Sodium Content in Commonly Consumed Foods and Its Contribution to the Daily Intake

nutrients

Article Sodium Content in Commonly Consumed Foods and Its Contribution to the Daily Intake

Sonia Rosario Calliope and Norma Cristina Samman * Facultad de Ingeniería, Universidad Nacional de Jujuy, CIITED-CONICET, Ítalo Palanca Nº 10, Jujuy PC 4600, Argentina; [email protected] * Correspondence: [email protected]

Received: 26 October 2019; Accepted: 3 December 2019; Published: 21 December 2019

Abstract: Salt consumption in many countries of the world exceeds the level recommended by WHO (5 g/day), which is associated with negative eﬀects on health. Public health strategies to achieve the WHO’s objectives include salt content monitoring, improved nutritional labelling and product reformulation. This study aimed to determine the sodium content in street food (SF), fast foods (FF) and artisanal foods (AF) of the Northwest of Argentina, which is not regulated. Moisture, ash and sodium were determined according to the Oﬃcial Methods of Analysis (AOAC) in 189 samples from each of the three categories. The average and range values were: SF 520 (R: 74-932); FF 599 (R: 371-1093) and AF 575 (R: 152-1373) mg Na/100 g. Thus, general sodium content is high, which means that the consumption of a serving from most of the studied foods leads to an individual exceeding the recommended daily intake values. This study contributes to the knowledge of sodium content in evaluated foods and its contribution to the population intake. This reinforces the importance of implementing new public policies and regulations, advising consumers to check food nutritional labels andselect foods lower in salt content, raising food manufacturers’ awarenessabout the importance of reducing sodium content in foods they produce and in public health.

Keywords: sodium content; street food; fast food; artisanal food; monitoring

1. Introduction Dietary salt intake has increased continuously in recent decades to reach 18 g/person/day in some regions of the world. This is associated with a marked increase in the prevalence of hypertension [1,2]. Batuman (2013) suggests that excess salt consumption may have detrimental effects on cardiovascular health regardless of hypertension [3]. More recent studies in humans confirmed that the low-salt diet lowers blood pressure in both normotensive and hypertensive individuals [4]. A well-known dietary trial on Dietary Approaches to Stop Hypertension (DASH) showed that reducing salt intake from 8 to 4 g/person/day reduced blood pressure among hypertensive and normotensive individuals [5]. There is currently a consensus that the beneficial effect of salt reduction begins with daily intake levels of 5 g/day or less [6,7]. Evidence also suggests that to obtain maximum benefit, salt reduction should begin at an early age [8,9]. In Latin America and the Caribbean, hypertension rates are between 20–40% and are among the highest in the world [10]. Worldwide, hypertension is the cause of 62% of stroke and 49% of coronary heart disease [11]. The National Survey on Risk Factors of the Ministry of Health of Argentina [12] shows that 34.1% of the adult population is hypertensive and it is estimated that the average salt intake per individual is around 12 g/p/day [13]; 37% of cardiovascular deaths are attributable to hypertension [14]. As a prevention system, the WHO and other health authorities recommend reducing salt intake by 5–6 g/day. Most countries have committed to the overall objectives of reducing salt in their food.

Nutrients 2020, 12, 34; doi:10.3390/nu12010034 www.mdpi.com/journal/nutrients Nutrients 2020, 12, 34 2 of 15

The implementation of sodium reduction policies has been shown to be cost-effective and efficient in reducing overall cardiovascular diseases (CVD) by improving the health of the general population [15]. Argentina has established voluntary agreements based on the Healthy Argentina Plan of the Ministry of Health and has implemented the project titled “Less Salt More Life” since 2011, to reduce the use of salt in industrialized products and in artisan bakeries. Then, Law 26,905 [16] on the regulation of sodium consumption was enacted, which established maximum sodium contents for meat products and derivatives; farinaceous; soups, dressings and preserves. This law proposed the progressive reduction of salt content in industrialized foods to reach maximum values established for each group; besides, it also regulates the inclusion of warnings on the risks of excessive salt consumption in the packaging, promotes the elimination of salt shakers at restaurant tables, establishes that the salt content of each individual envelope should not exceed 500 mg and implements penalties for offenders of these regulations. Estimates from the Ministry of Health of Argentina indicated that 65–70% of sodium intake in the diet comes from processed foods [17]. Technical feasibility is often cited by the industry as an impediment to reduce salt content, being necessary to develop new processes and technologies to deliver low salt content products. The food industry has an increasingly important role in public health. In order to verify whether the industry has reached the technical limits of salt reduction in the world, a study was carried out on the fulfilment of the sodium reduction targets in industrialized foods of the priority groups [18]. In addition, consumers purchase food outside their home; “street” sales throughout Latin America constitute a relevant phenomenon at the sociocultural, economic and health level. On the other hand, artisanal foods contribute to the gastronomic richness of a country and represent the consumption of local foods; fast foods are generally associated with consumption close to work environments and young people. The consumption of these types of products is very common in Latin American countries, and is higher in populations with increasing socioeconomic and working conditions. All the above-mentioned food categories are unregulated products that depend on the practices and customs of the processors, which contribute to the lack of knowledge of sodium consumption levels. Food practices are a consequence of multiple individual, sociocultural and economic dimensions and of the accumulated learning by different generations [19]. Knowing about the perception that people have in regard to their daily salt consumption can be useful for the development of interventions aimed at reducing intake. In order to continue with the research on foods that can contribute to the increase in sodium intake and consequently to non-communicable diseases, the objective of this study was to determine the sodium content in street foods, fast foods and artisanal foods that are consumed with high frequency in the Northwest of Argentinaand estimate their contribution to daily intake.

