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Published in final edited form as: Appl Physiol Nutr Metab. 2016 Apr 26;41(6):684–690. doi: 10.1139/apnm-2015-0617

Examination of food industry progress in reducing the sodium content of packaged foods in Canada: 2010 to 2013

JoAnne Arcand 1, Katherine Jefferson 2, Alyssa Schermel 3, Ferdeela Shah 4, Susan Trang 5, Daniela Kutlesa 6, Wendy Lou 7, Mary R L’Abbe 8,
PMCID: PMC4891191  CAMSID: CAMS5554  PMID: 27113326

Abstract

In 2010, as part of a national sodium reduction strategy, Canada published sodium reduction benchmark targets for packaged foods; however, no evaluation of this policy has occurred. The objective was to evaluate changes in the sodium content of packaged foods, identify categories reduced in sodium and determine the proportion meeting Health Canada’s sodium reduction benchmarks. This was a cross-sectional analysis of Canadian packaged foods in 2010 and 2013 (n=10,487 and n=15,394, respectively). Sodium content was obtained from the Nutrition Facts table. Overall, 16.2% of food categories had significantly reduced sodium levels. The greatest shifts in the distribution of sodium within food categories occurred in (mean ± standard deviation, mg/100g) imitation seafood (602±50 to 444±81, 26.2%, p=0.002), condiments (1309±790 to 1048±620, 19.9%, p=0.005), breakfast cereals (375±26 to 301±242, 19.7%, p=0.001), canned vegetables/legumes (269±156 to 217±180, 19.3%, p<0.001), plain chips (462±196 to 376±198, 18.6% p=0.004), hot cereals (453±141 to 385±155, 15.0%, p=0.011), meat analogues (612±226 to 524±177, 14.4%, p=0.003), canned condensed soup (291±62 to 250±57, 14.1%, p=0.003), and sausages and wieners (912±219 to 814±195, 10.7%, p=0.012). The proportion of foods meeting at least one of the three phases of the sodium reduction benchmark targets slightly increased (51.4% to 58.2%) and the proportion exceeding maximum benchmark levels decreased (25.2% to 20.8%). These data provide a critical evaluation of changes in sodium levels in the Canadian food supply. Although progress in reducing sodium in packaged foods is evident, the food industry needs to continue efforts in reducing the sodium in the foods they produce.

Keywords: sodium, sodium reduction, food supply, food industry, diet, policy

INTRODUCTION

Population-wide dietary sodium reduction is a public health priority worldwide (Beaglehole R et al. 2011), due to the adverse cardiovascular and cerebrovascular outcomes associated with excess sodium consumption (Aburto et al. 2013; Institute of Medicine 2015). To address the health and economic burden of excess sodium, the United Nations has set a target for countries to reduce dietary salt intake by 30% by 2025 (WHO 2012). The average daily sodium intake in Canada is 3400 mg/day, which is more than two times higher than the recommended Adequate Intake level of 1500 mg and well above the Tolerable Upper Level of 2300 mg (Garrigeut 2007). Since most dietary sodium is derived from packaged and prepared foods, interventions to lower sodium in these foods is considered one of the most effective and equitable strategy to reduce sodium intakes (Fischer et al. 2009).

In 2010, a multi-stakeholder Sodium Working Group published Canada’s Sodium Reduction Strategy. The Strategy included recommendations directed at the food supply, education and awareness, and research initiatives. The interim goal was to reduce average sodium consumption to 2300 mg/day by 2016 in the majority of the Canadian population (Sodium Working Group 2010). There were 10 food supply recommendations, including Recommendation 1-1: “The Working Group recommends that Health Canada continue to work with the food industry to establish voluntary sodium reduction targets by food category”, to guide voluntary, incremental sodium reduction in packaged foods. Following a public consultation period, Health Canada published a set of benchmark targets to guide this process (Health Canada 2012).

