on the labels for sodium-modified foods and their regular counterparts suggests that reformulation did not include the addition of significant amounts of sugars, fats, or other macronutrients among major food brands in the selected categories. Potassium content and additional food categories deserve further investigation.

CDC's Active People, Healthy NationSM: Creating an Active America, Together.

Physical activity can reduce the risk of at least 20 chronic diseases and conditions and provide effective treatment for many of these conditions. Yet, physical activity levels of Americans remain low, with only small improvements over 20 years. The Centers for Disease Control and Prevention (CDC) considered what would accelerate progress and, as a result, developed Active People, Healthy NationSM, an aspirational initiative to improve physical activity in 2.5 million high school youth and 25 million adults, doubling the 10-year improvement targets of Healthy People 2020. Active People, Healthy NationSM will implement evidence-based guidance to improve physical activity through 5 action steps centered on core public health functions: (1) program delivery, (2) partnership mobilization, (3) effective communication, (4) cross-sectoral training, and (5) continuous monitoring and evaluation. To achieve wide-scale impact, Active People, Healthy NationSM will need broad engagement from a variety of sectors working together to coordinate activities and initiatives.

Sodium, sugar, and fat content of complementary infant and toddler foods sold in the United States, 2015.

Background: As part of a healthy diet, limiting intakes of excess sodium, added sugars, saturated fat, and trans fat has been recommended. The American Heart Association recommends that children aged <2 y should avoid added sugars.Objective: We sought to determine commercial complementary infant-toddler food categories that were of potential concern because of the sodium, added sugar, saturated fat, or trans fat content.Design: Nutrition label information (e.g., serving size, sodium, saturated fat, trans fat) for 1032 infant and toddler foods was collected from manufacturers' websites and stores from May to July 2015 for 24 brands, which accounted for >95% of infant-toddler food sales. The presence of added sugars was determined from the ingredient list. Reference amount customarily consumed (RACC) categories were used to group foods and standardize serving sizes. A high sodium content was evaluated on the basis of the Upper Intake Level for children aged 1-3 y and the number of potential servings per day ([i.e., 1500 mg/7 servings (>210 mg/RACC)], a sodium amount >200 mg/100 g, or a mean sodium density >1000 mg/1000 kcal.Results: In 2015, most commercial infant-only vegetables, fruit, dinners, and cereals were low in sodium, contained no saturated fat, and did not contain added sugars. On average, toddler meals contained 2233 mg Na/1000 kcal, and 84% of the meals had >210 mg Na/RACC (170 g), whereas 69% of infant-toddler savory snacks had >200 mg Na/100 g. More than 70% of toddler meals, cereal bars and breakfast pastries, and infant-toddler grain- or dairy-based desserts contained ≥1 sources of added sugar. Approximately 70% of toddler meals contained saturated fat (mean: 1.9 g/RACC), and no commercial infant-toddler foods contained trans fats.Conclusion: Most commercial toddler meals, cereal bars and breakfast pastries, and infant-toddler snacks and desserts have high sodium contents or contain added sugars, suggesting a need for continued public health efforts to support parents in choosing complementary foods for their infants and toddlers.

Sodium Intake among US School-Aged Children: National Health and Nutrition Examination Survey, 2011-2012.

BACKGROUND: Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake, which occurs among 90% of US school-aged children. OBJECTIVE: To describe major food sources, places obtained, and eating occasions contributing to sodium intake among US school-aged children. DESIGN: Cross-sectional analysis of data from the 2011-2012 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING: A nationally representative sample of 2,142 US children aged 6 to 18 years who completed a 24-hour dietary recall. MAIN OUTCOME MEASURES: Population proportions of sodium intake from major food categories, places, and eating occasions. STATISTICAL ANALYSES PERFORMED: Statistical analyses accounted for the complex survey design and sampling. Wald F tests and t tests were used to examine differences between subgroups. RESULTS: Average daily sodium intake was highest among adolescents aged 14 to 18 years (3,565±120 mg), lowest among girls (2,919±74 mg). Little variation was seen in average intakes or the top five sodium contributors by sociodemographic characteristics or weight status. Ten food categories contributed to almost half (48%) of US school-aged children's sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. More than 80 food categories contributed to the other half of children's sodium intake. Foods obtained from stores contributed 58% of sodium intake, fast-food/pizza restaurants contributed 16%, and school cafeterias contributed 10%. Thirty-nine percent of sodium intake was consumed at dinner, 31% at lunch, 16% from snacks, and 14% at breakfast. CONCLUSIONS: With the exception of plain milk, which naturally contains sodium, the top 10 food categories contributing to US schoolchildren's sodium intake during 2011-2012 comprised foods in which sodium is added during processing or preparation. Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the US food supply.

Do Lower Calorie or Lower Fat Foods Have More Sodium Than Their Regular Counterparts?

