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Figure. Distribution of food categories by availability of potassium content on the nutrition facts panel. The grey bar represents a range of 0% to less than 1%; black bars represent consecutive 10% ranges.

Figure. Distribution of food categories by availability of potassium content on the nutrition facts panel. The grey bar represents a range of 0% to less than 1%; black bars represent consecutive 10% ranges.

1.
Cook NR, Obarzanek E, Cutler JA,  et al; Trials of Hypertension Prevention Collaborative Research Group.  Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study.  Arch Intern Med. 2009;169(1):32-40PubMedArticle
2.
Xu J, Kochanek KD, Tejada-Vera B. Deaths: preliminary data for 2007.  Natl Vital Stat Rep. 2009;58(1):1-52
3.
Yang Q, Liu T, Kuklina EV,  et al.  Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey.  Arch Intern Med. 2011;171(13):1183-1191PubMedArticle
4.
US Department of Agriculture, US Department of Health and Human Services.  Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing Office; 2010
5.
Institute of Medicine.  Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press; 2010
6.
US Food and Drug Administration.  Nutritional Labeling and Education Act (NLEA) Requirements. 1994. http://www.fda.gov/ICECI/Inspections/InspectionGuides/ucm074948.htm. Accessed January 10, 2013
7.
US Food and Drug Administration.  Guidance, Compliance & Regulatory Information: Nutrition Labeling. 2009. http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/FoodLabelingNutrition/FoodLabelingGuide/default.htm. Accessed January 10, 2013
8.
Silver LD, Farley TA. Sodium and potassium intake: mortality effects and policy implications.  Arch Intern Med. 2011;171(13):1191-1192PubMedArticle
9.
New York City Department of Health and Mental Hygiene.  Health organizations call for a public national nutrition database on food products. July 11, 2011. http://www.nyc.gov/html/doh/html/pr2011/pr017-11.shtml. Accessed September 13, 2012
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Food and Drug Administration, Center for Food Safety and Applied Nutrition.  Calories count: report of the working group on obesity. http://www.fda.gov/Food/LabelingNutrition/ReportsResearch/ucm081696.htm. Accessed July 26, 2012
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Research Letters
May 13, 2013

Availability of Potassium on the Nutrition Facts Panel of US Packaged Foods

Author Affiliations

Author Affiliations: New York City Department of Health and Mental Hygiene (NYC DOHMH), Queens, New York.

JAMA Intern Med. 2013;173(9):828-829. doi:10.1001/jamainternmed.2013.3807

Studies have indicated that diets low in potassium and high in sodium are associated with increased risk for cardiovascular disease,1 the leading cause of death in the United States,2 whereas higher potassium intake is associated with reduced risk for both all-cause and cardiovascular disease–related mortality.3 Yet, the majority of US adults consume considerably less than the 4700 mg/d of potassium that is recommended by the 2010 Dietary Guidelines for Americans.4

Information about nutrients such as potassium in foods is important for researchers and policy makers, who use the information to monitor or make recommendations on the nutritional quality of the food supply, and also for guiding individuals to healthy choices. Notably, a subset of the population with renal impairment or on diuretics must restrict or adjust their potassium intake.5 Food processing is ubiquitous and often removes potassium and adds sodium; however, some packaged foods can be a rich source of potassium; examples include tomato juice (920 mg per serving), canned soup (900 mg per serving), and canned beans (490 mg per serving). Sodium content and percent daily value have been required on nutrition facts panels (NFPs) by the US Food and Drug Administration (FDA) since 19946; however, despite its important role in health, displaying potassium content is optional.7

We assessed the percentage of US packaged foods that include potassium content on the NFP under the current policy of optional disclosure. To our knowledge, this study is the first to assess the availability of potassium content information on the NFP across major US retailers.

Methods

We used a database developed in 2009 for the National Salt Reduction Initiative (NSRI) (http://www.nyc.gov/health/salt), which merged product-level sales and nutrition data by universal products code (UPC) for the top-selling packaged food products in 61 food categories. Detailed information about the methodology has been published elsewhere.5 The top 80% of products sold within each category with available sodium information were included in this analysis.

Results

Of the 6560 packaged food products in our analysis, potassium content was available for less than 10% (n = 500) of products. In almost half of the categories (n = 30), potassium content was available for less than 1% of products; only 5 categories had potassium content available for at least half of the products (Figure). Categories with potassium information available for more than half of products were vegetable juice; seasoned processed potatoes; instant hot cereal; french toast, pancakes and waffles; and major main entrée sauce (eg, spaghetti sauce and related sauces). Potassium content in these 5 categories ranged from 0 to 920 mg per serving.

