How Salty Is Too Salty? Designing Sodium Warning Label Policies to Identify High-Sodium Items on Restaurant Menus in the United States.

Two U.S. cities require chain restaurants to label menu items that exceed 100% of the Daily Value (DV) for sodium, informing consumers and potentially prompting restaurant reformulation. To inform policy design for other localities, this study determined the percentage of the top 91 U.S. chain restaurants' menu items that would be labeled if a warning policy were established for menu items exceeding the thresholds of 20%, 33%, 50%, 65%, and 100% of the sodium DV for adults. We obtained U.S. chain restaurants' nutrition information from the 2019 MenuStat database and calculated the percentage of items requiring sodium warning labels across the food and beverage categories at all the restaurants and at the full- and limited-service restaurants separately. In total, 19,038 items were included in the analyses. A warning label covering items with >20%, >33%, >50%, >65%, and >100% of the sodium DV resulted in expected coverage of 42%, 30%, 20%, 13%, and 5% of menu items at all the restaurants, respectively. At each threshold, the average percentage of items labeled per restaurant was higher among the full-service restaurants than the limited-service restaurants. These results suggest that restaurant warning policies with a threshold of 100% of the sodium DV per item would cover a minority of high-sodium menu items and that lower thresholds should be considered to help U.S. consumers reduce their sodium consumption.