Skip to main content
. 2020 Dec 21;17(24):9570. doi: 10.3390/ijerph17249570

Table 1.

Characteristics of restaurant salt reduction policies implemented in different countries.

Country Policy Scope of Implementation Effective Year Strategies Adopted Applicability Restaurant Type and Size Effect
Argentina Less Salt, More Life [63] Nationwide 2011 Menu labeling, target setting Mandatory Unspecified Unknown
Argentina An agreement removes salt shakers [77] Buenos Aires 2011 Table salt removal Mandatory Hotel and restaurant Unknown
Australia Healthy Food Partnership (a successor to “Food and Health Dialogue”) [28] Nationwide 2015 Target setting, reformulation, consumer education Voluntary Quick service restaurants Unknown
Belgium Unspecific [63] Nationwide 2009 Target setting, reformulation Voluntary Unspecified Unknown
Belgium EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Bulgaria EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Canada Health Canada’s Healthy Eating Strategy [25] Nationwide 2003 Menu labeling Voluntary Restaurants and food services establishments A study compared laboratory values with Nutrition Facts table (NFt) values of foods from supermarkets, bakeries, and restaurants showed:

  • 16.7% (n = 169) of foods exceeding ±20% of the NFt

  • Sodium was the least accurate content (n = 49, 18.4%), all underreported than laboratory values
Canada Sodium Reduction Strategy for Canada [49,79] Nationwide 2010 Menu labeling, target setting Voluntary Restaurants and food services establishments with a high degree of standardization

  • −25 mg (p < 0.001) sodium per serving overall;

  • There were increases and decreases in different kinds of food;

  • −220 mg (a decline of 19%) in reduced-sodium foods;

  • No change in percentage of foods exceeding recommended sodium intake (1500 mg and 2300 mg per day)
Canada Informed Dining program (IDP) [24,59,60,61] Province of British Columbia 2012 Menu labeling Voluntary Range from small independent cafes to national restaurant chains Little or no impact
China Healthy Restaurant (in National Healthy Lifestyle Action) [99] Nationwide 2013 Menu labeling, reformulation, consumer education, chef training Voluntary Unspecified Unknown
China “EatSmart Restaurant Star+” Campaign [53] Hong Kong Unknown Menu labeling Voluntary Unspecified Unknown
Costa Rica Unspecific [73] Nationwide Unknown Table salt removal Voluntary Unspecified Unknown
Finland Reducing salt intake in populations ** [54] Nationwide 2006 Menu labeling, consumer education, government assistance, toolkits delivery Voluntary Caterers, restaurants and others involved in commercial meal preparation Unknown
Finland EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Finland Unspecific [63,64] Nationwide 2011 Target setting Mandatory University restaurants (main meals and all meal components) Unknown
France Reducing salt intake in populations ** [54] Nationwide 2006 Menu labeling, consumer education, government assistance, toolkits delivery Voluntary Caterers, restaurants and others involved in commercial meal preparation Unknown
France Unspecific [63] Nationwide Unspecific Table salt removal Voluntary Unspecified Unknown
Greece EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Hungary EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Ireland Reducing salt intake in populations ** [54] Nationwide 2006 Menu labeling, consumer education, government assistance, toolkits delivery Voluntary Caterers, restaurants, and others involved in commercial meal preparation Major high-street restaurant chains all reported a greater reduction in salt from products.
Latvia EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Lithuania EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Mexico − Sal + Salud [73] Mexico City Unknown Table salt removal, media campaign Voluntary Unspecified Unknown
Netherlands EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Portugal EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Romania EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Slovak Republic EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Slovenia EU Salt Reduction Framework * [62,64] Involved in the EU Framework 2010 Target setting, reformulation Voluntary Unspecified Unknown
Spain Reducing salt intake in populations ** [54] Nationwide 2006 Menu labeling, consumer education, government assistance, toolkits delivery Voluntary Caterers, restaurants, and others involved in commercial meal preparation Unknown
Sri Lanka Unspecific [75] Nationwide Unknown Reformulation Unspecified Food outlets and restaurants Unknown
Sweden Keyhole label [48] Nationwide 2009 Menu labeling Voluntary Unspecified The Keyhole symbol is widely recognized by Swedish consumers and has been promoted to restaurants
Thailand Thai Food, Good Heart [63] Nationwide 2004 Reformulation, chef training Voluntary Thai Food restaurants (10 famous Thai dishes) Unknown
UK UK Food Standards Agency’s (FSA) salt reduction programme [39,40,98] Nationwide 2003 Target setting, reformulation Voluntary Catering sector, quick-service restaurants, workplace caterers, pub and high-street restaurant chains, and coffee and sandwich shops Overall salt reduction effects: population’s average daily salt intake was reduced from 9.5 g in 2000–2001 to 8.6 g in 2008. Some foods reduced salt levels by up to 70%.
UK Reducing salt intake in populations ** [54] Nationwide 2006 Menu labeling, consumer education, government assistance, toolkits delivery Voluntary Caterers, restaurants, and others involved in commercial meal preparation Unknown
UK New Department of Health (DoH) voluntary targets [74] Nationwide 2014 Target setting Voluntary Unspecified Unknown
UK The Public Health Responsibility Deal (RD) in England [36,44,76] England 2017 Target setting, reformulation Voluntary Unspecified Unknown
UK EU Salt Reduction Framework * [62,64] Wales (involved in the EU Framework) 2010 Target setting, reformulation Voluntary Unspecified Unknown
Uruguay Unspecific [63] Nationwide Unknown Menu labeling, reformulation, table salt removal Mandatory Unspecified Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] Nationwide 2008 Menu labeling, target setting Mandatory Large, multiunit chain restaurant/foodservice operations Unknown
USA Menu Labeling Provisions (of Section 4205 of the Patient Protection and Affordable Care Act) [19,20,26] Nationwide 2010 Menu labeling Mandatory Chain restaurants and similar retail food establishments with 20 or more locations

