Researchers urge culturally tailored advice as sodium intake differs by race and ethnicity

While nearly all US adults consume more sodium than recommended, the sources and usage of this common ingredient vary significantly across different racial and ethnic groups, according to a recent study. The authors underscore the importance of culturally customized approaches to advise on sodium intake.

Excessive sodium consumption is a known contributor to increased risk of high blood pressure and cardiovascular disease. On average, the report reveals that US adults consume approximately 3,400 mg of sodium daily, far exceeding the American Heart Association’s recommendation of no more than 2,300 mg per day, or about one teaspoon of salt.

For individuals with high blood pressure, an ideal target is 1,500 mg of sodium per day, underscore the paper authors. Moreover, they say reducing daily sodium intake by just 1,000 mg can positively impact blood pressure and overall heart health.

“The World Health Organization calls sodium reduction one of the most cost-effective strategies for addressing chronic conditions such as heart disease. High sodium intake can even affect non-heart-related diseases like kidney disease,” says lead study author Jessica Cheng, Ph.D., a postdoctoral research fellow in epidemiology at the Harvard T. H. Chan School of Public Health in Boston, US.

“To lower sodium intake in diverse populations, researchers, health care professionals, and policymakers should help people understand the sodium content in packaged foods, restaurant meals, home cooking, and table salt while suggesting methods to cut their salt intake.”

Cultural cravings dictate sodium intake

The study, published in the Journal of the American Heart Association, analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2020, which is representative of the general US population. Participants self-reported their use of salt at the table and in cooking.

Key findings from the study include that pizza, soup, and chicken were among the top sources of sodium for adults across all racial and ethnic groups.

For Asian American adults, four unique cultural food sources contributed over 14% of their daily sodium intake: soy-based condiments (soy sauce), fish, fried rice and lo/chow mein, and stir-fry/soy-based sauce mixtures.

Mexican American adults identified Mexican mixed dishes like enchiladas, tamales, taquitos, gorditas, chimichangas, quesadillas, burrito bowls, fajitas, chiles rellenos, and chilaquiles as their top sources of sodium.

Among Black adults, chicken patties, nuggets, and tenders were notable top sources of sodium.

Disparities across demographics

Black adults reported the highest rates of “attempting to” lower sodium (67%) compared to white adults (44%). They also had the highest rates of receiving physician advice to lower sodium intake (35%), in contrast to 18% for Asian Americans.

Asian American adults were most likely to use salt while cooking, but least likely to use salt at the table. Assuming that rice was unsalted, the estimated daily sodium intake of Asian American adults reduced by approximately 325 mg.

“We may have been overestimating sodium intake among Asian Americans for the last decade by assuming that salt was added to rice. Past research found that Asian American adults and children had the highest sodium intake of all racial and ethnic groups,” Dr. Cheng notes.

“However, those analyses assumed that rice was cooked with salt. Culturally, not all Asians salt plain rice. If they don’t add salt to rice when cooking, then their sodium intake is among the lowest across all racial and ethnic groups.”

Tailored advice

Dr. Cheng offers practical advice for sodium reduction, suggesting dietary variation and increasing potassium-rich foods like vegetables. She also recommends considering salt substitutes that contain potassium for non-pregnant adults without kidney issues, noting that less than 4% of US adults currently use them despite their availability and affordability.

“Excess sodium intake is a critical driver of heart attacks and strokes in the US,” says Stephen Juraschek, M.D., Ph.D., FAHA, an American Heart Association expert volunteer not affiliated with the study.

“This study raises awareness of how sodium is introduced across cultural groups in the US Such knowledge is critical for health professionals counselling patients on how they can reduce sodium in their lives and within their families. Interventions targeting sodium reduction should account for differences among groups and tailor to patients’ unique needs.”

The paper acknowledges limitations, including its reliance on self-reported dietary data that may not always be accurate. Another drawback was that the study did not analyze different Asian American subgroups separately.

Additionally, while the “Hispanic” group was divided into “Mexican American” and “Other Hispanic,” further subgroup analysis for “Other Hispanic” was not possible.

The report authors also acknowledge that participants reported on their eating habits over the last 24 hours — aiming to minimize misremembering — and that it is possible that underestimated portion sizes were registered or certain food items were forgotten.

The paper builds on a growing body of research investigating the need for “culturally appropriate food choices.” In one previous study in Nutrients, scientists assessed carbohydrate quality against different diets and budgets, shedding light on these disparities.