2. Materials and Methods

2.1. Methodological Design A descriptive study was conducted through an anonymous survey, randomized to adults over the age of 18, who were in public places. They were personal surveys and were conducted by previously trained university students. The survey was designed with 10 simple-answer questions: yes, no, you donot know, there is no answer. Descriptive statistics were used for the analysis of responses, which were also described through absolute and percentage frequencies. To calculate ﬁnal sample size (n0) the Cochran method was used [20], Formulas (1) and (2):

z2 p q n0 = × × (1) e2 Nutrients 2020, 12, 34 3 of 15

n0 n0 = (2) (n0 1) 1 + N− where

n0: theoretical sample size; n0: final sample size; z2: zeta score is 1.96 for a 95% confidence level; p: maximum variability of the population at 50%. i.e., (0.5); q: 1 p = 0.5; − e2: sampling error (0.05); 1 α: 95% confidence level; − N: population size (3,800,000), which covers three provinces of Northwestern Argentina.

The resulting (n0) was 384 people.

A survey was carried out in order to determine the frequency of consumption of three food categories and which were the most consumed.

2.2. Food Categories Food categories studied: Street food (SF), fast food (FF), and artisanal food (AF). The characteristics of each food category as taken for this work were following: Street Food: Ready-to-eat foods and drinks that sellers prepare and sell in public places. The stalls are located outdoors or under a roof, are easily accessible for the consumers and have and aﬀordable prices. Fast food: Are sold in formal food services such as cafeteria, take-out food and chain restaurants. In each place there is little variety of products and there is no delay in the service. Artisanal food: The elaboration of artisanal foods is mostly in manual form and the production is carried out by small businesses or family groups. In them, the addition of ingredients depends on the criteria of the processor and the knowledge that was transmitted from generation to generation

2.3. Survey The survey (AppendixA) was conducted primarily to collect information on types of food consumed and the frequency of consumption for each category mentioned (fast food, artisanal food and street food) and then select the subcategories (The most consumed types), which would be sampled and analyzed. The survey was applied according to the following inclusion criteria: A total of 486 men and women who are in public space, in fast food places and places of sale of artisanal food. Ages were >18 years old (age range in which consumers can provide reliable information and deepen their preferences and motivations in relation to their diet). They were asked whether or not they consumedfoods from the three defined categories. If an affirmative answer was given, they informed about the frequency of consumption and listed the 3 most consumed products for each category. With this information, a list from highest to lowest was prepared with foods classified by frequency of occurrence and the first seven of each category were included for the study.In the survey it was also asked the minimum serving size of each food (MSS) per meal.

2.4. Food Sampling Plan 7 food items from each category were selected and 9 samples from each were analyzed. • 7 foods 3 categories = 21 foods to sample • × 21 foods 9 samples/food = 189 samples to collect (total) • × Nutrients 2020, 12, 34 4 of 15

The moisture determination was made in triplicate (567 determinations), ashes and sodium were determined in duplicate (378 determinations of each). As a sample unit size for each food, 300 g or more were set. Each sample unit was the one corresponding to a plate or serving (as it is usually consumed). For the food of smaller portions, aminimum quantity of units was included until completing the ﬁxed size. The sampling was carried out in 3 provinces of Northwestern Argentina: Jujuy, Salta and Tucumán, as they are places where the consumption of the selected food categories is widespread.

2.5. Sample Preparation The acquired samples were packed in hermetically sealed polyethylene bags and kept refrigerated, labelled with food name, place of sampling, date, time and responsible person and after they were transferred to the laboratory. The moisture of each sample was immediately determined and the rest was dried, homogenized and kept packaged and refrigerated until processing. Finally, by quartering the sample size was reduced to analyze moisture, ashes and sodium. A description of the ingredients of each food was made and photographs were taken to create a database.

2.6. Chemical Analysis Association of Oﬃcial Analytical Chemists (AOAC) methodswere performed [21]. Moisture: (Method N◦ 945.15); ash: by calcination in muffle (Method N◦ 923.03); sodium: by suspension of ashes in 3N nitric acid and reading in flame photometer model ZF 250/240 (Method N◦ 963.15).

2.7. Statistical Analysis The information collected in the surveys was analyzed on qualitative variables, using the deductive method to describe the most common trends. Quantitative values were expressed as mean SD. ± Variance analysis between categories was performed and Tukey’s test at a signiﬁcance level of 0.05 was used. Data analysis was performed using InfoStat-Statistical Software version 2008, and a p-value < 0.05 was considered to indicate statistical signiﬁcance.

3. Results The number of surveys carried out was 486. Table1 reports the descriptive statistics and the percentages of the survey responses. Of the surveys, 131 (27%) were answered by men (19 to 47 years old) and 355 (73%) by women (20 to 40 years old). More than 70% of respondents showed their concern and interest in healthy eating, however very few of them reported knowing the daily recommended sodium intake. Only 12% admitted having cardiovascular disease. A high percentage responded knowing the difference between salt and sodium. According to the answers obtained, the seven most named foods were selected for each proposed category (street food, fast food and artisanal food) to be analyzed. Figure1 shows the distribution of all the foods mentioned in each category. It can be seen that some foods were named in more than one category; the highest frequency was selected for its definitive classification. Figure2 shows the responses on frequency of consumption including the three categories studied. It was adopted to perform some calculations (not shown in this manuscript) 4–6 times per week. Nutrients 2020, 12, 34 5 of 15

Table 1. Descriptive statistics and percentages of the survey responses.