Although the sodium reduction benchmark targets exist in Canada, the Sodium Working Group was disbanded prior to implementation of an evaluation framework, which was part of the Sodium Working Group’s Terms of Reference. Therefore, there is currently no federal or provincial sodium-monitoring program to track the food industry’s progress. Although sodium reduction efforts occurring globally, most published studies report on changes in sodium in a few, pre-selected food categories (Dunford et al 2011; Trevena et al. 2014; Christoforou et al 2013) or selected foods (Jacobson et al 2013). There are no known comprehensive evaluations across a broad range of food categories that contribute significant amounts of sodium, which would give an indication of areas of success and challenge across a variety of sectors of the food supply. Therefore, the purpose of this study was to comprehensively assess changes in sodium levels in packaged foods sold in Canada from 2010 to 2013, particularly to determine changes in the distribution of sodium from 2010 to 2013 within foods categories, to assess the proportion of food categories that have had changes in sodium, and to examine food industry progress in meeting Health Canada’s sodium reduction benchmark targets.

MATERIALS AND METHODS

This analysis utilized two cross-sectional datasets that are part of the University of Toronto Food Label Information Program (FLIP) database (Schermel et al. 2013). The database contains the nutrition information on a national sample of packaged foods and beverages that was systematically collected from February 2010 to April 2011 (n=10,487) and from May 2013 to September 2013 (n=15,394). Data included national and private-label brand foods from the four largest Canadian grocery chains, accounting for approximately 75% of food retail sales (Mintel International 2013). Products with multiple package sizes were captured only once. Data entered into the database included the Nutrition Facts table information, company, brand, price, container size, date and location of collection, and nutrition marketing information. The Canadian Nutrient File was used to create recipes so that food products could be reported, “as consumed”. Recipes were used so that like-products sold in different forms could be compared in an “as consumed” form in the same food category (i.e., so that baked cakes could be compared to dry mix cakes), which allows for accurate comparisons of sodium content when in a standardized format by food weight (mg sodium/100 g). Quality assurance procedures were implemented to ensure data quality and a protocol was developed to ensure consistency in classifications, weight conversions and recipes between the 2010–11 and 2013 datasets.

Assessment of Sodium Levels

The sodium content in foods was obtained from the Nutrition Facts table (mg/serving) and was converted to standardized units (mg/100g). Health Canada’s document “Guidance for the Food Industry on Reducing Sodium in Processed Foods” guided the classification of foods into food group categories, major subcategories and minor subcategories (Arcand et al. 2014; Health Canada 2012). Health Canada did not develop sodium reduction benchmarks for foods without a high sodium content or that did not contribute significantly to Canadian sodium intakes (i.e., fruit juices, dried pasta or rice without sauces or seasonings) (Health Canada 2012); therefore, the current analysis excluded these foods.

Statistical Analysis

Continuous variables were presented as mean and standard deviations. Percentiles were calculated for each food category and subcategory. Changes in the distribution of sodium between 2010 and 2013 were examined using the Kolmogorov-Smirnov test. To calculate the overall proportion of categories that had statistically significant changes in sodium, we counted major subcategories and minor subcategories, taking steps to ensure categories/foods were not double counted i.e., all minor subcategories and major subcategories without minor subcategories were included (n=105 categories overall). Categorical variables were presented as frequencies and percentages. Health Canada’s sodium reduction benchmarks include two interim benchmark target levels (Phase 1 and 2), a 2016 goal level (Phase 3), and a maximum level for each food category (Health Canada 2012). Standardized units (mg/100g) were used to determine the proportion of products meeting the phased benchmarks and the maximum levels. All analyses were conducted using SAS version 9.4 (SAS Institute Inc., Cary, NC).

