ArticleThe American journal of clinical nutrition2026
Changes in dietary sodium knowledge, attitudes and behaviors among Canadian adults in 2011 and 2024: a repeated cross-sectional study.
Article in The American journal of clinical nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundExcess sodium intake is a leading modifiable risk for noncommunicable diseases. Despite some national sodium-reduction initiatives, no population-level updates to sodium-related knowledge, attitudes, behaviors (KAB) have been available since 2011.
objectivesThis study aimed to compare sodium-related KAB among Canadian adults in 2011 and 2024 and examine differences by sex and age, hypothesizing limited changes due to insufficient national sodium-reduction initiatives.
methodsRepeated cross-sectional national surveys were conducted in 2011 (n = 2603) and 2024 (n = 3267), readministering the same sodium KAB questions from the 2011 survey. Knowledge responses were coded as correct/incorrect, and 5-point Likert-scale items were recoded or dichotomized. Data were weighted to the Canadian census. Rao-Scott adjusted χ
resultsThe proportion of adults actively limiting sodium intake declined from 57.4% in 2011 to 37.3% in 2024 (P < 0.001). Concurrently, engagement in nearly all sodium-reduction behaviors decreased in 2024, including avoiding processed foods (69.3%-52.3%), not adding salt at the table (69.2%-58.1%), avoiding salt during cooking (62.3%-43.4%) (all P < 0.001), and reading Nutrition Facts labels (54.2%-49.6%, P = 0.005). Paradoxically, overall population sodium concern remained high and unchanged (66.3%-65.9%, P = 0.812). Food label interpretation and awareness of recommended sodium intake improved (P < 0.001), but knowledge of health-related conditions linked to sodium such as blood pressure, heart disease, and stroke decreased (all P < 0.001). Reported barriers to sodium reduction included cost, taste, time constraints, and lack of social support.
conclusionsMany indices of sodium-related KAB deteriorated from 2011 to 2024 among Canadian adults, despite their continued concern about sodium intake. These findings highlight a widening knowledge-to-action gap and reinforce the need for comprehensive public health efforts to support population-wide dietary sodium reduction.
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