Variable Category Frequency (%) Age up to 20 years 15.00 up to 30 years 70.00 up to 40 years 8.33 up to 50 years 6.67 Sex Female 73.00 Nutrients 2019, 12, x FOR PEER REVIEW Male 27.00 5 of 15

Survey QuestionsDo you try to eat healthy diet? AnswersYes 76.79 Frequency (%) No 7.14 Do you try to eat healthy diet? Yes 76.79 NoI donot know 3.57 7.14 IUnanswered donot know 12.50 3.57 Do you try to minimize salt intake? UnansweredYes 73.21 12.50 Do you try to minimize salt intake? YesNo 8.93 73.21 NoI donot know 8.93 8.93 IUnanswered donot know 8.93 8.93 Do you know which foods contain much salt? UnansweredYes 66.07 8.93 Do you know which foods contain much salt? YesNo 21.43 66.07 NoI donot know 5.36 21.43 IUnanswered donot know 7.14 5.36 How many times do you add salt on your meals? UnansweredAlways 3.57 7.14 How many times do you add salt on your meals? AlwaysSometimes 41.07 3.57 SometimesRarely 33.93 41.07 RarelyNever 21.43 33.93 How much salt do you think consume? NeverToo much 26.79 21.43 How much salt do you think consume? TooFew much 67.86 26.79 FewI donot know 3.57 67.86 INo donot answer know 1.79 3.57 No answer 1.79 Have you had hypertension problems? No 87.50 Have you had hypertension problems? No 87.50 yes 12.50 yes 12.50 Do you know if there is a recommended amount of salt intake? Yes 17.86 Do you know if there is a recommended amount of salt intake? Yes 17.86 No 76.79 No 76.79 I donot know 5.36 I donot know 5.36 Do you know the difference between salt and sodium? Yes 67.86 Do you know the diﬀerence between salt and sodium? Yes 67.86 NoNo 17.86 17.86 UnansweredUnanswered 5.36 5.36 II donot donot knowknow 8.93 8.93

Fast food 2% 1% 3% 2% 2% Napolitan milanese Loin sandwich 3% Pizza 23% Hamburguer 5% Milanese sandwich 6% Chicken with salad Chard cake 8% Hot dog 19% battered 10% meat empanadas 16% salads panchuque chicken sandwich

Figure 1. Cont.

Nutrients 2019, 12, x FOR PEER REVIEW 6 of 15

NutrientsNutrients2020 2019, 12,, 1 342, x FOR PEER REVIEW 6 of6 of15 15 Street food 2% 2% 3% 2% Street food Hot dog 2% 3%2% 3% 2% FrenchHot dog fries 3% 25% CrumbFrench sandwich fries 6% Tortillas (bread) 25% Crumb sandwich 6% 10% BrochetteTortillas (bread)chicken Choripanes 10% Brochette chicken 5% MeatChoripanes empanadas 5% 22% 5% chicharonMeat empanadas con mote 5% 15% 22% hamburguerchicharon con mote 15% panchuquehamburguer

panchuque

1% Artisanal food 2% 1% 1% Artisanal food Tamales Cheese empanada 2%1% 1% 4% HumitasTamales 1% 5% 15% 1%2% GoatCheese cheese empanada 4% PastafrolaHumitas 2% 5% 2% 1% 2% 15% PicklesGoat cheese 2% MaicenasPastafrola 2% 2% 2% 15% bollosPickles apiMaicenas and donut 2% 2% 2% 3% 15% icebollos cream lemon pai 3% api and donut 2% 3% locroice cream 6% 10% tortillalemon pai 3% Meatlocro empanadas 6%6% 10% 7% 9% vaciotortilla 6% chorizoMeat empanadascriollo 7% 9% caramelvacio chorizo criollo caramel Figure 1. Distribution of total foods mentioned by consumers. Figure 1. Distribution of total foods mentioned by consumers. Figure 1. Distribution of total foods mentioned by consumers.

every two months

everyeach two 15 months days eachmonthly 15 days once amonthly week 2 to 3 times/weekonce a week

2 to 3 oncetimes/week a day Frequency of of consumptionFrequency twiceonce daily a day