RESULTS

Changes in the distribution of sodium between 2010 and 2013

The analysis overall included 16,105 packaged foods from 2010 (n=6,918) and 2013 (n=9,199) in 12 major food categories, which were further divided into major subcategories and minor subcategories for detailed analyses. On examination of the distribution of sodium levels between 2010 and 2013, 16.2% of food categories had statistically significant decreases in sodium, 1.9% had statistically significant increases in sodium, and 81.9% of food categories had no change in sodium (Supplementary Table S1). Statistically significant changes from 2010 to 2013 occurred in (presented as mean ± SD, mg/100g): imitation and simulated seafood (602 ± 50 to 444 ± 81; 26.2% reduction, p=0.002), condiments (1309 ± 790 to 1048 ± 620; 19.9% reduction, p=0.005), ready-to-eat breakfast cereals (375 ± 246 to 301 ± 242; 19.7% reduction, p=0.001), canned vegetables and legumes (269 ± 156 to 217 ± 180; 19.3% reduction, p<0.001), plain chips (462 ± 196 to 376 ± 198; 18.6% reduction, p=0.004), instant hot cereals (453 ± 141 to 385 ± 155; 15.0% reduction, p=0.011), meat analogues (612 ± 226 to 524 ± 177; 14.4% reduction, p=0.003), canned condensed soup (291 ± 62 to 250 ± 57; 14.1% reduction, p=0.003), sausages and wieners (912 ± 219 to 814 ± 195; 10.7% reduction, p=0.012), granola and cereal bars (279 ± 108 to 254 ± 99; 9.0% reduction, p=0.020), fresh and frozen meat and poultry (535 ± 228 to 496 ± 323; 7.3% reduction, p=0.001), shelf-stable mixed dishes (330 ± 114 to 308 ± 111; 6.7% reduction, p=0.002), packaged bread products (448 ± 125 to 418 ± 129; 6.6% reduction, p=0.012) and pizza (529 ± 121 to 494 ± 118; 6.7% reduction, p=0.018) (Table 1, Supplementary Table S1). Median sodium levels showed similar trends.

Table 1.

