SANDWICHES A MAJOR CONTRIBUTOR TO DIETARY SODIUM INTAKE
Sandwiches make up a
substantial part of the American diet and are a significant contributor to
daily energy and sodium intake. By closely analyzing data from the federal
nationwide dietary intake survey known as "What We Eat in America NHANES
2009-2010," a team of Department of Agriculture (USDA) researchers found
that on any given day 49 percent of U.S. adults eat at least one sandwich, and
sandwiches account for one-fifth of total daily sodium intake. The study was
conducted by USDA Agricultural Research Service (ARS) investigators at the Food
Surveys Research Group. ARS is USDA's chief intramural scientific research
agency and is partnering with the U.S. Department of Health and Human Services
in conducting the survey. The study findings were published in the Journal of the Academy of
Nutrition and Dietetics.
Sandwiches are a
mainstay of American cuisine, but they pose a challenge to survey researchers
since they can be comprised of a wide variety of different ingredients. In What
We Eat in America NHANES 2009-2010, participants reported everything they ate
and drank the previous day. Each food and beverage reported was then assigned
one or more food codes so that its nutrient content could be determined.
For most sandwiches,
participants reported the various components of their sandwich (such as bread
and fillings) individually. Those components were then coded separately with
multiple food codes that were linked to indicate they were eaten together as a
sandwich. For instance, a ham and cheese sandwich may have been coded as
specific amounts of bread, ham, cheese, lettuce, and mayonnaise. On the other
hand, some sandwiches, especially fast-food sandwiches, were coded using a
single food code (for instance, "turkey submarine sandwich, with cheese,
lettuce, tomato, and spread" or "bacon cheeseburger, ¼ lb meat, with
tomato and/or catsup, on bun").
Because previous
studies had defined sandwiches as only those that were represented by a single
food code, those analyses found that sandwiches only contributed about 4
percent of daily sodium intake. In this innovative study, investigators
broadened the sandwich definition by including sandwiches that were coded as
multiple ingredients as well as those coded using a single food code. By
including sandwiches coded both ways, researchers discovered that sandwiches
actually account for one-fifth of total sodium intake and that on any given day
nearly half of the adults in America aged 20 years and older eat a sandwich.
"In 2009-2010,
only about 20 percent of all sandwiches were represented by a single food
code," explains study co-author ARS nutritionist Rhonda Sebastian, MA.
"For that reason, previously published estimates of sandwich contributions
to sodium intake that were based on only single-code sandwiches are
considerably underestimated."
The 2010 Dietary
Guidelines for Americans recommend a maximum intake of 2,300 milligrams of
sodium per day. For certain groups -- adults over 50, African-Americans, and
those with certain medical conditions, such as high blood pressure, diabetes,
or chronic kidney disease -- the recommended amount is reduced to 1,500
milligrams per day. This study revealed that, for adults, sandwiches alone
contribute 30 percent of the less restrictive guideline and 46 percent of the
stricter guideline.
Researchers also found
that people who ate sandwiches had significantly higher energy intakes than
those who did not. Those who consumed a sandwich on the survey day took in, on
average, around 300 kilocalories more than those who did not report eating a
sandwich. Sandwich reporters also had higher total sodium intakes, averaging
around 600 milligrams per day higher than sandwich non-reporters.
"The
unanticipated finding that sandwich consumption is associated with higher
overall intake of energy underscores the importance of making healthful choices
of sandwich ingredients," says co-author ARS nutritionist Cecilia
Wilkinson Enns, MS, RD. "Many sandwiches, such as burgers and franks, and
common sandwich components, such as yeast breads, cheese, and cured meats, are
among the top contributors not only to sodium but also to energy in the diets
of adult Americans."
The study found that
the higher levels of sodium intake among sandwich reporters were linked to the
higher levels of daily energy consumption. "Regardless of sandwich
reporting status, sodium density was approximately 1,700-1,800 mg per 1,000
kilocalories, suggesting that the higher sodium levels of sandwich reports are
explained by their higher energy intake," states Sebastian.
As Americans search
for ways to improve their diets, taking another look at sandwiches may help
people make better choices and avoid consuming both too many calories and too
much sodium. "Though much national attention is appropriately focused on
reducing sodium in the food supply, consumer choices still play a vital
role," concludes Wilkinson Enns. "Due to sandwiches' frequent
consumption and considerable contributions to sodium intake, substituting
lower-sodium for higher-sodium ingredients in sandwiches could significantly
impact sodium intakes."
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