4 of consumptionFrequency to 6 times pertwice week daily

4 to 6 times per week0 5 10 15 20 25 30 Answer (%) 0 5 10 15 20 25 30

Figure 2. Frequency of consumption ofAnswer these (%) types of foods. Figure 2. Frequency of consumption of these types of foods. Table2 shows the three food categories under study with the respective subcategories selected, the size Figure 2. Frequency of consumption of these types of foods. of each sample unit, usual portion size, description of each product and a photograph. These products are generally classified as very palatable and easily acquired, especially street food. They are also cheaper than those acquired in formal places. Often more than one usual serving is consumed. 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Table 2.Categories and subcategories of selected foods. areproductsCategory also cheaperare generallySubcategories than classifiedthose acquired as very Ingredientsin palatable formal andplaces./UW-MSS* easily Often acquir moreed, especiallythan one streetusualPhoto food.serving They is consumed. Table 2.Categories and subcategories of selected foods. areCategory also cheaper Subcategories than those acquiredDough, Ingredientscheese,in formal onion, places./UW-MSS* pea, Oftenegg, potato more than one usualPhoto serving is Table 2.Categories and subcategories of selected foods. consumed.CategoryNutrients 2020 , 12Subcategories, 34 UW:Dough, 56 gIngredientscheese, onion,/UW-MSS* pea, egg, potato Photo 7 of 15 Table 2.Categories and subcategories of selected foods. Category Subcategories MSS:UW:Dough, 56168 Ingredientsgcheese, g (3 units) onion, /UW-MSS* pea, egg, potato Photo Cheese Table 2.Categories and subcategories of selected foods. Category Subcategories Dough,MSS:UW: 56168 Ingredientscheese,g g (3 units) onion,/ UW-MSS* pea, egg, potato Photo empanadaCheese Table 2. Categories and subcategories of selected foods. Category Subcategories Dough,UW:MSS: 56 168 gIngredientscheese, g (3 units) onion, /UW-MSS* pea, egg, potato Photo CategoryempanadaCheese Subcategories Ingredients/UW-MSS * Photo UW:MSS: 56168 g g (3 units) Cheeseempanada Dough, cheese, onion, pea, egg, potato MSS:UW: 56168 g g (3 units) Cheeseempanada GoatMSS: milk,168Dough, g rennet,(3 units) cheese, salt. onion, pea, egg, empanada Cheese Cheese UW:Goat 366milk,potato g rennet, salt. empanadaempanada UW: 56 g MSS:UW:Goat 36660gmilk, g rennet, salt. MSS: 168 g (3 units) Goat cheese GoatMSS:UW: 366milk,60g g rennet, salt. Goat cheese GoatUW:MSS: 366 milk,60g g rennet, salt. Goat cheese UW:MSS:Goat 366milk,60g g rennet, salt. Goat cheese MSS:UW: 36660gGoat g milk, rennet, salt. Goat cheeseGoat cheeseCornmeal,MSS: 60gUW: meat, 366 g potatoes, condiments Goat cheese UW:Cornmeal, 142MSS: g meat, 60g potatoes, condiments MSS:UW:Cornmeal, 142284 gg meat,(2 units) potatoes, condiments Tamales Cornmeal,MSS:UW: 142284 gg meat,(2 units) potatoes, condiments Tamales Cornmeal,UW:MSS: 142 284 g g meat, (2 units) potatoes, condiments Tamales UW:MSS:Cornmeal, 142284Cornmeal, gg meat,(2 units) meat,potatoes, potatoes, condiments condiments Artisanal TamalesTamales MSS:UW: 142284UW: gg (2 142 units) g Artisanalfood Tamales GroundMSS: 284MSS: fresh g (2 284 units)cornpaste, g (2 units) semi-hard Artisanalfood Tamales cheese,Ground pumpkin, fresh cornpaste, seasonings semi-hard Artisanalfood UW:cheese,Ground 231 pumpkin, freshg cornpaste, seasonings semi-hard food Humitas GroundMSS:463UW:cheese, 231 pumpkin, fresh gg (2 units) cornpaste, seasonings semi-hard Artisanal Ground fresh cornpaste, Artisanalfood Humitas Groundcheese,MSS:463UW: 231semi-hard pumpkin, fresh g (2 units) cornpaste, cheese, seasonings pumpkin, semi-hard foodArtisanal Humitas food Humitas cheese,UW:GroundMSS:463 231seasonings pumpkin, freshg (2 units) cornpaste, seasonings semi-hard Humitas UW:MSS:463cheese, 231UW: pumpkin, g (2 231 units) g seasonings MSS:463 g (2 units) Humitas MSS:463ChiliUW: 231pepper, gg (2 units)carrot, onion, broccoli, Humitas cauliflower,MSS:463Chili pepper, g (2 vinegar, units)carrot, onion,salt broccoli, UW:cauliflower,Chili 562 pepper, g vinegar, carrot, onion,salt broccoli, Pickles ChiliMSS:UW:cauliflower, 562pepper,50Chili g g (2 pepper, vinegar,table carrot, spoon) carrot, onion, salt onion, broccoli, broccoli, cauliflower, vinegar, salt Pickles Pickles cauliflower,MSS:UW: 56250 g g (2 vinegar,table spoon) salt Chili pepper,UW: 562 carrot, g onion, broccoli, Pickles cauliflower,UW:ChiliMSS: 562 pepper,50MSS: gg (2 50 vinegar,table carrot, g (2 tablespoon) onion,salt spoon) broccoli, Pickles UW:MSS:cauliflower, 56250 g g (2 vinegar,table spoon) salt Pickles MSS:Wheat-flour,UW: 56250 g g (2 table butter, spoon) eggs, quince jam, Pickles sugarMSS:Wheat-flour, 50 g (2 table butter, spoon) eggs, quince jam, UW:sugarWheat-flour, 405 Wheat-flour, g butter, butter, eggs, eggs, quince quince jam, jam, sugar PastafrolaPastafrola MSS:UW: 405102 gg Wheat-flour,sugar UW: 405 butter, g eggs, quince jam, Nutrients 2019, 12, x FOR PEER REVIEW 8 of 16 Pastafrola Wheat-flour,sugarMSS:UW: 405 102MSS: gg 102 butter, g eggs, quince jam, Pastafrola sugarUW:Wheat-flour,MSS: 405 102 g g butter, eggs, quince jam, Wheat flour, corn starch, eggs, butter, Pastafrola UW:MSS:sugar 405102 gg sugar, caramel, grated coconut Pastafrola MSS:UW: 405102Wheat gg flour, corn starch, eggs, UW: 53 g Pastafrola MSS: 102butter, g sugar, caramel, grated MaicenasMaicenas MSS: 159coconut g (3 units) UW: 53 g MSS: 159 g (3 units)

Base dough: Wheat flour, oil, salt, yeast; toppings: Cheese, tomato sauce, olives, chili pepper Pizzas UW: 513 g (1 medium pizza) MSS: 193 g (3/8 portions)

Breaded beef-steak (covered with egg and breadcrumbs); toppings: tomato sauce, cheese, cooked ham, olives; Napolitan accompanied by fried egg and milanese Frenchfries UW: 608 g (1 plate) MSS: 304 g (1/2 plate) Bread, beef burger, egg, tomato, lettuce, ham, cheese, mayonnaise, ketchup Simple UW: 217 g Hamburger MSS: 217 g

Fast food Bread, beef-steak, fried egg, tomato, lettuce, mayonnaise UW: 364 g (1 sandwich): Loin sandwich MSS: 364 g

Bread, milanese, fried egg, ham, cheese, tomato, lettuce, mayonnaise UW: 394 g (1 sandwich) Milanese MSS: 394 g sandwich

Chicken leg and lettuce and tomato salad UW: 422 g (1 plate) Chicken with MSS: 422 g salad

Nutrients 2019, 12, x FOR PEER REVIEW 8 of 16 Nutrients 2019, 12, x FOR PEER REVIEW 8 of 16 Nutrients 2019, 12, x FOR PEER REVIEWWheat flour, corn starch, eggs, butter, 8 of 16 Nutrients 2019, 12, x FOR PEER REVIEWsugar,Wheat caramel,flour, corn grated starch, coconut eggs, butter, 8 of 16

