Use of Sodium Information on the Nutrition Facts Label in New York City Adults with Hypertension

doi:10.1016/j.jand.2014.08.027

Journal of the Academy of Nutrition and Dietetics

Volume 115, Issue 2, February 2015, Pages 278-283

https://doi.org/10.1016/j.jand.2014.08.027 Get rights and content

Abstract

The Nutrition Facts (NF) label was established to help individuals monitor their nutrient intake and select healthier foods. This tool is particularly useful for individuals for whom dietary improvements are recommended, such as those with hypertension. Study objectives were to examine the independent association between hypertension and frequency of use of the NF label for sodium information and determine whether frequent use in individuals with hypertension was associated with differences in mean sodium intake assessed through 24-hour urine samples. Data came from the New York City Community Health Survey Heart Follow-Up Study, a cross-sectional study conducted in 2010 in a representative sample of New York City adults (n=1,656). Participants were asked questions regarding frequency of checking the NF label and also had 24-hour urine samples collected to assess actual sodium intake. Results indicated that hypertension was associated with frequent use of the NF label for sodium information (adjusted odds ratio 1.71, 95% CI 1.07 to 2.73). In individuals with hypertension, sodium intake did not differ between frequent vs nonfrequent use of the NF label for sodium information (3,084 mg/day vs 3,059 mg/day; P=0.92). Although individuals with hypertension compared to those with no hypertension had 71% higher odds of frequently using the NF label for sodium information, suggesting they may be interested in decreasing sodium intake, sodium intake did not differ by frequency of NF label use among those with hypertension. Future research should explore strategies to ensure that when nutrition information is used, it is translated into meaningful results, especially in individuals with health concerns such as hypertension.

Section snippets

Study Design

Data for this analysis came from the New York City Community Health Survey (CHS) Heart Follow-Up Study (HFUS), a cross-sectional study conducted in 2010 to assess population-based sodium intake from a representative sample of New York City adults. Details of the study can be found in the comprehensive methodology report.¹⁵ Study participants were recruited from the CHS, an annual telephone survey conducted by the New York City Health Department that includes 8,000 to 10,000 adult New Yorkers.¹⁶

Results and Discussion

The age-adjusted prevalence of self-reported hypertension in the New York City adult population was 29.2%. Those with hypertension tended to be older, women, black, have lower incomes, have lower levels of educational attainment, report a less-healthful diet, and report having other CVD comorbidities compared with those without hypertension (Table 1).

Use of the NF label did not differ by hypertension status: 78.7% of individuals with and 82.3% of those without hypertension reported use of the

Conclusions

Hypertension, a major risk factor for CVD, was associated with frequent use of the NF label for sodium information, suggesting that individuals with hypertension report engaging in behaviors to improve their health. However, among those with hypertension, frequent use of the NF label for sodium information was not associated with lower mean sodium intake using measured biomarker data. Therefore, although the NF label provides valuable information to consumers, additional research is needed to

T. Elfassy is a student in the doctorate degree program, Department of Public Health, University of Miami Miller School of Medicine, Miami, FL; at the time of the study, she was a research scientist, Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Long Island City, NY.

