Changes in dietary sodium knowledge, attitudes and behaviors among Canadian adults in 2011 and 2024: a repeated cross-sectional study.

BACKGROUND

Excess 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.

OBJECTIVES

This 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.

METHODS

Repeated 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 χ2, t-tests and regression models assessed changes over time, stratifying by sex and age.

RESULTS

The 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.

CONCLUSIONS

Many 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.