Abstract P1103: Sodium Misestimation in the National Health and Nutrition Examination Survey (NHANES): Implications for Surveillance

Abstract

Background: Over the past ten years, the National Health and Nutrition Examination Survey (NHANES) has consistently shown Asian Americans have the highest sodium intake of all racial and ethnic groups with foods in the ‘rice’ category accounting for about 10% of their intake. However, foods in the ‘rice’ category include only plain rice. The underlying food and nutrient database for dietary studies (FNDDS) assumption that plain rice is salted may be inappropriate for at least some Asian American subgroups. How this assumption affects sodium estimation, given frequent rice consumption among Asian Americans, is unclear. Methods: Using NHANES 2017-2020 pre-pandemic data, population-level mean sodium intake was estimated by racial and ethnic group when varying the assumption that rice is salted. Estimates were calculated based on dietary recalls using the National Cancer Institute method. Estimates were compared to mean sodium estimates based on Intersalt, Tanaka, and Sun C spot urine calibration equations. Results: Assuming rice is unsalted reduces Asian American sodium intake estimates by ~325 mg/day but makes little difference to the sodium intake estimates of other racial and ethnic groups. Under an assumption that rice is unsalted, Asian Americans have among the lowest sodium intake of all groups. Estimates of sodium intake based on spot urine similarly show that Asian American sodium intake is less than or equal to other groups. Conclusions: Given the White House’s National Strategy on Hunger, Nutrition, and Health calls for better sodium surveillance, the FNDSS database may need to be altered to better capture Asian American sodium intake. To confirm this finding, 24-hour urine should be collected among a nationally representative sample of Asian Americans, and differences in rice salting practices and sodium intake should be explored between Asian American subgroups. This finding highlights the importance of culturally sensitive nutritional research.