Changes in the sodium content of Canadian packaged foods from 2010 to 2013

Year n Mean Sodium (mg/100g) Sodium Percentiles (mg/100g) Mean %Δ p value1
Min 10th 25th 50th 75th Max
BAKERY PRODUCTS
Packaged Bread Products 2010 379 448 ± 125 11 298 368 446 521 976 −6.7 0.012
2013 445 418 ± 129 0 267 351 413 507 782
Cookies 2010 309 298 ± 141 18 121 189 294 393 900 −7.0 0.344
2013 398 277 ± 128 0.4 100 185 286 360 667
Granola and Cereal Bars 2010 172 279 ± 108 13 150 200 269 333 553 −9.0 0.020
2013 200 254 ± 99 16 150 187 243 304 553
Crackers 2010 268 749 ± 376 0 357 500 676 951 2105 −1.3 0.537
2013 301 739 ± 316 0 375 525 700 900 1857
Pancakes, Waffles, French Toast 2010 71 531 ± 110 248 404 462 515 614 775 −5.5 0.154
2013 92 502 ± 119 242 357 425 506 599 769
Breadcrumbs and Croutons 2010 53 878 ± 305 133 450 714 929 1143 1357 1.9 0.732
2013 64 895 ± 392 133 357 586 904 1175 1800
Baked Desserts 2010 379 301 ± 145 25 143 193 280 388 1408 −1.0 0.512
2013 482 298 ± 128 18 150 204 298 371 956
BREAKFAST CEREAL
Ready to Eat Breakfast Cereals 2010 230 375 ± 246 0 33 173 383 552 933 −19.7 0.001
2013 250 301 ± 242 0 7 82 255 481 929
Instant Hot Cereal 2010 50 453 ± 141 200 267 319 464 576 711 −15.0 0.011
2013 60 385 ± 155 0 201 300 442 475 778
CHEESE
Natural Cheese 2010 348 659 ± 311 125 333 500 667 733 2533 5.3 0.908
2013 437 694 ± 405 12 333 500 667 733 3000
Processed Cheese Products 2010 47 1467 ± 378 310 935 1381 1600 1714 2000 4.0 0.948
2013 56 1525 ± 313 788 1000 1390 1619 1758 1905
FATS AND OILS
Margarine, Salted 2010 49 672 ± 110 300 550 600 700 700 1000 −2.8 0.856
2013 49 653 ± 93 300 600 600 650 700 850
Butter, Salted 2010 20 670 ± 127 550 550 600 600 800 950 −0.9 0.998
2013 19 664 ± 188 71 550 600 600 800 950
Mayonnaise 2010 96 882 ± 243 375 567 742 900 1000 1500 −5.4 0.236
2013 124 834 ± 225 267 533 656 833 1000 1467
Salad Dressing 2010 163 948 ± 328 233 531 781 938 1125 1813 −8.9 0.101
2013 167 864 ± 381 12 406 688 867 1000 2600
FISH AND SEAFOOD
Canned Tuna 2010 28 312 ± 107 83 117 250 309 393 500 −9.0 0.508
2013 46 284 ± 108 27 117 250 294 327 596
Other Canned Fish and Seafood 2010 109 390 ± 134 80 235 298 400 473 774 42.8 0.126
2013 121 557 ± 804 45 244 327 400 536 6000
Frozen Fish and Seafood 2010 174 474 ± 259 45 200 300 424 580 1436 11.0 0.443
2013 219 526 ± 831 24 200 289 400 595 8796
MIXED DISHES
Shelf-Stable Mixed Dishes 2010 358 330 ± 114 0 226 262 310 377 822 −6.7 0.002
2013 374 308 ± 111 6 199 247 283 350 822
Refrigerated and Frozen Appetizers, Sides and Entrees 2010 528 337 ± 157 49 191 231 301 400 1214 3.3 0.457
2013 779 348 ± 168 18 189 231 317 421 1214
Pizza 2010 91 529 ± 121 200 386 447 542 604 832 −6.6 0.018
2013 156 494 ± 118 215 361 416 494 568 1000
Pizza Snacks and Frozen Sandwiches 2010 63 504 ± 145 329 341 398 461 563 906 −3.2 0.500
2013 54 488 ± 89 338 376 430 481 542 716
Frozen Fries, Hashbrowns and Potato Patties 2010 45 228 ± 170 18 20 47 200 365 595 1.8 0.970
2013 67 232 ± 154 15 24 76 200 365 595
Dry Mashed or Scalloped Potatoes 2010 30 352 ± 170 217 232 274 313 378 1178 −11.6 0.458
2013 38 311 ± 68 134 223 275 310 351 449
MEAT AND MEAT SUBSTITUTES
Bacon 2010 7 694 ± 152 420 420 589 776 813 840 −6.5 0.499
2013 35 649 ± 173 298 389 575 640 760 1038
Sausages and Wieners 2010 100 912 ± 219 245 671 794 872 1036 1857 −10.7 0.012
2013 141 814 ± 195 254 571 730 827 921 1436
Packaged Deli Meats 2010 171 1096 ± 346 424 727 889 1000 1321 2429 −0.9 0.100
2013 238 1086 ± 388 394 683 810 972 1309 2429
Meat Sticks and Jerky 2010 15 1759 ± 635 750 1040 1154 1733 2300 2771 −9.3 0.280
2013 40 1595 ± 468 750 963 1312 1527 1949 2533
Fresh and Frozen Meat and Poultry 2010 257 535 ± 228 49 289 380 483 680 1330 −7.3 0.001
2013 348 496 ± 323 49 265 353 450 562 5000
Meat Analogues 2010 28 612 ± 226 135 319 447 600 774 1154 −14.4 0.003
2013 70 524 ± 177 290 332 409 473 565 1020
SOUP
Broth 2010 48 248 ± 85 33 204 237 276 360 469 6.5 0.202
2013 110 264 ± 114 16 61 213 264 350 494
Canned Condensed Soup 2010 71 291 ± 62 128 221 248 291 333 477 −14.1 0.003
2013 77 250 ± 57 128 186 194 248 298 399
Ready to Serve Soup 2010 142 247 ± 67 55 183 189 252 281 474 −7.7 0.076
2013 147 228 ± 83 8 137 188 234 256 536
Dry Soup Mixes 2010 56 305 ± 93 135 208 250 280 349 628 −12.1 0.059
2013 54 268 ± 81 5 168 243 260 310 463
Fresh and Instant Oriental Noodles 2010 17 222 ± 110 37 99 154 183 336 451 16.2 0.025
2013 76 258 ± 79 110 164 204 236 314 451
SNACKS
Plain Chips 2010 81 462 ± 196 0 240 360 460 540 1000 −18.6 0.004
2013 106 376 ± 198 0 160 270 368 480 960
Flavoured Chips 2010 151 734 ± 218 200 520 600 700 840 1460 −7.2 0.090
2013 185 681 ± 181 279 460 540 658 800 1351
Popcorn 2010 58 647 ± 295 0 304 467 653 800 1350 −3.9 0.580
2013 75 622 ± 220 213 375 460 594 760 1170
Pretzel and Snack Mixes 2010 30 1146 ± 466 213 758 850 990 1480 2080 −15.9 0.104
2013 56 964 ± 385 175 480 637 957 1280 1720
SAUCES, DIPS, GRAVIES AND CONDIMENTS
Pasta Sauce 2010 169 444 ± 239 136 272 331 399 496 2667 −3.2 0.246
2013 228 430 ± 292 70 248 292 372 468 3600
Tomato Sauce 2010 13 256 ± 168 15 15 38 308 385 485 16.0 1.00
2013 17 297 ± 177 15 23 231 308 385 736
Other Sauces, Dips, Gravies and Condiments 2010 500 986 ± 806 0 333 468 733 1200 5800 6.1 0.002
2013 825 1046 ± 1243 0 300 417 621 1105 9600
CANNED VEGETABLES AND LEGUMES
Canned Vegetables and Legumes 2010 328 269 ± 156 0 20 192 263 335 1238 −19.3 <0.001
2013 371 217 ± 180 0 8 128 211 293 2143
Vegetable Juice and Cocktail 2010 35 210 ± 93 51 53 136 233 249 370 −12.4 0.234
2013 41 184 ± 81 53 54 160 187 241 327
Pickled Vegetables 2010 112 820 ± 423 188 383 533 767 974 2467 6.0 0.390
2013 153 869 ± 499 17 357 567 800 1069 3500
Olives 2010 47 1489 ± 492 633 750 1000 1563 1867 2533 −1.9 0.996
2013 90 1461 ± 477 556 758 1067 1567 1813 2667

