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 per menu item 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 no change in the overall likelihood of items requiring a warning icon (OR = 1.32, 95% CI: 0.97,1.79), or when comparing new versus discontinued items (OR = 2.08, 95% CI: 1.02,4.24) (p = 0.04, not significant following Bonferroni correction for multiple analyses). Our findings that the sodium content of menu items did not change following the sodium warning icon regulation underscore difficulties in reducing sodium levels in restaurants; however, our results may be limited by follow-up data collection occurring less than one year post-enforcement. It may take additional time and similar action from other jurisdictions for restaurants to reduce the sodium content of menu items.