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Nutrition Label Use Is Related to Chronic Conditions among Mexicans: Data from the Mexican National Health and Nutrition Survey 2016
2020, Journal of the Academy of Nutrition and Dietetics
Citation Excerpt :
These results are contradictory to ours, one of the reasons might be that they evaluated the Nutrition Facts label and the present study evaluated the nutrition labeling system, including the Daily Food Guidelines displayed on the front of the package. Regarding hypertension, we did not find statistically significant results, but the study that mentioned that hypertension was associated with frequent label use assessed the Nutrition Facts label.57 Furthermore, the few studies that have examined this relationship were performed in countries like the United States and France.19,38,45,46
Non-communicable diseases, such as obesity, diabetes, and hypertension, can be prevented and treated through a balanced nutrient-rich diet. Nutrition labels have been recognized as crucial to preventing obesity and non-communicable diseases through a healthier diet.
Our aim was to examine the association between nutrition label use and chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension) among an adult Mexican population.
This was a cross-sectional study that used data from the Mexican National Health and Nutrition Survey of 2016 (ENSANUT MC 2016).
The participants were 5,013 adults aged 20 to 70 years old. Older adults (>70 years), illiterate participants, pregnant women, and participants with implausible blood pressure data were excluded from the sample. The survey was conducted from May to August 2016 in the participants’ households.
We measured chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension).
Pearson χ² test was used to examine the associations among the use of nutrition labels and sociodemographic characteristics and chronic conditions. Multiple logistic regression was used to determine the association between nutrition label use and chronic conditions adjusting for the effect of confounding variables like sex, age, body mass index, education level, marital status, ethnicity, residence area, region, and socioeconomic status.
From the total sample, 40.9% (95% CI 38.4% to 43.8%) reported using nutrition labeling. Respondents with overweight or obesity were less likely to use nutrition labels (odds ratio 0.74; P<0.05). Participants who self-reported diabetes had significantly lower odds of nutrition label use than participants who did not report to have diabetes (odds ratio 0.66; P<0.05). Participants having 3 chronic conditions had lower odds of nutrition label use (odds ratio 0.34; P<0.01) relative to having zero chronic conditions.
This study suggests an association between nutrition label use and chronic conditions (obesity and diabetes). These findings demonstrate that people with obesity, diabetes, and a combination of chronic conditions were less likely to use nutrition labels than people without these conditions.
Nutrition Label Use and Sodium Intake in the U.S.
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Similarly, nutrition labeling, a widely used population-level public health intervention to promote a healthy diet, has not been shown to be efficacious in reducing sodium intake or the consumption of high-sodium foods.10,11 A few studies based on regional data have shown limited effects of nutrition label use on sodium consumption, however, particularly for people with diabetes or hypertension.11,27,29 Public health professionals and policymakers are in need of stronger evidence supporting the usefulness of nutrition labels in influencing sodium consumption.
High sodium intake is a major risk factor for hypertension, but evidence is limited on which interventions are effective in reducing sodium consumption. This study examined the associations between frequent use of nutrition labels and daily sodium intake and the consumption of high-sodium foods in the U.S.
Using the 2007–2008 and 2009–2010 Flexible Consumer Behavior Survey, this study compared sodium intake measured from the 24-hour dietary recalls, availability of salty snacks at home, and frequencies of eating frozen meals/pizzas between frequent (i.e., always or most of the time) and infrequent nutrition label users. Also, the study examined the association between nutrition label use and sodium-related dietary behaviors across different demographic and socioeconomic groups. Data were analyzed in 2016.
Frequent users of nutrition labels consumed 92.79 mg less sodium per day (95% CI= −160.21, −25.37), were less likely to always or most of the time have salty snacks available at home (OR=0.86, 95% CI=0.76, 0.97), but were just as likely to eat frozen meals or pizzas (incidence rate ratio=0.96, 95% CI=0.84, 1.08) compared with infrequent label users. The associations between nutrition label use and sodium intake differed considerably across age, gender, and socioeconomic groups.
Frequent use of nutrition labels appears to be associated with lower consumption of sodium and high-sodium foods in the U.S. Given this small reduction, interventions such as enhancing nutrition label use could be less effective if implemented without other strategies.
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S. Yi is an assistant professor, Department of Population Health, New York University School of Medicine, New York, NY; at the time of the study, she was director, Data and Analytics, Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Long Island City, NY.

D. Eisenhower is retired; at the time of the study, she was director, Survey Unit, Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Long Island City, NY.

At the time of the study, A. Lederer was director, Nutrition Strategy Program, Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Long Island City, NY.

C. J. Curtis is assistant commissioner, Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Long Island City, NY.

: STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

: FUNDING/SUPPORT The Heart Follow-Up Study was made possible by funding from the Robert Wood Johnson Foundation, the New York State Health Foundation, the National Association of County & City Health Officials, the Centers for Disease Control and Prevention (grant no. 5U38HM000449-02), the W.K. Kellogg Foundation, and the US Department of Health and Human Services. This funding is administered by the Fund for Public Health in New York, a private nonprofit organization that supports innovative initiatives of the New York City Department of Health and Mental Hygiene. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the funders. The New York City Department of Health and Mental Hygiene staff were involved in the study design; collection, analysis, and interpretation of the data; writing of the manuscript; and the decision to submit the manuscript for publication. Outside funders were not involved.

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ResearchResearch and Professional BriefsUse of Sodium Information on the Nutrition Facts Label in New York City Adults with Hypertension

Abstract

Section snippets

Study Design

Results and Discussion

Conclusions

Can J Cardiol

Am J Clin Nutr

J Am Diet Assoc

Am J Prev Med

Am J Prev Med

Deaths: Final data for 2010

Natl Vital Stat Rep

Effects on blood pressure of reduced dietary sodium and the Dietary Approaches Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group

N Engl J Med

Primary prevention of hypertension: Clinical and public health advisory from The National High Blood Pressure Education Program

JAMA

New food label to enhance healthful diets

JAMA

Who uses nutrition labeling, and what effects does label use have on diet quality?

J Nutr Educ

Hold the salt! Effects of sodium information provision, sodium content, and hypertension on perceived cardiovascular disease risk and purchase intentions

J Public Policy Market

Sodium consumption among hypertensive adults advised to reduce their intake: National Health and Nutrition Examination Survey, 1999-2004

J Clin Hypertens

Research
Research and Professional Briefs
Use of Sodium Information on the Nutrition Facts Label in New York City Adults with Hypertension