Data presented as means ± standard deviation.

1

Statistically significant changes in the distribution of sodium were determined by the Kolmogorov-Smirnov test. A p value <0.05 was considered statistically significant.

This table presents a summary of data. For data on all major categories, major subcategories and minor subcategories, please see the Online Supplementary material.

For the above-mentioned categories, the statistically significant changes in the distribution of sodium for major subcategories were often driven by certain minor food categories. For example, English muffins (462 ± 190 to 299 ± 77, 35.3% reduction, p=0.008) and pantry rolls and buns (488 ± 88 to 444 ± 78; 9.0% reduction, p=0.003) influenced the significant reduction in sodium in packaged breads from 2010 to 2013, whereas the other 9 minor packaged bread categories, which included pantry breads, had no significant change (Supplementary Table S1). Likewise, changes to the shelf-stable mixed dishes major subcategory was influenced by pasta noodles with sauce (324 ± 76 to 291 ± 78; 10.2%; reduction, p<0.001), with no significant change in the 5 other minor categories. Breaded meat and poultry (605 ± 157 to 523 ± 198; 13.6% reduction, p=0.001) and chicken wings (779 ± 244 to 705 ± 266; 9.5% reduction, p=0.012) were the minor categories responsible for the sodium reduction observed in the fresh and frozen meat and poultry major subcategory.

