Understanding cultural differences in salt usage may help lower consumption

(Press-News.org) Research Highlights:

An analysis of data from a national health survey conducted before the pandemic found that pizza, soup and chicken are some of the main sources of sodium (salt) intake for people in all racial and ethnic groups. The study also showed clear differences among adults based on race and ethnicity. Asian American adults were more likely to add salt in cooking than white adults, Black adults and Mexican American adults. However, Asian Americans were the least likely group to add salt to their food at the table. In addition, Black adults reported the highest rates of attempting to reduce salt intake, as well as being the group most likely to have received a physician recommendation to lower sodium intake. Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, May 28, 2025

DALLAS, May 28, 2025 — Almost all adults in the U.S. consume more sodium (salt) than recommended, yet the sources and use of sodium vary among people of different races and ethnicities, indicating the need for culturally customized advice about sodium intake, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Consuming too much sodium can increase the risk of high blood pressure and cardiovascular disease. The average U.S. adult consumes about 3,400 mg of sodium each day, often in prepared foods, such as pizzas, tacos, burritos, cold cuts, canned soup and breads. According to the U.S. Department of Agriculture, one 6-inch Italian sub sandwich (bread, ham, cheese, salami, pepperoni) has approximately 3,110 mg of sodium.

The American Heart Association recommends that you eat no more than 2,300 mg of sodium each day, which is about one teaspoon of salt. Ideally, if you have high blood pressure, you should aim for 1,500 mg of sodium per day. If you cut your sodium intake by just 1,000 mg daily, it can help improve your 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,” said 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. “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.”

In this study, researchers examined data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 (pre-pandemic) to assess racial and ethnic differences in sodium intake. A secondary analysis was conducted to challenge the database assumption that Asian Americans add salt to rice.

Among the study's findings:

Pizza, soup and chicken were among the top sources of sodium among people in all racial and ethnic groups. Among Asian American adults, four culturally unique food sources accounted for more than 14% of daily sodium intake: soy-based condiments (soy sauce), fish, fried rice & lo/chow mein and stir-fry/soy-based sauce mixtures. Mexican mixed dishes like enchiladas, tamales, taquitos, pupusas, gorditas, chimichangas, quesadillas, burrito bowls, fajitas, chiles rellenos and chilaquiles were unique top sources of sodium for Mexican American adults. For Black adults, foods such as chicken patties, nuggets and tenders were among the top sources of sodium. Black adults reported the highest rates of “attempting to” lower sodium compared with white adults, 67% versus 44%, respectively, and they had the highest rates of receiving physician advice to lower sodium intake at 35% versus 18% for Asian Americans. Asian American adults were the most likely to use salt while cooking, yet they were the least likely to use salt at the table. When comparing estimates derived under the assumption that rice is salted, assuming rice is unsalted reduces the daily sodium intake of Asian American adults by approximately 325 mg per day. “We may have been over-estimating sodium intake among Asian Americans for the last decade by assuming that salt was added to rice,” said Cheng, who is also a postdoctoral research fellow in internal medicine at Massachusetts General Hospital. “Past research found that Asian American adults and children had the highest sodium intake of all racial and ethnic groups. 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.”

Cheng said that reducing sodium is good for everyone, and it doesn’t have to be difficult. “Based on these findings, I suggest varying your diet and adding more potassium-rich foods such as vegetables, which can also help reduce blood pressure. You don’t have to avoid pizza completely; eat it less often or try making it at home with low-sodium cheese, dough and tomato sauce you make from scratch.”

Cheng also suggested people consider a salt substitute to reduce sodium intake. “The World Health Organization recently recommended that non-pregnant adults without kidney issues opt for low-sodium salt substitutes that contain potassium. According to our analysis, which used the NHANES 2017-2020 pre-pandemic dataset, less than 4% of U.S. adults use salt substitutes despite their wide availability in U.S. supermarkets and relatively affordable cost. Talk to your health care professional before making this switch if you are concerned about your kidney function or medications that might affect kidney function,” she said.

American Heart Association expert volunteer and past member of the Association’s Nutrition Committee of the Lifestyle and Cardiometabolic Health Council Stephen P. Juraschek, M.D., Ph.D., FAHA, said, “Excess sodium intake is a critical driver of heart attacks and strokes in the U.S. This study raises awareness of how sodium is introduced across cultural groups in the U.S. 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.” Juraschek, who is not affiliated with the study, is an associate professor of medicine at Harvard Medical School and an associate professor of nutrition at Harvard T.H. Chan School of Public Health in Boston.

The study had some limitations. It depended on people describing their own eating habits, which may not always be accurate, however, participants reported what they ate in the last 24 hours, so it’s less likely that they misremembered their meals. However, they might still misreport for several reasons. They may struggle to estimate the portion sizes of their meals, not be aware of how the food was prepared, or forget to include some items, especially those that are easy to overlook, like ketchup on a hamburger. Also, the study did not analyze different Asian American subgroups separately. Researchers did separate the “Hispanic” group into “Mexican American” and “Other Hispanic” adults; however, they could not break down the “Other Hispanic” group into subgroups.

Study details, background and design:

Race and ethnicity were self-reported by participants. The analysis reviewed data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 public use dataset and is representative of the general U.S. population. Data were collected from 2017 to March 2020, which was the start of the COVID-19 pandemic. Dietary information was collected from participants using a 24-hour recall method, where they self-reported the foods they ate within the previous 24 hours. Participants also self-reported how often and the type of salt used at the table (i.e., regular iodized salt, sea salt, seasoning salts made with regular salt, lite salt/salt substitute) or if they did not use salt at the table. Almost all participants self-reported salt use (i.e., never, rarely, occasionally, very often) in cooking and food preparation. Co-authors, disclosures and funding sources are listed in the manuscript.

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Additional Resources:

Multimedia is available on the right column of release link including video clips with an American Heart Association volunteer expert offering perspective on the study. Spanish news release | Chinese news release (doc) After May 28, view the manuscript online. AHA health information: Why should I limit sodium? AHA health information: Salty Six Infographic AHA news release: Reducing sodium intake significantly lowered blood pressure in as little as one week (Nov. 2023) AHA news release: Heart-healthy, lower sodium version of traditional Chinese cuisine lowered blood pressure (July 2022) Follow AHA/ASA news on X @HeartNews Follow news from the Journal of the American Heart Association @JAHA_AHA ###

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