Nutrients 2019, 12, x FOR PEER REVIEW UW:sugar,Wheat 53 caramel, flour,g corn grated starch, coconut eggs, butter, 8 of 16 Wheat flour, corn starch, eggs, butter, Maicenas MSS:UW:sugar, 53159 caramel, g g (3 units) grated coconut sugar, caramel, grated coconut Maicenas WheatMSS:UW: 53159 flour, g g (3 corn units) starch, eggs, butter, UW: 53 g Maicenas sugar,MSS: 159caramel, g (3 units) grated coconut Maicenas MSS: 159 g (3 units) UW: 53 g Nutrients 2020, 12, 34 8 of 15 Maicenas MSS:Base dough:159 g (3 Wheat units) flour, oil, salt, yeast;Base dough: toppings: Wheat Chee flour,se, tomato oil, salt, sauce, olives,yeast;Base dough: toppings:chili pepper WheatTable Chee 2.flour,se,Cont tomato oil,. salt, sauce, Base dough: Wheat flour, oil, salt, Pizzas UW:olives,yeast; 513 toppings:chili g (1 pepper medium Chee se,pizza) tomato sauce, Category Subcategoriesyeast; toppings: Ingredients Cheese,/UW-MSS tomato *sauce, Photo Pizzas BaseMSS:UW:olives, dough: 513193 chili gg (1(3/8 pepperWheat medium portions) flour, pizza) oil, salt, olives, chili pepper Nutrients 2019, 12, Pizzasx FOR PEER REVIEWyeast; MSS:UW: 513193toppings: g (1(3/8 medium portions)Cheese, pizza) tomato sauce, 8 of 15 Pizzas UW: 513Base g (1 dough: medium Wheat pizza) ﬂour, oil, salt, MSS: 193 g (3/8 portions) olives, yeast;chili pepper toppings: Cheese, tomato BreadedMSS: 193 bee g (3/8f-steak portions) (covered with egg Pizzas Pizzas UW:Breaded 513sauce, beef-steakg (1 olives,medium chili(covered pizza) pepper with egg MSS:andBreaded breadcrumbs); 193UW: beef-steakg (3/8 513 gportions) (1 medium toppings:(covered pizza) withtomato egg sauce,and breadcrumbs); cheese,MSS: 193 cooked g (3/ 8toppings: portions) ham, olives; tomato Napolitan Breaded beef-steak (covered with egg accompaniedBreaded beef-steak by fried (covered egg and with egg milanese sauce,and breadcrumbs); cheese, cooked toppings: ham, olives; tomato milaneseNapolitan and breadcrumbs);Breaded beef-steak toppings: (covered tomato with Frenchfriesaccompaniedsauce, cheese, by cooked fried eggham, and olives; milanese Breadedegg beef-steak and breadcrumbs); (covered toppings:with egg Napolitan UW:sauce, 608 cheese, g (1 plate) cooked ham, olives; Napolitan andFrenchfriesaccompanied breadcrumbs);tomato sauce,by fried toppings: cheese, egg cookedand tomato ham, milaneseNapolitan MSS:accompanied 304 g (1/2 by plate) fried egg and milanese sauce,MSS:UW:Frenchfries 608304 cheese,olives; gg (1(1/2 accompaniedplate) cooked plate) ham, by olives; fried egg Napolitanmilanese Frenchfries accompaniedBread,MSS:UW: 608304 andbeef g Frenchfries (1(1/2burger, byplate) plate) fried egg, egg tomato, and milanese UW: 608UW: g (1 608 plate) g (1 plate) Frenchfrieslettuce,Bread,MSS: 304 beef ham, g burger,(1/2 cheese, plate) egg, mayonnaise, tomato, Simple MSS: 304 g (1/2 plate) ketchupMSS: 304 g (1/2 plate) HamburgerSimple UW:lettuce,Bread, 608 beefham, g (1 burger, plate)cheese, egg, mayonnaise, tomato, UW:ketchupBread, 217 beef g burger, egg, tomato, MSS:lettuce, 304 ham, g (1/2 cheese, plate) mayonnaise, HamburgerSimple lettuce,Bread, ham, beefcheese, burger, mayonnaise, egg, tomato, Bread,MSS:UW:ketchup 217217 beeflettuce, gg burger, ham, cheese,egg, tomato, mayonnaise, HamburgerSimple Simple ketchup Simple Bread,MSS:UW: 217 ketchupbeef-steak, g fried egg, tomato, HamburgerHamburger lettuce, ham, cheese, mayonnaise, lettuce,UW: 217UW: mayonnaise g 217 g Fast food Hamburger ketchupMSS: 217 g SimpleLoin sandwich UW:Bread,MSS: 364 217 MSS:beef-steak, g g (1 217 sandwich): g fried egg, tomato, Fast food UW: 217 g Hamburger MSS:lettuce,Bread, 364 beef-steak, mayonnaise g fried egg, tomato, Fast food MSS: 217 g Fast food UW:lettuce,Bread, 364 beef-steak,mayonnaise g (1 sandwich): fried egg, tomato, Bread, Bread,beef-steak, beef-steak, fried friedegg, egg,tomato, Loin sandwich Bread,MSS:UW:lettuce, 364364 milanese, mayonnaise gg (1 sandwich): fried egg, ham, tomato, lettuce, mayonnaise Fast foodFast foodLoin sandwichLoin sandwich MSS:lettuce, 364 mayonnaise g Bread,cheese,UW: 364 beef-steak,UW: tomato, g (1 364 sandwich):g lettuce, (1 fried sandwich): egg,mayonnaise tomato, Milanese UW: 364 g (1 sandwich): Loin sandwich lettuce,UW:MSS: 394 364MSS: mayonnaise g g (1 364 sandwich) g Loin sandwich MSS: 364 g sandwich UW:MSS: 364 394 g g (1 sandwich):

