Development of a brief screening tool for sodium intake

INTRODUCTION: As evidence of the health consequences of high sodium intake accumulates, medical treatment and public health prevention programs need a rapid, reliable method to screen for sodium intake and compliance with dietary guidelines. As a developer of food frequency questionnaires (FFQ) and dietary screeners, our company was asked by a state-wide cardiac rehab program to develop a short Sodium Screener in a food frequency questionnaire format, that could be hand-scored. METHODS: We examined “top sources” of sodium intake by US adults in two large data files, one from food frequency questionnaires and one from 24-hour recalls (NHANES 2007-2008), and selected food items for the screener that would capture the top 80+% of sodium consumption. We also estimated the amount of sodium reduction achieved by persons who avoid salt when cooking food at home. We simulated screener responses in a large FFQ data set and tested a number of experimental scoring systems. We used regression analysis to assess the need for portion information, separately for men and women, and added portion questions for 7 foods and salt added at the table. RESULTS: The Sodium Screener includes 26 food items and adjusts for respondent efforts to reduce sodium intake. The screener is hand-scorable, with cut-points indicating compliance with Dietary Guidelines for Americans 2010 for sodium intake at the 2300 mg and 1500 mg levels. Prediction equations generate point estimates of sodium intake (mg. per day). DISCUSSION: Sodium Screener estimates correlate well with sodium intake estimates from a full-length FFQ. A validation and reliability study is planned.