Comment

Most packaged food products do not include potassium content on the NFP. One might expect items with high levels of potassium to more often be labeled; however, categories where potassium information was most available had a wide range of potassium content, while some categories with expected high levels of potassium, such as canned whole tomatoes and canned beans, had low potassium information availability.

The lack of potassium information on the NFP presents a problem for patients and consumers trying to make informed decisions when purchasing foods, particularly those motivated to minimize their risk of cardiovascular disease and those for whom potassium intake must be restricted. Lack of potassium information is also a problem for researchers and policy makers interested in understanding the overall and potassium-specific nutritional content of the packaged food supply.8

The New York City Department of Health and Mental Hygiene, along with 35 health authorities and health organizations, has called for a publicly accessible, product-specific nutrition database of packaged food products.9 The creation of such a database would allow for analyzing nutritional trends, which would inform recommendations to improve nutritional intake. While such a database is valuable with existing NFP information, its public health value would be enhanced if potassium information was consistently available.

A limitation of this study is that the NSRI database was originally created to assess changes in sodium concentration; therefore, it includes a wide range of products, but only in food categories with significant potential for sodium reduction (eg, some desserts and beverages are not included). Also, only the top 80% of products sold within each category are represented in the analyses.

The FDA is planning to revise the NFP, and potential improvements to its content and format are under consideration.10 The addition of potassium content and percent daily value to required NFP information could remedy the described deficit in publicly available nutrition information. Providing this important information to consumers, patients, and researchers would allow a more detailed understanding of the food supply, which would complement existing strategies to improve population nutritional intake.

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Article Information

Correspondence: Ms Curtis, Director of Nutrition Strategy, New York City Department of Health and Mental Hygiene, 42-09 28th St, Ninth Floor, Queens, NY 11101 (cjohnso8@health.nyc.gov).

Published Online: February 25, 2013. doi:10.1001/jamainternmed.2013.3807

Author Contributions: Ms Curtis had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Curtis. Acquisition of data: Curtis. Analysis and interpretation of data: Curtis, Niederman, and Kansagra. Drafting of the manuscript: Curtis and Niederman. Critical revision of the manuscript for important intellectual content: Curtis and Kansagra. Statistical analysis: Niederman. Obtained funding: Curtis. Administrative, technical, and material support: Curtis and Kansagra. Study supervision: Curtis and Kansagra.

Conflict of Interest Disclosures: None reported.

Funding/Support: The creation of the NSRI database was made possible by funding from the US Department of Health and Human Services, W. K. Kellogg Foundation, and New York City tax levy dollars. This funding is administered by the Fund for Public Health in New York, a private nonprofit organization that supports innovative initiatives of the NYC DOHMH.

Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the funders.

Additional Contributions: Ayana Douglas-Hall, MPH, NYC DOHMH, assisted in conducting statistical analyses. No compensation received for her role. Jenifer Clapp, MPP, NYC DOHMH, assisted in reviewing and editing the article. No compensation received for her role.

References
1.
Cook NR, Obarzanek E, Cutler JA,  et al; Trials of Hypertension Prevention Collaborative Research Group.  Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study.  Arch Intern Med. 2009;169(1):32-40PubMedArticle
2.
Xu J, Kochanek KD, Tejada-Vera B. Deaths: preliminary data for 2007.  Natl Vital Stat Rep. 2009;58(1):1-52
3.
Yang Q, Liu T, Kuklina EV,  et al.  Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey.  Arch Intern Med. 2011;171(13):1183-1191PubMedArticle
4.
US Department of Agriculture, US Department of Health and Human Services.  Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing Office; 2010
5.
Institute of Medicine.  Strategies to Reduce Sodium Intake in the United States. Washington, DC: The National Academies Press; 2010
6.
US Food and Drug Administration.  Nutritional Labeling and Education Act (NLEA) Requirements. 1994. http://www.fda.gov/ICECI/Inspections/InspectionGuides/ucm074948.htm. Accessed January 10, 2013
7.
US Food and Drug Administration.  Guidance, Compliance & Regulatory Information: Nutrition Labeling. 2009. http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/FoodLabelingNutrition/FoodLabelingGuide/default.htm. Accessed January 10, 2013
8.
Silver LD, Farley TA. Sodium and potassium intake: mortality effects and policy implications.  Arch Intern Med. 2011;171(13):1191-1192PubMedArticle
9.
New York City Department of Health and Mental Hygiene.  Health organizations call for a public national nutrition database on food products. July 11, 2011. http://www.nyc.gov/html/doh/html/pr2011/pr017-11.shtml. Accessed September 13, 2012
10.
Food and Drug Administration, Center for Food Safety and Applied Nutrition.  Calories count: report of the working group on obesity. http://www.fda.gov/Food/LabelingNutrition/ReportsResearch/ucm081696.htm. Accessed July 26, 2012
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