In contrast, three categories showed a statistically significant increase in mean sodium levels from 2010 to 2013. These included the sauces, dips, gravies and condiments major subcategory (986 ± 806 to 1046 ± 1243; 6.1% increase, p=0.002), which was influenced by the minor category soya and other oriental sauces (1355 ± 1345 to 3783 ± 2443; 179.2% increase, p<0.001) (Table 1, Supplementary Table S2). Sodium levels were also higher in oriental noodles in 2013 compared to 2010 (222 ± 110 to 258 ± 79; 16.2% increase, p=0.025). Several other categories had nutritionally relevant but not statistically significant increases in sodium, such as uncooked moisture enhanced meat, seasoned and stuffed fish and seafood and sweet oriental sauces. However, these changes in the distribution of sodium likely resulted from large outliers or by sampling variation between 2010 and 2013.

Changes in the proportion of products meeting Health Canada’s Sodium Benchmarks

Overall, there was a slight increase in the proportion of foods that met at least one of the benchmark targets, from 51.4% of products in 2010 to 58.2% in 2013 (Figure 1a, Supplementary Table S2). This pattern was evident in most major food categories with the greatest improvements from 2010 to 2013 observed among canned vegetables and legumes (33.5% to 46.1%), meat and meat substitutes (49.6% to 61.0%), and ready-to-eat breakfast cereals (64.1% to 74.2%). In contrast, nut butters had a lower proportion of products that met any benchmark in 2013 (83.3% to 71.4%) (Figure 1b. Supplementary Table S2).

Figure 1.

Figure 1

Figure 1a. Proportion of packaged foods meeting and exceeding Health Canada’s sodium benchmark targets in 2010 and 2013

The proportion of all packaged food products that do not meet any of the benchmark targets (Red), and that meet the interim benchmark targets Phase 1 (yellow), Phase 2 (blue), and the 2016 goal (Phase 3) benchmark targets (brown), established by Health Canada (Health Canada 2012). Full set of data presented in Supplementary Table S2.

Figure 1b. Proportion of packaged foods by food group categories meeting and exceeding sodium benchmark targets in 2010 and 2013

The proportion of products in food group categories that do not meet any of the benchmark targets (Red), and that meet the interim benchmark targets Phase 1 (yellow), Phase 2 (blue), and the 2016 goal (Phase 3) benchmark targets (dark brown), established by Health Canada (Health Canada 2012). Full set of data presented in Supplementary Table S2.

In 2013, the greatest proportion of products meeting the phase 3 goal benchmark targets were among breakfast cereals (51.3%), dairy products (48.5%), soups (44.4%) and meat and meat substitutes (39.8%) (Figure 1b, Supplementary Table S2). From 2010 to 2013, most categories made a positive change towards meeting the phase 3 benchmark targets, increasing from 28.6% to 33.6%, overall. The greatest positive changes were seen in soups (28.4% to 44.4%), meat and meat substitutes (30.8% to 39.8%), snack foods (21.6% to 30.4%) and ready-to-eat breakfast cereals (42.7% to 51.3%). In contrast, nut butters and dairy products had a decrease in the proportion of products meeting the phase 3 goal benchmark level, 43.3% to 28.6% and 50.6% to 48.5%, respectively.

The proportion of foods that exceeded Health Canada’s maximum benchmark level reduced from 25.2% in 2010 to 20.8% in 2013 (Figure 1a, Supplementary Table S2). The greatest reductions were observed among meat and meat substitutes (60.9% to 46.2%), canned vegetables and legumes (28.7% to 21.5%), breakfast cereals (14.6% to 9.0%) and bakery products (24.3% to 19.6%). These data are supported by the findings of a shift in the distribution of sodium from 2010 to 2013, whereby many categories had reduced sodium levels at the maximum end of the range such as packaged bread products (range: 11–976 to 0–782 mg/100g) and canned condensed soup (range: 128–477 to 128–399 mg/100g). Additionally, a slight reduction in sodium content was also observed at the 75th percentile for many of these categories. These data point to efforts that are being made to improve the products with the highest levels of sodium.

