Food types, preparation methods, and use of high-sodium seasonings in chain restaurants in Jamaica – Implications for Sodium Consumption and Food Policy

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Bennett, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7228602/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Objectives: Food sold in restaurants is a major contributor to sodium consumption patterns. We report findings on the types of foods sold, preparation methods, and the use of high-sodium seasonings in chain restaurants in Jamaica and discuss the implications for sodium consumption and food policy. Results: Data were collected from chain restaurants (defined as ≥3 stores locally) as part of the Jamaica Salt Consumption Study. Interviewers collected information via questionnaire on restaurant characteristics, menu items, types of seasonings used during food preparation, and availability of low-salt options. Only 24% of restaurant chains identified participated. Of the 107 menu items identified, the most frequently sold were chicken (21.5%), fish (15.9%), and soup (9.4%). The most common methods of preparation for meat were frying (20.6%), boiling (18.7%), baking (17.8%), and stewing(17.8%). Commonly used high-sodium seasonings included sea salt (37.4%), table salt (17.8%), and soy sauce (16.8%). Six of the restaurant chains implemented salt reduction measures, including portion control and the use of unsalted seasonings and herbs. Conclusion: Most restaurants evaluated used salt-containing seasonings but also offered low-salt options. Healthier dietary options and meal preparation methods in restaurants will be a critical part of food policy and for national sodium reduction interventions. Chain restaurants salt/ sodium content fast-food restaurants full-service restaurants high–sodium seasonings low–salt options Introduction Excess dietary sodium (i.e. ≥ 2000 mg/day sodium or 5 grams/day of salt) is a major contributor to adverse health outcomes globally (1, 2). The burden of diseases attributed to poor-quality diets has impacted public health considerably and accounts for substantial direct and indirect financial costs to economies (2, 3). Excess dietary salt has been linked to high blood pressure (HBP) and cardiovascular diseases (CVDs) as well as other adverse health outcomes globally (4, 5). Reduction in sodium consumption is recommended as the primary approach for addressing the high burden of premature mortality resulting from these conditions (2-4). Data from the Jamaica Health and Lifestyle Survey 2016 – 2017 (JHLS-III) suggest that over 60% of Jamaicans have elevated blood pressure, with one-third of the population being hypertensive (6). In 2016, CVDs were the leading cause of death, accounting for 31% of total deaths (7). Salt reduction interventions are therefore critical in reducing the impact of hypertension and CVDs on the population. The Jamaica Salt Consumption study was conducted to gather data on salt consumption in Jamaica as part of Jamaica’s response to the World Health Organisation (WHO) SHAKE Technical Package (2, 7). One component of this study was to determine the salt content of foods sold in restaurants, as evidence in other settings suggests that most of the salt consumed is from processed and restaurant foods (8-10). Previous reports from JHLS-III found that approximately 31% of Jamaicans consume food from fast food restaurants 1 – 6 times per week (6). Efforts to identify high-sodium sources in restaurant items are crucial in developing effective salt reduction interventions. Effective population-wide sodium reduction strategies must include an overall reduction of sodium in the food supply and incorporate efforts from stakeholders in the restaurant industry (11). Here, we describe the types of food sold, preparation methods, and use of high-sodium seasonings among chain restaurants in Jamaica and efforts these restaurants have made to reduce salt or sodium use or provide low-sodium options. Methods We conducted a cross-sectional survey of chain restaurants, defined herein as commercial entities with three or more locations in Jamaica. The methods employed were previously published in the study protocol (7). Briefly, restaurants were identified using data from the Companies Office of Jamaica and the Yello Directory. Restaurants were classified as either full-service (FS-R) or fast food (FF-R) restaurants. FS-R were those that had table service provided by waiter staff, while FF-R were quick-service restaurants that provided menu items typically prepared quickly and served packaged. Food establishments that sold ready-to-eat food items prepared at the restaurants were eligible for inclusion in the study. Initially, restaurants were contacted via telephone, and the study and its objectives were introduced. Follow-up was conducted using email or in-person visits. Trained interviewers administered questionnaires (in-person) on restaurant characteristics, meal items sold, information on recipes/ingredient