The objective of this study was to compare the sodium content of a regular food and its lower calorie/fat counterpart. Four food categories, among the top 20 contributing the most sodium to the US diet, met the criteria of having the most matches between regular foods and their lower calorie/fat counterparts. A protocol was used to search websites to create a list of "matches", a regular and comparable lower calorie/fat food(s) under each brand. Nutrient information was recorded and analyzed for matches. In total, 283 matches were identified across four food categories: savory snacks (N = 44), cheese (N = 105), salad dressings (N = 90), and soups (N = 44). As expected, foods modified from their regular versions had significantly reduced average fat (total fat and saturated fat) and caloric profiles. Mean sodium content among modified salad dressings and cheeses was on average 8%-12% higher, while sodium content did not change with modification of savory snacks. Modified soups had significantly lower mean sodium content than their regular versions (28%-38%). Consumers trying to maintain a healthy diet should consider that sodium content may vary in foods modified to be lower in calories/fat.

Sodium and sugar in complementary infant and toddler foods sold in the United States.

OBJECTIVES: To evaluate the sodium and sugar content of US commercial infant and toddler foods. METHODS: We used a 2012 nutrient database of 1074 US infant and toddler foods and drinks developed from a commercial database, manufacturer Web sites, and major grocery stores. Products were categorized on the basis of their main ingredients and the US Food and Drug Administration's reference amounts customarily consumed per eating occasion (RACC). Sodium and sugar contents and presence of added sugars were determined. RESULTS: All but 2 of the 657 infant vegetables, dinners, fruits, dry cereals, and ready-to-serve mixed grains and fruits were low sodium (≤140 mg/RACC). The majority of these foods did not contain added sugars; however, 41 of 79 infant mixed grains and fruits contained ≥1 added sugar, and 35 also contained >35% calories from sugar. Seventy-two percent of 72 toddler dinners were high in sodium content (>210 mg/RACC). Toddler dinners contained an average of 2295 mg of sodium per 1000 kcal (sodium 212 mg/100 g). Savory infant/toddler snacks (n = 34) contained an average of sodium 1382 mg/1000 kcal (sodium 486 mg/100 g); 1 was high sodium. Thirty-two percent of toddler dinners and the majority of toddler cereal bars/breakfast pastries, fruit, and infant/toddler snacks, desserts, and juices contained ≥1 added sugar. CONCLUSIONS: Commercial toddler foods and infant or toddler snacks, desserts, and juice drinks are of potential concern due to sodium or sugar content. Pediatricians should advise parents to look carefully at labels when selecting commercial toddler foods and to limit salty snacks, sweet desserts, and juice drinks.

Iodized salt sales in the United States.

Iodized salt has been an important source of dietary iodine, a trace element important for regulating human growth, development, and metabolic functions. This analysis identified iodized table salt sales as a percentage of retail salt sales using Nielsen ScanTrack. We identified 1117 salt products, including 701 salt blends and 416 other salt products, 57 of which were iodized. When weighted by sales volume in ounces or per item, 53% contained iodized salt. These findings may provide a baseline for future monitoring of sales of iodized salt.

Sodium content in major brands of US packaged foods, 2009.

BACKGROUND: Most Americans consume more sodium than is recommended, the vast majority of which comes from commercially packaged and restaurant foods. In 2010 the Institute of Medicine recommended that manufacturers reduce the amount of sodium in their products. OBJECTIVE: The aim was to assess the sodium content in commercially packaged food products sold in US grocery stores in 2009. DESIGN: With the use of sales and nutrition data from commercial sources, we created a database with nearly 8000 packaged food products sold in major US grocery stores in 2009. We estimated the sales-weighted mean and distribution of sodium content (mg/serving, mg/100 g, and mg/kcal) of foods within food groups that contribute the most dietary sodium to the US diet. We estimated the proportion of products within each category that exceed 1) the Food and Drug Administration's (FDA's) limits for sodium in foods that use a "healthy" label claim and 2) 1150 mg/serving or 50% of the maximum daily intake recommended in the 2010 Dietary Guidelines for Americans. RESULTS: Products in the meat mixed dishes category had the highest mean and median sodium contents per serving (966 and 970 mg, respectively). Products in the salad dressing and vegetable oils category had the highest mean and median concentrations per 100 g (1072 and 1067 mg, respectively). Sodium density was highest in the soup category (18.4 mg/kcal). More than half of the products sold in 11 of the 20 food categories analyzed exceeded the FDA limits for products with a "healthy" label claim. In 4 categories, >10% of the products sold exceeded 1150 mg/serving. CONCLUSIONS: The sodium content in packaged foods sold in major US grocery stores varied widely, and a large proportion of top-selling products exceeded limits, indicating the potential for reduction. Ongoing monitoring is necessary to evaluate the progress in sodium reduction.