DISCUSSION

This data provides a detailed first evaluation of the effects of Canada’s voluntary approach to sodium reduction in foods that contribute the most sodium to the Canadian diet, work that is crucial in the absence of any federal or provincial sodium-monitoring program. This study is also one of the largest known comprehensive assessments of changes to sodium levels in the food supply, globally, an approach that offers insight into food categories that are rapidly improving. In this study, only 16% of categories showed a statistically significant reduction in sodium from 2010 to 2013. Thus, despite some foods that had modest changes, not attaining statistical significance, the majority of food categories achieved no significant change. There was an overall increase in the proportion of foods meeting one of Health Canada’s sodium benchmark targets, from 51.4% in 2010 to 58.2% in 2013, and a reduction in the proportion of foods exceeding Health Canada’s maximum benchmark level (25.2% to 20.8%). This data has identified areas for action for the government and the food industry as other sodium reduction initiatives are implemented in an effort to meet the sodium intake goals set for 2016.

The 2010 “baseline” data on sodium levels in packaged foods represented the food supply at the release of Canada’s Sodium Reduction Strategy in 2010, with comparable data two years into implementation of that Strategy. The benchmark targets were set to achieve a 25–30% overall sodium reduction by 2016, with interim targets developed to encourage incremental reductions of approximately 1/3 (8–10% reduction) for Phase 1, and 2/3 (16–20% reduction) for Phase 2. Examining the data in this manner allows for the observation of gradual incremental reductions that are occurring in the food supply, given that this is a midterm analysis. Indeed, our data show that some manufacturers have opted to make dramatic reformulations in a short period of time. For example, ready-to-eat breakfast cereals, instant hot cereals, canned vegetables and legumes, plain chips, condiments, and imitation and simulated seafood each achieved a reduction in sodium of almost 15% or more. More modest, yet significant reductions in sodium of 7% to 14% occurred in packaged bread products, canned condensed soup, sausages and wieners, granola and cereal bars, fresh and frozen meat and poultry, shelf-stable mixed dishes, pizza and meat analogues. These early, progressive changes may reflect the nature of sodium reduction in these types of foods i.e., they may be more easily reformulated considering product quality and food safety or reformulated products may be well-accepted by consumers. In categories that did not achieve statistical significance, there was evidence of product reformulations occurring at the higher range of sodium, as demonstrated by lower sodium levels at the 75th percentile, lower maximum values, and reductions in the proportion of foods exceeding Health Canada’s maximum benchmark level. Despite these successes, statistically significant reductions in sodium were only observed in a small number of food categories. Since variations in food intake patterns vary across population subgroups, sodium reduction will eventually need to occur across all sectors of the foods supply to ensure equitable benefits for all Canadians.

Overall, the majority of categories (84%) had no significant change in sodium content between 2010 and 2013. Additionally, some of the foods that contribute the most significant amounts of dietary sodium remained relatively unchanged. For example, changes to the sodium content of packaged bread products were driven by reductions in English muffins and rolls and buns. Whereas, pantry breads, a widely consumed food, had only a 6.7% reduction in sodium with no significant change in the distribution of sodium from 2010 to 2013, a less than the expected rate of reduction. Other countries have made far greater gains in the reformulation of breads. Over a similar time period, sodium in breads have been reduced by 18% in Argentina and Spain (Ballesteros 2014; Ministry of Health 2014), 12% in France (De L’Agence Nationale de Sécurité Sanitaire de L’alimentation de L’environnement et du Travail 2014), and 9% in Australia (Dunford et al. 2011). After breads, processed meats are the second greatest contributor to the sodium intakes of Canadians. Only sausages and wieners and fresh and frozen meat and poultry products had significantly lower levels of sodium in 2013. Importantly, the widely consumed package deli meat category had an insignificant 0.9% reduction in mean sodium levels, with no differences from 2010 to 2013 in the sodium content of either fully cooked or dry cured meats (data not presented). While some movement has been made on the proportion of deli meats that exceed Health Canada’s maximum benchmark level, as a whole, sodium levels have not changed enough to shift the distribution of the sodium content of foods in this category. On examination of all of the packaged foods included in this analysis, 41.8% of foods still do not meet any benchmark target and 20.8% still exceed Health Canada’s maximum benchmark level; therefore there is still much progress to be made.