quantities, methods of food preparation, use of salt or high-sodium seasonings and sauces, and availability of low-salt options. The questionnaire was developed by the study investigators (see supplementary files). Study nutritionists coded the foods into food categories based on food types and preparation methods. Data were analysed using Stata 18 statistical software, and descriptive analyses were performed using standard methods. Results Twenty-nine eligible chain restaurants were approached, and seven (2 FS-R; 5 FF-R) agreed to participate. A profile of individual restaurants is shown in the Appendix (Table S1 ). One hundred and seven (107) menu items were identified from the restaurants (70 in FF-R and 37 in FS-R) and subdivided into 16 food item categories. Of the 16 categories of food items sold (Table 1 ), chicken (21.5%), fish (15.9%), and soup (9.4%) were the most frequently sold in all restaurants. Fish (21.6%) was the most frequently sold item in FS-R and chicken (25.7%) in FF-R. Table 2 indicates that of the seven methods of preparation identified in all surveyed restaurants, the most used methods were fried (20.6%), boiled (18.7%), baked (17.8%), and stewed (17.8%). The most utilised method of preparation in the FF-R was frying (27.1%) and stewing (32.4%) in the FS-R. Table 1 Categories of food sold in all restaurants Food Category All restaurants N = 107 N (%) Full-Service Restaurants n = 37 n (%) Fast Food Restaurants n = 70 n (%) Chicken 23 (21.5) 5 (13.5) 18 (25.7) Fish 17 (15.9) 8 (21.6) 9 (12.9) Soup 10 (9.4) 4 (10.8) 6 (8.6) Seafood 8 (7.5) 5 (13.5) 3 (4.3) Pastry 8 (7.5) 2 (5.4) 6 (8.6) Pasta 7 (6.5) 2 (5.4) 5 (7.1) Vegetarian 7 (6.5) 4 (10.8) 3 (4.3) Pork 7 (6.5) 2 (5.4) 5 (7.1) Patty 5 (4.7) 0 (0) 5 (7.1) Mutton 4 (3.7) 2 (5.4) 2 (2.9) Bread/ Flour /Starch 4 (3.7) 2 (5.4) 2 (2.9) Beef 2 (1.9) 0 (0) 2 (2.9) Potato 2 (1.9) 0 (0) 2 (2.9) Rice and Peas 1 (0.9) 0 (0) 1 (1.4) Ackee and Saltfish 1 (0.9) 0 (0) 1 (1.4) Bammy 1 (0.9) 1 (2.7) 0 (0) Table 2 Method of Cooking by Food Establishment Type Method of Cooking All restaurants n (%) Full-Service Restaurants n (%) Fast Food Restaurants n (%) Boiled 20 (18.7) 7 (18.9) 13 (18.6) Baked 19 (17.8) 5 (13.5) 14 (20.0) Fried 22 (20.6) 3 (8.1) 19 (27.1) Stewed 19 (17.8) 12 (32.4) 7 (10.0) Steamed 7 (6.5) 4 (10.8) 3 (4.3) Roasted, grilled, or jerked 8 (7.5) 2 (5.4) 6 (8.6) Other 1 12 (11.2) 4 (10.8) 8 (11.4) Total 107 (100) 37 (100) 70 (100) p = 0.032 (Fisher’s exact) for overall difference by Food establishment type 1 Other preparation methods included curried, stir fried, sautéed, etc. Table 3 shows thirteen seasoning ingredients used in all restaurant categories. Sea salt (37.4%) table salt (17.8%) and soy sauce (16.8%) were the most used seasoning ingredients, while bouillon (0.9%), baking soda (2.8%) and barbecue sauce (2.8%) were the least used. Sea salt was primarily used in FS-R (86.5%), whereas table salt was primarily used in FF-R (17.1%). Ingredients such as soy sauce, ketchup, jerk seasoning marinade, and jerk seasoning powder were more often used in FF-R compared to FS-R, while onion powder and garlic were least used. The use of seasonings by food group is shown in Table S2 in the appendix. Salty seasonings were primarily used in the meat, chicken, seafood, and fish categories, with sea salt, soy sauce, and ketchup being the most used. Table 3 Use of Salts, Seasonings, Sauces and Spices by Food Establishment Type Salt, Seasonings, Sauces, Spices All restaurants N (%) Full-Service Restaurants n (%) Fast Food Restaurants n (%) Table salt 19 (17.8) 7 (18.9) 12 (17.1) Sea Salt *** 40 (37.4) 32 (86.5) 8 (11.4) MSG * 10 (9.4) 0 (0) 10 (14.3) Baking Powder 5 (4.7) 2 (5.4) 3 (4.3) Baking Soda 3 (2.8) 2 (5.4) 1 (1.4) Ketchup 17 (15.9) 4 (10.8) 13 (18.6) Barbeque Sauce 3 (2.8) 0 (0) 3 (4.3) Soy Sauce * 18 (16.8) 2 (5.4) 16 (22.9) Jerk Seasoning Marinade 15 (14.0) 2 (5.4) 13 (18.6) Powdered Jerk Seasoning 16 (15.0) 4 (10.8) 12 (17.1) Garlic Salt *** 7 (6.5) 7 (17.9) 0 (0) Onion Powder** 9 (8.4) 8 (21.6) 1 (1.4) Bouillon 1 (0.9) 1 (2.7) 0 (0) *p < 0.05; **p < 0.01; ***p < 0.001 (Fisher’s exact) MSG = monosodium glutamate (seasoning salt) Three of the seven restaurants reported having nutrition profiles, however these were not made available to the study team. Low salt options were offered by five of the seven restaurants surveyed, and six implemented steps to reduce the salt content in their menu. These steps included using natural seasonings, utilising low-sodium products, and implementing low-sodium measures directly related to the portion size of items being prepared (See Table S3 in the appendix). Six restaurants also reported offering catering services, and five offered customised meals with lower sodium. Customised meals were based on customer requests and the establishments’ standard formulation and procedures. Discussion Only seven of the twenty-nine chain restaurants approached participated in the survey. Among the seven restaurants, the food items most frequently sold were chicken, fish, and