Loin sandwich MSS:Bread, 364 milanese, g fried egg, ham, cheese,Bread, milanese,tomato, lettuce, fried egg, mayonnaise ham, Bread, milanese, fried egg, ham, UW:cheese,Bread, 394cheese, milanese,tomato, g (1 sandwich) tomato, lettuce, fried lettuce, egg, mayonnaise ham, MilaneseMilanese MSS:UW:Bread, 394394 mayonnaisemilanese, gg (1 sandwich) fried egg, ham, sandwich cheese, tomato, lettuce, mayonnaise sandwichMilanese cheese,UW: tomato, 394 g lettuce, (1 sandwich) mayonnaise Bread,MSS:UW: 394 milanese, g (1 sandwich) fried egg, ham, sandwichMilanese UW: 394MSS: g (1 394 sandwich) g Milanese cheese,MSS: 394 tomato, g lettuce, mayonnaise sandwich MSS: 394 g sandwich UW: 394 g (1 sandwich) Milanese Chicken leg and lettuce and tomato MSS:Chicken 394 leg g and lettuce and tomato Chicken leg and lettuce and sandwich saladChicken leg and lettuce and tomato Chicken Chickenwith with tomato salad UW:salad 422 g (1 plate) saladChicken saladwith ChickenUW: leg 422 and g (1lettuce plate) and tomato Nutrients 2019, 12, x FOR PEER REVIEW MSS:UW:Chicken 422422MSS: leggg (1 422and plate) g lettuce and tomato 9 of 16 saladChicken with salad MSS:salad 422 g salad ChickenUW: 422 leg g (1 and plate) lettuce and tomato Chicken with Wheat-flourUW: 422 g (1 dough, plate) chard, beaten egg, Chicken with saladMSS: 422 g salad onion,MSS: 422 grated g cheese, condiments Wheat-ﬂour dough, chard, beaten salad UW: 422 g (1 plate) Chicken with UW: 383egg, g onion, grated cheese,

MSS: 422 g saladChard cakeChard cakeMSS: 192condiments g (Half unit)

UW: 383 g

MSS: 192 g (Half unit) Wheat-flour dough, chard, beaten egg,

onion, grated cheese, condiments French fries, mayonnaise, salt Chard cake UW: 383 g UW: 81 g MSS: 192 g (Half unit) MSS: 81 g

French fries French fries, mayonnaise, salt UW: 81 g Street food French fries MSS: 81 g Vienna bread, sausage, mustard, mayonnaise, ketchup UW: 77 g Hot dog MSS: 154 g (2 units)

Crumb bread, ham, cheese, mayonnaise Crumb UW: 65 g sandwich MSS: 195 g (3 units)

Street food Spiced chicken, sliced onion, pepper or roasted tomato. UW: 183 g Chicken MSS: 386 g (2 units) brochette

Wheat flour dough, fat, water UW: 426 g MSS: 213 g (Half unit) Tortillas (bread)

French-type bread and pork sausage, mayonnaise. UW: 179 g Choripan MSS: 179 g

Nutrients 2019, 12, x FOR PEER REVIEW 9 of 16 Nutrients 2019, 12, x FOR PEER REVIEW 9 of 16 Nutrients 2019, 12, x FOR PEER REVIEW Wheat-flour dough, chard, beaten egg, 9 of 16 Nutrients 2019, 12, x FOR PEER REVIEWWheat-flour onion, grated dough, cheese, chard, condiments beaten egg, 9 of 16 Nutrients 2019, 12, x FOR PEER REVIEWonion,Wheat-flour UW: 383 grated g dough, cheese, chard, condiments beaten egg, 9 of 16 Chard cake UW:onion,MSS: 383 192 grated g g (Half cheese, unit) condiments Nutrients 2019, 12, x FOR PEER REVIEWWheat-flour dough, chard, beaten egg, 9 of 16 Chard cake MSS:UW:onion,Wheat-flour 383192 grated gg (Half dough, cheese, unit) chard, condiments beaten egg, Chard cake MSS: 192 g (Half unit) UW:Wheat-flouronion, 383 grated g dough, cheese, chard, condiments beaten egg, Chard cake MSS:onion,UW: 383192 grated gg (Half cheese, unit) condiments Chard cake UW:MSS:French 383192 fries, gg (Half mayonnaise, unit) salt Nutrients 2020, 12, 34 9 of 15 Chard cake FrenchMSS:UW: 81192 fries, g g (Half mayonnaise, unit) salt UW:FrenchMSS: 81 81 fries,g g mayonnaise, salt French fries MSS:UW: 8181 gg French fries, mayonnaise,Table 2. Cont salt. French fries MSS:UW:French 8181 fries, gg mayonnaise, salt CategoryFrench fries Subcategories Ingredients/UW-MSS * Photo MSS:FrenchUW: 8181 fries, gg mayonnaise, salt French fries UW:MSS: 8181 gg French fries Vienna bread, sausage, mustard, MSS: 81French g fries, mayonnaise, salt French friesFrench friesViennamayonnaise,UW: bread, 81 ketchup gsausage, mustard, mayonnaise,ViennaUW: 77MSS: bread, g 81 ketchup gsausage, mustard, Hot dog UW:mayonnaise,ViennaMSS: 77 154 bread,g g (2 ketchup units)sausage, mustard, Hot dog MSS:UW:mayonnaise,Vienna 77154 bread,g g (2 ketchupunits) sausage, mustard, Hot dog MSS: 154 g (2 units) UW:Viennamayonnaise, 77 bread,g ketchup sausage, mustard, Hot dog MSS:mayonnaise,UW: 77154Vienna g g (2 ketchup bread,units) sausage, mustard, mayonnaise, ketchup Hot dogHot dog MSS:Crumb 154 bread, g (2 units) ham, cheese, UW: 77UW: g 77 g Crumbmayonnaise bread, ham, cheese, Hot dog MSS: 154MSS: g (2 154 units) g (2 units) Crumb mayonnaiseCrumbUW: 65 bread, g ham, cheese, Crumbsandwich UW:mayonnaiseCrumbMSS: 65 195 bread,g g (3 units)ham, cheese, sandwichCrumb MSS:UW:mayonnaiseCrumb 65195Crumb bread,g g (3 units) bread, ham, ham,cheese, cheese, sandwichCrumb MSS: 195 g (3 units) Crumb UW:Crumbmayonnaise 65mayonnaise bread,g ham, cheese, Street food sandwichCrumb sandwich SpicedUW: chicken, 65 g sliced onion, pepper or MSS:mayonnaiseUW: 65195 g g (3 units) Street food sandwich Spicedroasted MSS:chicken, tomato. 195 gsliced (3 units) onion, pepper or Crumb UW:MSS: 65195 g g (3 units) Street food roastedSpicedUW: 183 chicken, tomato. g sliced onion, pepper or sandwichChicken MSS: 195 g (3 units) UW:roastedSpicedMSS: 183 386 chicken, tomato. g g (2 units) sliced onion, pepper or Street food Chickenbrochette MSS:UW:roastedSpiced 183386 Spicedchicken, tomato. gg (2 chicken,units) sliced sliced onion, onion, pepper or Street food brochetteChicken Chicken pepper or roasted tomato. MSS:UW:roasted 183386 tomato. gg (2 units) Street foodStreet foodbrochetteChickenbrochette Spiced UW:chicken, 183 g sliced onion, pepper or MSS:roastedUW: 183386MSS: tomato. gg (2 386 units) g (2 units) brochetteChicken UW:MSS:Wheat 183386 flour gg (2 dough, units) fat, water Chickenbrochette WheatMSS:UW: 426386 flour gg (2 dough, units) fat, water brochette UW:WheatMSS: 426 213 flour g g (Half dough, unit) fat, water Tortillas (bread) MSS:UW:Wheat 426213 Wheatflour gg (Half dough, ﬂour unit) dough, fat, water fat, water Tortillas Tortillas(bread) (bread)MSS:UW:Wheat 426213 UW:flour gg (Half 426 dough, g unit) fat, water Tortillas (bread) MSS: 213 g (Half unit) MSS:WheatUW: 426213 flour gg (Half dough, unit) fat, water Tortillas (bread) UW:MSS: 426213 gg (Half unit) Tortillas (bread) MSS:French-type 213 g (Half bread unit) and pork sausage, Tortillas (bread) French-typemayonnaise. bread and pork sausage, mayonnaise.French-typeUW: 179French-type g bread breadand pork and pork sausage, sausage, mayonnaise. ChoripanChoripan UW:mayonnaise.MSS: 179 179 g g French-typeUW: 179 bread g and pork sausage, Nutrients 2019, 12,Choripan x FOR PEER REVIEWMSS:UW:mayonnaise. French-type 179179MSS: gg 179 bread g and pork sausage, 10 of 16 Choripan MSS: 179 g UW:French-typemayonnaise. 179 g bread and pork sausage, Wheat flour dough, ground meat, Choripan MSS:mayonnaise.UW: 179179 gg onion, pea, potato, hardboiled egg Choripan UW:MSS: 179179 gg UW: 59Wheat g ﬂour dough, ground meat, MeatChoripan MSS: 179 g Meat MSS: 177onion, g (3 pea, units) potato, hardboiled egg empanadasempanadas UW: 59 g MSS: 177 g (3 units)