  • No significant change in mean sodium overall;

  • −70 mg mean sodium across all restaurants in added vs. removed menu items at the 75th percentile
USA Statement of Policy Salt Reduction [81] Nationwide 2014 Menu labeling, target setting Voluntary Unspecified Unknown
USA Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments [55,56] Nationwide 2015 Menu labeling Mandatory Chain restaurant with 20 or more locations offering for sale substantially the same menu items

  • Mean sodium did not change significantly;

  • New menu items reduced 70 mg sodium on average than old ones
USA Unspecific [78] Nationwide 2015 Reformulation Voluntary Unspecified A study assessing children’s menus reported that the sodium target was the least frequently met healthy criteria
USA Voluntary Sodium Reduction Goals [70] Nationwide 2016 Target setting Voluntary Unspecified Unknown
USA Heart Check [35] Nationwide Unknown Menu labeling, target setting, Voluntary Unspecified Unknown
USA New US healthcare reform law [44] Nationwide Unknown Menu labeling Mandatory Retail food establishments with 20 locations Unknown
USA National Salt Reduction Initiative (NSRI) [20,32,33,83,84] New York with 100 city and state health authorities and national health organizations 2010 Target setting, reformulation Voluntary Unspecified

  • Minor effect on sodium levels in top chain restaurant foods;

  • Sodium far exceeded recommended limits
USA SB-1420 Food facilities: nutritional information [50] California 2009 Menu labeling, target setting Mandatory (fines imposed) Chain restaurants with 20 or more outlets in California Unknown
USA Smart Meal [35,86] Colorado Unknown Menu labeling, target setting Voluntary Local restaurants Unknown
USA Strategies to Reduce Sodium Intake in the United States (bill) [100] Delaware 2010 Menu labeling, consumer education Mandatory Foodservice establishment with 10 or more outlets in Delaware or nationwide Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] District of Columbia 2010 Menu labeling Mandatory Chain restaurants with 10 or more outlets nationwide Unknown
USA Healthy Choices [35,93] Erie County Unknown Menu labeling Voluntary Local restaurants Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] Florida 2010 Menu labeling Mandatory Chain restaurants with 19 or more outlets in Florida Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] Indiana 2009 Menu labeling Mandatory Chain restaurants of 20 or more outlets in Indiana Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] Kentucky 2009 Menu labeling Mandatory Chain restaurants with 10 or more locations in Kentucky Unknown
USA The King County Board of Health’s nutrition labeling regulation [29,43,69] King County 2010 Menu labeling Mandatory (fines imposed, was voluntary between 2008–2010) Chain restaurant meets all criteria: has 15 or more locations in King County or nationwide; has operating permits; total gross annual revenues of $1 million or more; has standardized menu items that use standard recipes