soup. Salt and salty seasonings or sauces were often used in food preparation, with sea salt, table salt, and soy sauce being the most used. Low salt options and measures to reduce salt content were implemented by some restaurants, but these were limited to individual customer requests. The finding that only 24% of the restaurants approached participated in the study may reflect the willingness of the food industry to provide data for health research to assess and improve the food environment. However, if a reduction in sodium levels in restaurant foods is to be achieved, restaurants will need to provide required data and participate in efforts to adjust food preparation to use less salt. This is an important component of the recommendations from the WHO SHAKE package, specifically, surveillance to measure and monitor the sodium content of foods and harnessing the industry to promote sodium reduction in the reformulation of recipes and meals ( 2 , 12 ). Food prepared outside the home is a major source of sodium intake and has become increasingly popular in recent years. This is partly due to individuals’ limited availability of time for meal preparation and rapid urbanization, making restaurant foods more convenient ( 13 , 14 ). Restaurant foods are generally higher in sodium content when compared with similar versions of home-made foods because of their varied sources of sodium or portion sizes of meals sold ( 10 , 15 ). According to a 2022 Food and Agriculture Organization (FAO) report, Jamaica has experienced increased consumption of fast foods, especially in urban areas ( 16 ). While food consumption patterns and habits of Jamaicans outside the home may not be established from the data in this study, the results obtained provide some insight regarding the types of foods eaten away from home and methods of preparation as supplied by the participating restaurants using the foods most consumed. In the United States, the National Health and Nutrition Examination Survey (NHANES) reported that food items prepared in restaurants contributed more to sodium intake than equivalent store-bought foods ( 11 ). When compared with their store-bought counterparts, food categories commonly sold, such as poultry, fish/seafood, and soup, had higher proportions of sodium ( 11 ). This suggests that menu items with higher sodium content that are frequently sold should be targeted for sodium reduction. Only three of the seven restaurants surveyed reported having nutrition profiles, and six offered customised meals. For consumers who want to make healthier food choices, information would not be readily available, as less than half of the restaurants surveyed would be able to provide details on the nutritional content of their menu items. Therefore, consumers must rely primarily on personal nutrition knowledge. However, by providing customised menu options, restaurants can facilitate customers making healthier, low-sodium meal choices tailored to suit their needs. This could potentially boost sales by providing valued added options which could attract patrons with higher purchasing power. All restaurants surveyed used high-sodium-containing seasonings. The establishments did not provide specific ingredients and quantities used in their meal preparation; however, the use of multiple varieties of high-sodium seasonings highlights this as a consistent practice of the food industry. Restaurant meals are typically high in sodium content because of their portion sizes or varied sodium sources ( 10 , 15 ). To determine the overall contribution to the sodium content of these meals, the details of the ingredients used, and their quantities are critical. Meals containing multiple sources of highly salted seasonings used in their preparation are more likely to be high in sodium than those without ( 15 ). Restaurants could consider using salt substitutes or enhancers such as calcium or potassium chloride, as is the practice of some leading Canadian fast-food chains, where more than 60% of their meals contain these ingredients ( 15 ). A similar commitment of food industry stakeholders to reduce sodium by using lower sodium seasonings or salt substitutes would help to reduce sodium consumption in Jamaica. Since much of the population consumes food outside the home, public education is critical in equipping them to make informed choices while eating out and create a demand for information surrounding nutrition content. The availability of healthier low-sodium alternatives in the local food landscape is beneficial and may contribute to the overall goal of achieving a population-wide sodium reduction. However, as previous studies have shown, restaurants may not voluntarily reduce the sodium content of foods, and efforts may be inconsistent ( 12 , 17 ). One reason for this is that the promotion of low-sodium or healthier foods by restaurants may be perceived as having a reverse effect and reduce sales of the respective menu items. Laws requiring labelling of menu items may be necessary to effect change ( 18 ) ( 18 ). Some studies suggest that customers value taste over health where restaurant meals are concerned ( 9 , 19 ). As an alternative, restaurants may opt to reduce sodium content gradually without alerting the public to such changes ( 20 ). A reduction in sodium of up to 20% may not be detectable by consumers and would provide restaurants with the opportunity to reduce sodium content and help in retraining consumers’ taste buds over time ( 18 , 21 ). While most of the restaurants surveyed used high-sodium seasonings, low-sodium options were available to their customers. An effective population-wide sodium reduction strategy will require public education to equip consumers with the knowledge required to make better choices. Interventions must include partnerships between the government and the local food industry, as their contribution to population health and well-being is integral. Consistent exposure to foods high in sodium influences a person’s preference and demand for these types of meals ( 17 ); therefore, reducing the exposure may affect consumers’ overall demand for high-sodium foods. Policies regulating the food industry and its contribution to overall sodium intake and sodium in the food supply may be necessary to harness their commitment and reduce the overall impact of NCDs on the Jamaican population. Limitations There are some limitations for this study. The sample size was small, and the response rate was low; therefore, the information obtained may not be generalisable to all restaurants in Jamaica; however, this study provides useful preliminary data. This study did not include stand-alone (non-chain) food establishments, which form an important part of the local food industry. The information obtained from chain restaurants represents an initial foray in the understanding of the food landscape in Jamaica and will serve as an impetus for further studies. In addition, specific ingredients and portion sizes were not provided; therefore, detailed data on sodium and nutrient contents were not available for the restaurants. Declarations Ethics approval and consent to participate This study was reviewed and approved by the Ethics Committees of the University of the West Indies and the Ministry of Health and Wellness (MOHW) - CREC-MN.153 2020/2021; MOHW – 2021/05. All participants provided written informed consent. Consent for publication Not applicable Availability of data and materials The datasets analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This project was supported by a research grant from the National Health Fund (Jamaica) (Grant # HSF 597). Authors' contributions STM wrote the first draft of the manuscript, contributed to data collection, contributed to the data analysis plan, interpreted the data, and revised the manuscript after critical review by co-authors. EW led data collection, contributed to the interpretation of the data, and critically reviewed the manuscript SSW contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript NRB contributed to study design and data collection, contributed to the data analysis plan, interpreted the data, and critically reviewed the manuscript. KWR contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript MKTR contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript TD contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript AG contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript JM contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript AB contributed to study design and data collection, contributed to the interpretation of the data, and critically reviewed the manuscript SGA contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript SS contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript NYC contributed to study design and data preparation, contributed to the interpretation of data, and critically reviewed the manuscript. TSF conceptualized the paper, developed the data analysis plan along with STM and NRB, interpreted the data, contributed to the first draft of the manuscript, and revised the manuscript after critical review by co-authors. Acknowledgements The authors would like to thank the Ministry of Health and Wellness and the National Health Fund Jamaica for support received for this study. We would also like to thank the Jamaica Salt Consumption Study field staff, restaurant managers who provided data, CAIHR/ERU administrative staff, and the unit driver for their support. References He FJ, Tan M, Ma Y, MacGregor GA. Salt Reduction to Prevent Hypertension and Cardiovascular Disease. Journal of the American College of Cardiology. 2020;75(6):632-47. World Health Organization (WHO). SHAKE the Salt Habit: The SHAKE Technical Package for Salt Reduction Geneva, Switzerland: WHO; 2016 [Available from: https://iris.who.int/bitstream/handle/10665/250135/9789241511346-eng.pdf. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-37. Kotchen TA, Cowley AW, Jr., Frohlich ED. Salt in Health and Disease — A Delicate Balance. The New England journal of medicine. 2013;368(13):1229 -37. Schuldt J, Levings JL, Kahn-Marshall J, Hunt G, Mugavero K, Gunn JP. Reducing sodium across the board: a pilot program in Schenectady County independent restaurants. J Public Health Manag Pract. 2014;20(1 Suppl 1): S31-7. The Jamaica Health and Lifestyle Writing Team (2022). The Jamaica Health and Lifestyle Survey 2016-17 (JHLS III): Ian Randle; 2024 [Available from: https://www.moh.gov.jm/wp-content/uploads/2024/03/Jamaica-Health-and-Lifestyle-Survey-2016-17-JHLSIII-Electronic.pdf. Ferguson TS, Webster-Kerr K, Tulloch-Reid MK, Bennett NR, Ho J, Davidson T, et al. The Jamaica Salt Consumption Study Protocol: Sodium Intake; Sodium Content in Restaurant Foods; Knowledge, Attitudes, and Practices; Spot Urine Sodium Validation. F1000Res. 2022;11:721. Ahuja JK, Pehrsson PR, Haytowitz DB, Wasswa-Kintu S, Nickle M, Showell B, et al. Sodium monitoring in commercially processed and restaurant foods. The American journal of clinical nutrition. 2015;101(3):622-31. Jostock C, Forde H, Roberts N, Jebb SA, Pechey R, Bandy L. Healthy eating interventions conducted in small, local restaurants and hot food takeaways: a systematic review. Public Health Nutr. 2025;28(1):e24. Maalouf J, Cogswell ME, Gunn JP, Curtis CJ, Rhodes D, Hoy K, et al. Monitoring the sodium content of restaurant foods: public health challenges and opportunities. American journal of public health. 2013;103(9):e21-30. Keast DR, Guenther PM. Sodium Content and Sodium Intake Contributions of Store-Bought and Restaurant-Prepared Foods in Their As-Eaten Form: National Health and Nutrition Examination Survey, 2009-2018. Curr Dev Nutr. 2024;8(10):104455. Santos JA, Sparks E, Thout SR, McKenzie B, Trieu K, Hoek A, et al. The Science of Salt: A global review on changes in sodium levels in foods. Journal of clinical hypertension (Greenwich, Conn). 2019;21(8):1043-56. Mandracchia F, Tarro L, Llauradó E, Valls RM, Solà R. Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis. Nutrients. 2021;13(4). Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3-21. Du W, Wang H, Zhang J, Zhang X, Wei N, Li Y, et al. Sodium content of restaurant dishes in China: a cross-sectional survey. Nutr J. 2022;21(1):10. Food and Agriculture Organization (FAO), European Union, CIRAD. Food Systems Profile - Jamaica. Catalysing the sustainable and inclusive transformations of food systems. Montpellier, Brussells: The Food and Agriculture Organization of the United Nations, The French Agricultural Research Centre for International Development, The European Union; 2022. Scourboutakos MJ, L'Abbé MR. Changes in sodium levels in chain restaurant foods in Canada (2010-2013): a longitudinal study. CMAJ Open. 2014;2(4):E343-51. Scourboutakos MJ, L'Abbé MR. Sodium levels in Canadian fast-food and sit-down restaurants. Can J Public Health. 2013;104(1):e2-8. Ma J, Lee S, Kim K, Lee YK. Sodium reduction in South Korean restaurants: A Daegu-based intervention project. Asia Pac J Clin Nutr. 2020;29(2):404-13. Trumbo PR, Kirkpatrick KM, Roberts J, Smith P, Zecca P. Perspective: Challenges and Strategies to Reduce the Sodium Content of Foods by the Food Service Industry. Adv Nutr. 2023;14(4):592-8. Levings JL, Gunn JP. From menu to mouth: opportunities for sodium reduction in restaurants. Preventing chronic disease. 2014;11:130237. Additional Declarations No competing interests reported. Supplementary Files Foodtypesandpreparationmethodsmanuscript20250724TSFFinalSupplement.docx SALTKAPFoodQuestionnaireMasterfinal13Oct2022.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Mar, 2026 Reviews received at journal 17 Nov, 2025 Reviews received at journal 13 Nov, 2025 Reviews received at journal 13 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers agreed at journal 02 Nov, 2025 Reviewers invited by journal 06 Aug, 2025 Editor assigned by journal 06 Aug, 2025 Editor invited by journal 04 Aug, 2025 Submission checks completed at journal 02 Aug, 2025 First submitted to journal 02 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7228602","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":495539845,"identity":"34e547f5-e724-443a-9d1e-a29904140972","order_by":0,"name":"Sherene T McNeil","email":"","orcid":"","institution":"The University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Sherene","middleName":"T","lastName":"McNeil","suffix":""},{"id":495539847,"identity":"7d64babd-8196-4411-a075-555cc2e0bf57","order_by":1,"name":"Evelyn Walker","email":"","orcid":"","institution":"The University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Evelyn","middleName":"","lastName":"Walker","suffix":""},{"id":495539849,"identity":"52cb0520-8351-4716-856e-c5cf26b49163","order_by":2,"name":"Suzanne Soares-Wynter","email":"","orcid":"","institution":"The University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Suzanne","middleName":"","lastName":"Soares-Wynter","suffix":""},{"id":495539852,"identity":"f08e1e3f-8922-409d-a6c4-d4cc4d1de1f6","order_by":3,"name":"Nadia R. Bennett","email":"","orcid":"","institution":"The University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Nadia","middleName":"R.","lastName":"Bennett","suffix":""},{"id":495539853,"identity":"0078d0f5-b5e6-4c03-a7bf-3650934838f2","order_by":4,"name":"Karen Webster-Kerr","email":"","orcid":"","institution":"Ministry of Health and Wellness","correspondingAuthor":false,"prefix":"","firstName":"Karen","middleName":"","lastName":"Webster-Kerr","suffix":""},{"id":495539854,"identity":"e5e67da6-d8be-4203-b60c-1ffc2a04d0da","order_by":5,"name":"Marshall K Tulloch-Reid","email":"","orcid":"","institution":"The University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Marshall","middleName":"K","lastName":"Tulloch-Reid","suffix":""},{"id":495539855,"identity":"c9cb21b2-2775-450c-9fb2-a9d474893e95","order_by":6,"name":"Tamu Davidson","email":"","orcid":"","institution":"Ministry of Health and Wellness","correspondingAuthor":false,"prefix":"","firstName":"Tamu","middleName":"","lastName":"Davidson","suffix":""},{"id":495539856,"identity":"a32fdc99-e2cf-4791-8011-931a407ac5d7","order_by":7,"name":"Andriene Grant","email":"","orcid":"","institution":"Ministry of Health and Wellness","correspondingAuthor":false,"prefix":"","firstName":"Andriene","middleName":"","lastName":"Grant","suffix":""},{"id":495539858,"identity":"8534070d-9ad8-4f64-8ec0-cb429fb05f01","order_by":8,"name":"Joette McKenzie","email":"","orcid":"","institution":"The University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Joette","middleName":"","lastName":"McKenzie","suffix":""},{"id":495539860,"identity":"9cbe053b-8aee-486d-805b-6b82ab63f1ff","order_by":9,"name":"Alphanso Blake","email":"","orcid":"","institution":"The University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Alphanso","middleName":"","lastName":"Blake","suffix":""},{"id":495539861,"identity":"863a58f4-ac66-4c78-b3ba-211f3f02351b","order_by":10,"name":"Simon G Anderson","email":"","orcid":"","institution":"The University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"G","lastName":"Anderson","suffix":""},{"id":495539863,"identity":"1894c174-121d-41f0-8b47-bf16cb33d4ed","order_by":11,"name":"Simone Spence","email":"","orcid":"","institution":"Ministry of Health and Wellness","correspondingAuthor":false,"prefix":"","firstName":"Simone","middleName":"","lastName":"Spence","suffix":""},{"id":495539865,"identity":"442d4ea5-7984-4ed1-82a6-87ae17958db0","order_by":12,"name":"Novie Younger-Coleman","email":"","orcid":"","institution":"The University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Novie","middleName":"","lastName":"Younger-Coleman","suffix":""},{"id":495539866,"identity":"9783a8ef-0650-4184-95d4-3845b5c852df","order_by":13,"name":"Trevor S. Ferguson","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYBADfhhDjoGBsYGBgQ23Uh4oLdkAZRiTriURwsCjxV768DGJj3sYJPilj1+T/FFxJ33DjeQGhg9lh3HbwpeWJjnjGYOEZF9OmTTPmWe5G24kNjDOOIdHCw+PsTHPAYY6gzM8adKMbYdzN9xObGDmbcOnhf8zSIuEPVCL5M+2w+kGIC1/8WrhYXwM0mLAw35MAmh4AlgLIz4tZ9gMH844ICEhcYaH2ZrnzGHDmfcfNhzsOZeOUwt7D/ODAx8O2Ejw97A/vPmj4rA835njDx/8KLPGqQUKJEAWGsC5Bwiph1n4gEiFo2AUjIJRMNIAAHT8UrMaPAY4AAAAAElFTkSuQmCC","orcid":"","institution":"The University of the West Indies","correspondingAuthor":true,"prefix":"","firstName":"Trevor","middleName":"S.","lastName":"Ferguson","suffix":""}],"badges":[],"createdAt":"2025-07-28 00:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7228602/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7228602/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88331052,"identity":"a10352ca-cf35-425f-90e3-af360f81acd4","added_by":"auto","created_at":"2025-08-05 10:51:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":726549,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7228602/v1/be32e6dc-701a-4e58-9914-52c7015bcc5d.pdf"},{"id":88330818,"identity":"4b9177dd-3855-4e8a-b055-f3e74b8c50a4","added_by":"auto","created_at":"2025-08-05 10:43:18","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":24410,"visible":true,"origin":"","legend":"","description":"","filename":"Foodtypesandpreparationmethodsmanuscript20250724TSFFinalSupplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-7228602/v1/401f40dc6b1e8e988c520b80.docx"},{"id":88329668,"identity":"4fb05a74-009b-47ab-9339-ba2c5efea663","added_by":"auto","created_at":"2025-08-05 10:35:18","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":511520,"visible":true,"origin":"","legend":"","description":"","filename":"SALTKAPFoodQuestionnaireMasterfinal13Oct2022.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7228602/v1/415c8920c307bf7610859285.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Food types, preparation methods, and use of high-sodium seasonings in chain restaurants in Jamaica – Implications for Sodium Consumption and Food Policy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eExcess dietary sodium (i.e. ≥ 2000 mg/day sodium or 5 grams/day of salt)\u0026nbsp;is a major contributor to adverse health outcomes globally (1, 2).\u0026nbsp;The burden of diseases attributed to poor-quality diets has impacted\u0026nbsp;public\u0026nbsp;health\u0026nbsp;considerably and accounts for substantial direct and indirect financial costs to economies\u0026nbsp;(2, 3). Excess\u0026nbsp;dietary salt\u0026nbsp;has been linked to high blood pressure (HBP) and cardiovascular diseases (CVDs) as well as\u0026nbsp;other\u0026nbsp;adverse health outcomes globally\u0026nbsp;(4, 5).\u0026nbsp; Reduction in sodium consumption is recommended as the primary approach for addressing the high burden of premature mortality resulting from these conditions\u0026nbsp;(2-4).\u0026nbsp;Data from the Jamaica Health and Lifestyle Survey 2016 – 2017 (JHLS-III) suggest that over 60% of Jamaicans have elevated blood pressure, with one-third of the population being hypertensive\u0026nbsp;(6).\u0026nbsp;In 2016, CVDs were the leading cause of death, accounting for 31% of total deaths\u0026nbsp;(7).\u0026nbsp;Salt reduction interventions are therefore critical in reducing the impact of hypertension and CVDs on the population.\u003c/p\u003e\n\u003cp\u003eThe Jamaica Salt Consumption study was conducted to gather data on salt consumption in Jamaica as part of Jamaica’s response to the World Health Organisation (WHO) SHAKE Technical Package (2, 7).\u0026nbsp;One component of this study was to determine the salt content of foods sold in restaurants, as evidence in other settings suggests that most of the salt consumed is from processed and restaurant foods\u0026nbsp;(8-10).\u0026nbsp;Previous reports from JHLS-III found that approximately 31% of Jamaicans consume food from fast food restaurants 1 – 6 times per week\u0026nbsp;(6).\u0026nbsp;Efforts to identify high-sodium sources in restaurant items are crucial in developing effective salt reduction interventions. Effective population-wide sodium reduction strategies must include an overall reduction of sodium in the food supply and incorporate efforts from stakeholders in the restaurant industry\u0026nbsp;(11).\u003c/p\u003e\n\u003cp\u003eHere, we describe the types of food sold, preparation methods, and use of high-sodium seasonings among chain restaurants in Jamaica and efforts these restaurants have made to reduce salt or sodium use or provide low-sodium options.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe conducted a cross-sectional survey of chain restaurants, defined herein as commercial entities with three or more locations in Jamaica. The methods employed were previously published in the study protocol (7). Briefly, restaurants were identified using data from the Companies Office of Jamaica and the Yello Directory. Restaurants were classified as either full-service (FS-R) or fast food (FF-R) restaurants. \u0026nbsp;FS-R were those that had table service provided by waiter staff, while FF-R were quick-service restaurants that provided menu items typically prepared quickly and served packaged. Food establishments that sold ready-to-eat food items prepared at the restaurants were eligible for inclusion in the study. Initially, restaurants were contacted via telephone, and the study and its objectives were introduced. Follow-up was conducted using email or in-person visits. Trained interviewers administered questionnaires (in-person) on restaurant characteristics, meal items sold, information on recipes/ingredient quantities, methods of food preparation, use of salt or high-sodium seasonings and sauces, and availability of low-salt options. The questionnaire was developed by the study investigators (see supplementary files). \u0026nbsp;Study nutritionists coded the foods into food categories based on food types and preparation methods. Data were analysed using Stata 18 statistical software, and descriptive analyses were performed using standard methods.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTwenty-nine eligible chain restaurants were approached, and seven (2 FS-R; 5 FF-R) agreed to participate. A profile of individual restaurants is shown in the Appendix (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). One hundred and seven (107) menu items were identified from the restaurants (70 in FF-R and 37 in FS-R) and subdivided into 16 food item categories. Of the 16 categories of food items sold (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), chicken (21.5%), fish (15.9%), and soup (9.4%) were the most frequently sold in all restaurants. Fish (21.6%) was the most frequently sold item in FS-R and chicken (25.7%) in FF-R. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e indicates that of the seven methods of preparation identified in all surveyed restaurants, the most used methods were fried (20.6%), boiled (18.7%), baked (17.8%), and stewed (17.8%). The most utilised method of preparation in the FF-R was frying (27.1%) and stewing (32.4%) in the FS-R.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCategories of food sold in all restaurants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFood Category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll restaurants\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;107\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFull-Service Restaurants\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;37\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFast Food Restaurants\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;70\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChicken\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23 (21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (25.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFish\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (12.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSoup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (8.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeafood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePastry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (8.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePasta\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (7.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVegetarian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePork\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (7.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (7.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMutton\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBread/ Flour /Starch\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBeef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePotato\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRice and Peas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAckee and Saltfish\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBammy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMethod of Cooking by Food Establishment Type\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMethod of Cooking\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll restaurants\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFull-Service Restaurants\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFast Food Restaurants\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoiled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (18.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (18.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaked\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (20.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (20.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (27.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStewed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (32.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSteamed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoasted, grilled, or jerked\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (8.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (11.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (11.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ep\u0026thinsp;=\u0026thinsp;0.032 (Fisher\u0026rsquo;s exact) for overall difference by Food establishment type\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e1\u003c/sup\u003eOther preparation methods included curried, stir fried, saut\u0026eacute;ed, etc.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows thirteen seasoning ingredients used in all restaurant categories. Sea salt (37.4%) table salt (17.8%) and soy sauce (16.8%) were the most used seasoning ingredients, while bouillon (0.9%), baking soda (2.8%) and barbecue sauce (2.8%) were the least used. Sea salt was primarily used in FS-R (86.5%), whereas table salt was primarily used in FF-R (17.1%). Ingredients such as soy sauce, ketchup, jerk seasoning marinade, and jerk seasoning powder were more often used in FF-R compared to FS-R, while onion powder and garlic were least used. The use of seasonings by food group is shown in Table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e in the appendix. Salty seasonings were primarily used in the meat, chicken, seafood, and fish categories, with sea salt, soy sauce, and ketchup being the most used.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUse of Salts, Seasonings, Sauces and Spices by Food Establishment Type\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSalt, Seasonings, Sauces, Spices\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll restaurants\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFull-Service Restaurants\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFast Food Restaurants\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTable salt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (17.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSea Salt ***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40 (37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (86.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (11.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMSG *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (14.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaking