Sandwiches Are a Major Contributor to Dietary Sodium Intake

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Sandwiches Are a Major Contributor to Dietary Sodium Intake

Sandwiches account for one-fifth of total sodium intake, with nearly half of American adults consuming them on any given day, according to new study published in the Journal of the Academy of Nutrition and Dietetics
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Tuesday, October 7, 2014 - 9:00am

CONTENT: Press Release

Philadelphia, PA, October 7, 2014 /3BL Media/ – 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.”


Notes for editors
“Sandwiches are a major contributor of sodium in the diets of American adults: Results from What We Eat in America, NHANES 2009-2010,” by Rhonda Sebastian, MA; Cecilia Wilkinson Enns, MS, RD; Joseph D Goldman, MA; M. Katherine Hoy, EdD, RD; Alanna J Moshfegh, MS, RD, Journal of the Academy of Nutrition and Dietetics, DOI: 10.1016/j.jand.2014.07.034, published by Elsevier.

Full text of this article is available to credentialed journalists upon request. Contact Eileen Leahy at +1 732-238-3628 or to obtain copies. Journalists wishing to interview the authors should contact Rosalie Marion Bliss, USDA Agricultural Research Service Public Affairs Specialist, at +1 301-504-4318, 301-504-1486 (fax) or

An audio podcast featuring Rhonda Sebastian, MA, and Cecilia Wilkinson Enns, MS, RD, and information specifically for journalists are located at Excerpts from the audio may be reproduced by the media; contact Eileen Leahy to obtain permission.

About the Journal of the Academy of Nutrition and Dietetics
The official journal of the Academy of Nutrition and Dietetics (, the Journal of the Academy of Nutrition and Dietetics ( is the premier source for the practice and science of food, nutrition and dietetics. The monthly, peer-reviewed journal presents original articles prepared by scholars and practitioners and is the most widely read professional publication in the field. The Journal focuses on advancing professional knowledge across the range of research and practice issues such as: nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, food service systems, leadership and management and dietetics education.

About the Academy of Nutrition and Dietetics
The Academy of Nutrition and Dietetics (, formerly the American Dietetic Association, is the world’s largest organization of food and nutrition professionals. The Academy is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy.

About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirectScopusElsevier Research Intelligence and ClinicalKey — and publishes nearly 2,200 journals, including The Lancet and Cell, and over 25,000 book titles, including a number of iconic reference works.

The company is part of Reed Elsevier Group PLC, a world-leading provider of professional information solutions in the Science, Medical, Legal and Risk and Business sectors, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).

Media contact
Eileen Leahy
+1 732-238-3628

Ryan O’Malley
Academy of Nutrition and Dietetics
+1 800-877-1600, ext. 4769

Keywords: Health | Academy | Dietary Sodium | Dietetics | Education | Elsevier | journal | nutrition | sandwiches

CONTENT: Press Release