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Sodium content of menu items in New York City chain restaurants following enforcement of the sodium warning icon rule, 2015-2017

In 2016, New York City (NYC) began enforcing a sodium warning regulation at chain restaurants, requiring placement of an icon next to any menu item containing >=2,300 mg sodium. As menu labeling may improve menu nutritional composition, we investigated whether sodium content of menu items changed following enforcement of the sodium warning icon. All menu offerings at 10 quick-service (QSR) and 3 full-service (FSR) chain restaurants were photographed in 2015 (baseline) and 2017 (follow-up) and matched to nutritional information from restaurant websites; items were categorized as being available at both baseline and follow-up, or at only one timepoint. Linear and logistic regression models, respectively, assessed changes in calculated mean sodium-per-serving and the odds of an item containing >=2,300 mg sodium. At baseline, mean per-serving sodium content was 2,160 mg at FSR and 1,070 mg at QSR, and 40.6% of FSR items and 7.2% of QSR items contained >=2,300 mg sodium per serving. Sodium content did not differ when comparing all items offered at follow-up to all offered at baseline (21 mg, 95% CI: -60,101), or when comparing new versus discontinued items (17 mg, 95% CI: -154, 187). At follow-up, there was a non-significant increase in the overall likelihood of items requiring a warning icon (OR=1.32, 95% CI: 0.97,1.79). When comparing new versus discontinued items, there was a twofold increase in the odds of requiring a warning icon (OR=2.08, 95% CI: 1.02,4.24). Our findings both highlight high sodium content of menu items at popular chain restaurants and underscore difficulties in motivating restaurants to reduce sodium levels.