Trends in Sodium Content of Menu Items in Large Chain Restaurants in the U.S.

Introduction Consuming too much sodium is associated with increased risk for cardiovascular disease, and restaurant foods are a primary source of sodium. This study assessed recent trends in sodium content of menu items in U.S. chain restaurants. Methods Data from 21,557 menu items in 66 top-earning chain restaurants available from 2012 to 2016 were obtained from the MenuStat project and analyzed in 2017. Generalized linear models were used to examine changes in calorie-adjusted, per-item sodium content of menu items offered in all years (2012–2016) and items offered in 2012 only compared with items newly introduced in 2013, 2014, 2015, and 2016. Results Overall, calorie-adjusted sodium content in newly introduced menu items declined by 104 mg from 2012 to 2016 (p<0.02). However, the magnitude and direction of these changes varied by menu category and restaurant type; sodium content, particularly for main course items, was high. Sodium declined by 83 mg in fast food restaurants, 19 mg in fast casual restaurants, and 163 mg in full service restaurants. Sodium in appetizer and side items newly introduced in 2016 increased by 266 mg compared with items on the menu in 2012 only (p<0.01). Sodium in main courses newly introduced in 2016 declined by 124 mg compared with items on the menu in 2012 only (p=0.01), with the greatest decline, 207 mg (p=0.03), among salads. Conclusions Average, adjusted, per-item sodium content was lower in newly introduced items in large chain restaurants. However, sodium content of core and new menu items remain high, and reductions are inconsistent across menu categories and restaurant types.