* UW: Unit Weight; MSS: Serving size of each food per meal. *UW: Unit Weight; MSS:Serving size of each food per meal.

Figure3a–c shows the average contents, maximum and minimum values by category /subcategory of food. As it can be observed, there is great(a) variability Fast food for each subcategory. If the sodium contents of the total foods analyzed are compared with those established by traffic light, it can be observed that only Chard cake French fries can be classified as low sodium ( 120 mg Na). Among the medium-content foods (>120 and ≤ Chicken<600 mg with of salad sodium), there are four foods from the fast food category, five artisanal foods and three of street-sale food. All other foods analyzed are classified as high in sodium ( 600 mg Na/100 g). ≥ Hamburguer

Milanese sandwich

Loin sandwich

Napolitan milanese

Pizza

0 200 400 600 800 1000 1200 1400 Na content (mg/100g) Traffic Light Low Medium High Maximun Minimun Mean

(b) Artisanal food Goat cheese

Pickles

Pastafrola

Maicenas

Humitas

Tamales

Cheese empanadas

0 200 400 600 800 1000 1200 1400 Na content (mg/100g) Traffic Light Low Medium High Maximun Minimun Mean

Nutrients 2019, 12, x FOR PEER REVIEW 9 of 15

Spiced chicken, sliced onion, pepper or roasted tomato. Chicken UW: 183 g brochette MSS: 386 g (2 units)

Wheat flour dough, fat, water UW: 426 g Tortillas (bread) MSS: 213 g (Half unit)

French-type bread and pork sausage, mayonnaise. Choripan UW: 179 g MSS: 179 g

Wheat flour dough, ground meat, onion, pea, potato, hardboiled egg Meat UW: 59 g empanadas MSS: 177 g (3 units)

Nutrients 2020, 12, 34 10 of 15 *UW: Unit Weight; MSS:Serving size of each food per meal.

(a) Fast food Chard cake

Chicken with salad

Hamburguer

Milanese sandwich

Loin sandwich

Napolitan milanese

Pizza

0 200 400 600 800 1000 1200 1400 Na content (mg/100g) Low Medium High NutrientsTraffic 2019Light, 12, x FOR PEER REVIEW 10 of 15 Maximun Minimun Mean

(b) Artisanal food Goat cheese

Pickles

Pastafrola

Maicenas

Humitas

Tamales

Cheese empanadas

0 200 400 600 800 1000 1200 1400 Na content (mg/100g) Traffic Light Low Medium High Maximun Minimun Mean

French fries

Tortillas (bread)

Brochette chicken

Crumb sandwich

Hot dog

Choripan

0 200 400 600 800 1000 1200 1400 Na (mg/100g) Traffic Light Low Medium High Maximun Minimun Mean

FigureFigure 3. 3.Classiﬁcation Classification of foods foods in in low, low, medium medium and andhigh highsodium sodium content content (mg of Na/100g (mg of food). Na/100g food).

Figure 3a–c shows the average contents, maximum and minimum values by category/subcategory of food. As it can be observed, there is great variability for each subcategory. If the sodium contents of the total foods analyzed are compared with those established by traffic light, it can be observed that only French fries can be classified as low sodium (≤120 mg Na). Among the medium-content foods (>120 and <600 mg of sodium), there are four foods from the fast food category, five artisanal foods and three of street-sale food. All other foods analyzed are classified as high in sodium (≥600 mg Na/100 g).