Top sources of dietary sodium from birth to age 24 mo, United States, 2003-2010.

BACKGROUND: Sodium intake is high in US children. Data are limited on the dietary sources of sodium, especially from birth to age 24 mo. OBJECTIVE: We identified top sources of dietary sodium in US children from birth to age 24 mo. DESIGN: Data from the NHANES 2003-2010 were used to examine food sources of sodium (population proportions and mean intakes) in 778 participants aged 0-5.9 mo, 914 participants aged 6-11.9 mo, and 1219 participants aged 12-23.9 mo by sociodemographic characteristics. RESULTS: Overall, mean dietary sodium intake was low in 0-5.9-mo-old children, and the top contributors were formula (71.7%), human milk (22.9%), and commercial baby foods (2.2%). In infants aged 6-11.9 mo, the top 5 contributors were formula (26.7%), commercial baby foods (8.8%), soups (6.1%), pasta mixed dishes (4.0%), and human milk (3.9%). In children aged 12-23.9 mo, the top contributors were milk (12.2%), soups (5.4%), cheese (5.2%), pasta mixed dishes (5.1%), and frankfurters and sausages (4.6%). Despite significant variation in top food categories across racial/ethnic groups, commercial baby foods were a top food contributor in children aged 6-11.9 mo, and frankfurters and sausages were a top food contributor in children aged 12-23.9 mo. The top 5 food categories that contributed to sodium intake also differed by sex. Most of the sodium consumed (83-90%) came from store foods (e.g., from the supermarket). In children aged 12-23.9 mo, 9% of sodium consumed came from restaurant foods, and 4% of sodium came from childcare center foods. CONCLUSIONS: The vast majority of sodium consumed comes from foods other than infant formula or human milk after the age of 6 mo. Although the majority of sodium intake was from store foods, after age 12 mo, restaurant foods contribute significantly to intake. Reducing the sodium content in these settings would reduce sodium intake in the youngest consumers.

Consumer sentiment on actions reducing sodium in processed and restaurant foods, ConsumerStyles 2010.

BACKGROUND: Current recommendations target sodium reduction in the food supply and intake; however, information is limited on consumer readiness for these actions. PURPOSE: Prevalence and determinants of consumer agreement for government restriction of manufacturers and restaurants putting excess salt in food and support for policies limiting sodium content of quick service restaurant (QSR) foods were examined. METHODS: Data were analyzed from 9,579 adults aged ≥18 years who responded to consumer readiness for sodium reduction questions in the 2010 ConsumerStyles survey. Responses were collapsed into three categories. Consumer agreement was determined and logistic regression was used to estimate ORs. Analyses were conducted in 2012. RESULTS: The majority of consumers agree that it is a good idea for government to restrict food manufacturers (55.9%) from putting excess salt in foods. About half agreed that it is a good idea for government to restrict restaurants from putting excess salt in foods and 81.5% supported sodium reduction policies in QSRs. Odds of agreement/support were higher for non-Hispanic blacks compared with non-Hispanic whites, and those with incomes <$40,000 compared with ≥$60,000. Those reporting "neutral" or "yes" to wanting to eat a diet low in sodium were more likely to agree/support government action compared to those answering "no." CONCLUSIONS: Nearly half of consumers agree with government actions to reduce sodium in manufactured and restaurant foods, with even greater support for QSRs. These findings could inform industry and public health partners about consumer preferences to lower the sodium content of the food supply.

Consumer Support for Policies to Reduce the Sodium Content in School Cafeterias.

Purpose/Objectives: The objective of this study was to assess consumer support for policies lowering the sodium content of cafeteria foods in schools. Methods: Data were used from 9,634 adults aged ≥18 years who responded to questions about sodium in general and in school foods in a 2010 national mail panel survey. Prevalence of consumer support was determined and logistic regression was used to estimate odds ratios. Results: Ninety percent (95% CI: 89.1%-90.8%) of respondents support policies that lower sodium content of cafeteria foods in schools. Support for policies was =78% for all subgroups examined. The odds of support were higher for females, non-Hispanic blacks and Hispanics compared with non-Hispanic whites and respondents who reside in the Northeast compared with the South. Those reporting "neutral" or "yes" to wanting to eat a diet low in sodium were more likely to support policies compared with those answering "no." In addition, the odds of support were higher for those with incomes between $40,000 and $59,999 compared to =$60,000 and those with self-reported high blood pressure. Applications to Child Nutrition Professionals: Results suggest most adults support policies that lower sodium content of cafeteria foods in schools. School nutrition staff can leverage this support by promoting the healthy changes to school meals to parents and community members and communicating how the school meals contribute to healthful eating behaviors. Additional strategies for change include working with school nutrition stakeholders to adopt and implement strong nutrition standards for all school foods and engaging students to help identify lower sodium recipes that they enjoy.