This data is a snapshot of the food industry’s progress two years into Health Canada’s sodium reduction target date of 2016; however, it raises the question of the effectiveness and sustainability of a voluntary approach to reducing sodium levels in packaged foods in the absence of other complementary policies or programs. In comparison, the success of voluntary trans fat reduction in the Canadian food supply is largely attributable to Health Canada’s Trans Fat Monitoring Program, which conducted planned, periodic analysis and public reporting of the trans fat content in foods (Ratnayake et al. 2009a and 2009b; Krenosky et al. 2013). A recent assessment found that 97% of Canadian packaged and restaurant foods fall within the recommended trans fat limits (Arcand et al. 2014). In the current Canadian political climate, however, it is unlikely that more assertive steps to sodium reduction will occur in Canada. Therefore, responsibility is now placed upon the food industry to honor their commitments, on the government and other third parties to monitor food industry progress, and on consumers to choose lower sodium foods. Although Canadian consumers report a preference for lower sodium foods (Wong et al. 2013), some of the top reported barriers to reducing sodium intake are the limited variety of lower sodium packaged foods and restaurant foods (Arcand et al. 2013). Therefore, industry must continue their efforts to meet the needs of engaged consumers. Reducing sodium across the food supply will also improve the health of Canadians who do not actively seek out lower sodium foods.

While this study offers a comprehensive look at nutritional changes in the packaged food supply, there are limitations. There were sample size differences between 2010 and 2013 in some food categories; however, the grocery stores where data was sampled remained the same, ensuring that major national brands on the market were captured. This analysis also included private label brands, a growing segment of the grocery marketplace that may have differing levels of sodium (International Markets Bureau 2010; Travena et al 2015). Cost limitations restricted access to sales weighted data for this analysis, therefore data are presented and analyzed un-weighted to market share. However, studies have shown little variation between weighted and un-weighted means with only select food group categories being affected (Ni Mhurchu et al. 2011). We also relied on the Nutrition Facts table data to provide information about sodium content, an approach taken by many investigators worldwide. However, even among products selectively identified for analysis, the proportion of inaccurate sodium content on the Nutrition Facts table remains relatively low (Fitzpatrick et al. 2014). Finally, since the 2010 “baseline” data collection extended into early 2011, the data may not represent a true baseline in relation to the Sodium Reduction Strategy recommendations and thus underestimate the observed magnitude of sodium reduction.

In summary, this study is the first comprehensive examination of early successes and shortcomings of the efforts made by the food industry in a voluntary program of reducing the sodium content of Canadian packaged foods. Though some progress has been made in various sectors, this data supports the need for continued efforts by the food industry in lowering the sodium content of packaged food items and for continued monitoring of this progress as foods are reformulated to meet the 2016 benchmark targets.

Supplementary Material

Supplementary Tables

Acknowledgments

This study was funded by grants from the Canadian Institutes for Health Research (201103SOK - 118150) and the Canadian Stroke Network (201103SOK - 01194-000). Supplementary funds were obtained from a collaboration of 7 food manufacturers and 5 retailers in Canada to pay for staff to process the data. J.A. had funding support from a Research Fellowship from the Heart and Stroke Foundation of Canada and M.R.L. from the Earle W. McHenry endowed Chair at the University of Toronto.

Footnotes

The authors have no conflicts of interest to disclose.

The authors have no commercial financial disclosures to report.

Contributor Information

JoAnne Arcand, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada and the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Katherine Jefferson, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Alyssa Schermel, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Ferdeela Shah, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Susan Trang, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Daniela Kutlesa, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Wendy Lou, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Mary R. L’Abbe, Earle W. McHenry Professor, and Chair, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, FitzGerald Building, 150 College Street, Rm 315, Toronto, ON, Canada M5S 3E2 Tel: (416) 978-7235; Fax: (416) 971-2366.

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