Nutrients 2020, 12, 34 11 of 15

Figure4a–c shows the contribution of sodium amount contained in a commonly consumed portion of each food (per subcategory), calculated with the average sodium content value. The WHO recommendedNutrients 2019 daily, 12, x intakeFOR PEER value REVIEW was included. 11 of 15

(a) Fast food 4000

3000

2000

1000

Sodium Sodium intake (mg/serving) 0

(b) Artisanal food

3000

2000

1000 Sodium Sodium intake (mg/serving) 0

3000

2000

1000

Sodium intake (mg/serving) Sodium intake (mg/serving) 0

Figure 4. Average sodium intake per serving. Figure 4. Average sodium intake per serving.

Nutrients 2020, 12, 34 12 of 15

These results show that sodium intake depends so much on the processor, due to the amount of salt that each of them adds and also on the consumer when choosing the portion size.

4. Discussion In Argentina, projects have been carried out to reduce salt consumption since 2011 by the national government. They worked on the project “less salt more life” and healthy school kiosks. In 2013, a law on the regulation of sodium content in industrialized foods was enacted. However, the average salt consumption continues to exceed 12 g salt/day. These projects and legislation do not consider the type of food studied, which due to its high consumption and salt content can be important contributors to the daily intake. The results of this study confirm that hypothesis. Therefore, it is of special interest that these foods are also taken into account to develop public policies related to sodium reduction. This study allowed us to know that consumers do not consider the size when selecting a portion of food or that the related contribution may be excessive. In general, they also do not know the foods with the highest salt intake or the WHO intake recommendation. The variability observed in the salt content between products of the same subcategory allows us to conclude that sodium content depends primarily on the processor. In some foods, like loin sandwich, which is easily manufactured, sodium content is due to the ingredients used. In others, e.g., French fries, the addition of salt depends a lot on the food habits of the consumer. The acquisition of food outside home in Latin America is already a culturally established activity, so it is a priority to constitute actions that also control this type of food. The results of this work show that the three categories studied are of habitual consumption and the contribution to sodium intake is high and can have detrimental eﬀects on health. Since sodium reduction is a public health objective, Argentina should promote the implementation of sodium reduction policies in these categories, expanding the list of foods promulgated by law and not limited only to industrial foods. This study would oﬀer criteria for classifying foods in these categories according to their critical nutrient content.

5. Conclusions Due to the low knowledge of consumers, more information campaigns should be carried out on the recommended daily amount of salt and on the risks of consuming it in excess. The sodium content in the three categories of food studied is high and the variability in each subcategory is wide. The high variability indicates that the greatest influence on the sodium content in this type of product is the salt added by the processor. The contribution of this type of food to the daily intake can be very high, for the high frequency of consumption informed in the surveys conducted to consumers (4 to 6 times/week and in opportunities more than once per day). This shows that it is necessary to raise awareness among food processors about the importance for health of reducing sodium consumption and the relevance they have to achieve this goal. Based on the results obtained, it is observed that the sodium intake of the Argentine population continues to be high, even though the efforts made by public health; therefore, an analysis is required on the types of food consumed daily. This study provides valuable information regarding the contribution of sodium to the diet by street food, artisanal food and fast food, which are of consumed in high quantities. Several of these foods would exceed the recommended maximum daily sodium intake of the WHO with just a single portion. This would allow the formulation of new public policies to implement regulations and to keep the consumer informed about the possible risks of consuming them. Considering Joint Resolution 12/2019 of the Ministry of Health Regulation and Management and the Secretary of Food and Bioeconomy of the Nation (which modifies article 21 of the Argentine Food Code [22] and establishes that any person who may be in contact with food must complete and approve a training course on safe food-handling), and considering that the World Health Organization declares that it is essential to prioritize training of the food-handling staff, with an approach based on the prevention of foodborne diseases, the concept could be extended so that food-handlers should alsobe trained in basic aspects of food, nutrition and health. Nutrients 2020, 12, 34 13 of 15

Author Contributions: Conceptualization, S.R.C. and N.C.S.; methodology, S.R.C. and N.C.S.; software, S.R.C.; formal analysis, S.R.C. and N.C.S.; investigation, all authors; resources, N.C.S.; data curation, S.R.C. and N.C.S.; writing—original draft preparation, S.R.C.; writing—review and editing, all authors, visualization, all authors; supervision, N.C.S.; funding acquisition, N.C.S. All authors have read and agreed to the published version of the manuscript. Funding: This research was funded by the International Development Research Centre (IDRC), Canada; Grant number 108167-001. Acknowledgments: The authors acknowledge the support of the IDRC, Facultad de Ingeniería-Universidad Nacional de Jujuy, INSIBIO-CONICET. Conﬂicts of Interest: The author declares no conﬂict of interest.

Appendix A QUESTIONNAIRE. Province: Date: Age: Sex: Do you consume artisanal foods? Yes No Mention 4 foods of this type that you usually consume (minimum serving size) ------Do you consume street foods? Yes No Mention 4 foods of this type that you usually consume (minimum serving size) ------Do you consume street foods? Yes No Mention 4 foods of this type that you usually consume (minimum serving size) ------How often do you consume these types of foods?

4 to 6 times per week twice daily once a day 2 to 3 times/week once a week monthly each 15 days every two months

1- Do you try to eat healthy diet? Yes No I do not know Unanswered 2- Do you try to minimize salt intake? Yes No I do not know Unanswered 3- Do you know which foods contain much salt? Yes No I do not know Unanswered 4- How many times do you add salt on your meals? Always Sometimes Rarely Never 5- How much salt do you think consume? Too much Few I do not know No answer 6- Have you had hypertension problems? Yes No 7- Do you know if there is a recommended amount of salt intake? Yes No I do not know Nutrients 2020, 12, 34 14 of 15

8- Do you know the diﬀerence between salt and sodium? Yes No I do not know Unanswered

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