  • −231 ± 727 mg (p < 0.01) in sodium for all entrees at sit-down chains (n = 11);

  • Levels still above the recommended limits (one-third of the nutrient intake recommendations)
USA Strategies to Reduce Sodium Intake in the United States [100] Maryland 2010 Menu labeling Mandatory Chain restaurants with 15 or more outlets nationwide Unknown
USA Healthy Howard Columbia [94] Maryland Unknown Government assistance Voluntary Local restaurants Unknown
USA The menu labeling requirement [100] Montgomery County 2010 Menu labeling Mandatory Chain restaurants with 20 or more outlets nationwide Unknown
USA New York City salt warning rule [47,51,52] New York 2015 Menu labeling, target setting, media campaign, consumer education Mandatory Chain restaurant with 15 outlets The effect of adding numeric sodium menu nutrition information depends on consumers’ taste intuition
USA Capitol Region Restaurant Operators Cooperative [35,95] New York Unknown Government assistance Voluntary Local restaurants Unknown
USA Winner’s Circle [35,88] North Carolina Unknown Menu labeling, target setting Unspecified Local restaurants Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] Oklahoma 2010 Menu labeling Mandatory Restaurants with 10 or more outlets in the state Unknown
USA State legislation [100] Oregon 2010 Menu labeling Mandatory Chain restaurants with 15 or more outlets nationwide Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] Pennsylvania 2009 Menu labeling Mandatory Chain restaurants with an average of at least $500,000 in food sales over the past 3 years Unknown
USA Philadelphia Menu Labeling Ordinance [27] Philadelphia 2010 Menu labeling Mandatory Restaurants with 15 or more outlets nationwide

  • Consumers at labeled restaurants purchased 224 mg less sodium than at unlabeled restaurants;

  • Consumers who reported menu label affecting their choices purchased 370 mg less sodium
USA Healthy Chinese Take-Out Initiative (HCTI) [30] Philadelphia 2012 Reformulation, chef training, toolkits delivery, media campaign Voluntary Chinese take-out restaurants in low-income urban communities 13–34% reduction in sodium content of 3 popular dishes 36 months after low-sodium cooking training
USA Sodium menu labeling legislation [65] Philadelphia 2019 Menu labeling Mandatory (fines imposed) Any chain retail food establishment Unknown
USA SmartMenu [31,34] Pierce County 2007 Menu labeling Voluntary Locally owned full-service restaurants

  • −45 mg sodium in the average entree after labeling;

  • About 1/3 patrons reported behavior change because of seeing nutrition information
USA ¡Por Vida! [35,87] San Antonio Unknown Menu labeling, target setting Unspecified Local restaurants Unknown
USA Healthy Food Incentives Ordinance [37,45,96] San Francisco 2011 Target setting (for children’s meals) Mandatory Local restaurants Two restaurants investigated did not change recipes to meet the nutrition criteria (only selling toys separately from children’s meals as response to the ordinance)
USA Sodium Savvy [35,90] Schenectady County Unknown Menu labeling, target setting, consumer education Unspecified Local restaurants Unknown
USA Healthy Kids Choice [35,85] Shasta County Unknown Menu labeling, target setting Unspecified Local restaurants Unknown
USA Cut the Sodium but Keep the Flavor [35,91] Shasta County Unknown Chef training Voluntary Local restaurants Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] Tennessee 2009 Menu labeling Mandatory Chain restaurants with 20 or more outlets nationwide Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] Texas 2010 Menu labeling Mandatory Chain restaurants with 19 or more locations in Texas Unknown
USA Strategies to Reduce Sodium Intake in the United States [100] Vermont 2010 Menu labeling Mandatory Restaurants with 10 or more outlets nationwide Unknown
Americas 1 Preventing Cardiovascular Disease in the Americas by Reducing Dietary Salt Intake Population-Wide [72] Countries in Americas 2014 Target setting, reformulation Voluntary Unspecified Unknown

* Count as one policy. ** Count as one policy. 1 One exception of heading: Americas is not a country.