Trends in Dietary Sodium Intake in the United States and the Impact of USDA Guidelines: NHANES 1999-2016.

Background: Moderation in sodium consumption is recommended to reduce morbidity and mortality; however, trends in intake and the impact of guidelines have not been examined.

Methods: Sodium intake data collected from 1999-2016 in the National Health and Nutrition Examination Surveys were analyzed. Trends in sodium intake for individuals aged 18 years or over and in subgroups based on age, sex, race and ethnicity, and sodium-sensitive chronic diseases were examined. Adherence to US Department of Agriculture guidelines was assessed. Multivariable regression analysis was performed to identify predictors of sodium intake from 2011-2016.

Results: A total of 47,509 individuals (median age = 44.0 years, 48.3% male) were included in the study. Median sodium consumption was 3232 mg per day (95% confidence interval [CI], 3210-3255), increasing from 3156 mg per day (95% CI 3,038-3,273) in 1999-2000 to 3273 mg per day (95% CI, 3218-3328) in 2015-2016 (P < .001). Intake declined with age (3427 mg per day for individuals aged 18-50 years, 3101 mg per day for individuals aged 51-70 years, and 2620 mg per day for individuals aged ≥71 years; P < .001) and was greater in males than in females (3827 mg per day vs 2778 mg per day; P < .001). Caucasians, Hispanics, and African Americans consumed 3278, 3117, and 3027 mg of dietary sodium per day respectively (P < .001). Individuals with hypertension, diabetes mellitus, and chronic kidney disease consumed 3073, 3062, and 2658 mg of dietary sodium per day respectively. Population adherence to US Department of Agriculture recommendations declined from 34% to 23% and all high-risk subgroups had < 10% adherence. Daily total calories was the strongest predictor of sodium consumption (overall r = 0.680).

Conclusion: Sodium intake has remained above recommended levels in all segments of the adult population and adherence to guidelines is poor. Novel interventions are needed to reduce sodium intake.