Hypertension, a major risk factor for cardiovascular diseases, occurs among 29% of U.S. adults, and lowering excess sodium intake can reduce blood pressure. Eighty-nine percent of adults and over 90% of children exceeded recommendations for sodium intake. Among hypertensive adults, 86% exceeded 2,300 mg dietary sodium per day. To address the high prevalence of excess sodium consumption in the U.S. population, the Institute of Medicine (IOM) recommended reducing sodium in the food supply, as excess sodium added to foods during commercial processing and preparation represents the main source of sodium intake in U.S. diets.

Most adults and children in the United States exceed the 2015–2020 Dietary Guidelines for Americans recommendation for dietary sodium. Even among groups at higher risk for cardiovascular disease, including adults aged ≥51 years, blacks, and adults with prehypertension and hypertension, at least three out of four consumed more than 2,300 mg daily, increasing their potential risk of stroke and coronary heart disease mortality (2).

The high prevalence of excess sodium intake and the amount of sodium consumed per calorie in this report are generally consistent with previous reports including one that examined trends in sodium consumption during 2003–2010 in relation to the IOM Dietary Reference Intakes (DRIs) (5–7). This suggests that overall sodium consumption and the concentration of sodium in foods consumed have not changed over the past decade. The top sources of sodium in the U.S. diet include breads and rolls, deli meats, pizza, poultry, soups, sandwiches, cheese, pasta dishes, meat mixed dishes, such as meatloaf with tomato sauce, and savory snacks.§

During 2009–2012, despite some differences by age, sex, race/ethnicity, and hypertension status, the vast majority of Americans across all subpopulations exceeded recommendations for sodium intake. Compared with adults without hypertension, adults with hypertension consumed slightly less dietary sodium, which might indicate efforts to reduce sodium consumption among this group. However, 86% of adults with hypertension still consumed too much sodium. Compared with persons without hypertension, persons with hypertension can benefit even more from reduced sodium consumption (2). Physicians and other health care professionals can counsel their patients to lower sodium intake through following a healthy dietary pattern. One example is the Dietary Approaches to Stop Hypertension eating plan,¶ which emphasizes fruits, vegetables, and low-fat dairy products.

The findings in this report are subject to at least three limitations. First, NHANES data are subject to response bias, although the data are weighted for some nonresponse. Second, dietary data are subject to both recall bias and bias because of underreporting of foods or portion sizes. Finally, sodium intake estimates excluded salt added at the table and from dietary supplements and antacids, which account for about 5%–6% of sodium intake (4).

Given that the majority of the population consumes excess dietary sodium and one third of adults have hypertension (8), sodium reduction is an integral part of initiatives to prevent cardiovascular diseases, such as Million Hearts, which aims to prevent a million heart attacks and strokes by 2017,** CDC’s Sodium Reduction in Communities Program,†† and the National Sodium Reduction Initiative, coordinated by New York City, in which some corporations have pledged to reduce sodium content to meet targets for specific food categories.§§ Other initiatives to help consumers lower sodium intake include the U.S. Department of Agriculture Nutrition Standards for school meals and competitive foods, and the Department of Health and Human Services Health and Sustainability Guidelines for Federal Concessions and Vending Operations. Reducing sodium added to foods by food manufacturers and restaurants is a fundamental public health strategy for reducing the intake of sodium to levels consistent with the 2015–2020 Dietary Guidelines for Americans (4). Globally, 36 countries have engaged industry to lower sodium intake through the setting of voluntary sodium targets for foods and meals (9). In the United Kingdom, reduction in sodium intake with this approach was associated with substantial reductions in hypertension and cardiovascular disease deaths (10). Cardiovascular diseases remain the number one killer in the United States (8), and a multifaceted strategy, including changes in individual lifestyles and how foods are produced, might contribute to the reduction of sodium consumption by Americans of all ages. Morbidity and Mortality Weekly Report (MMWR)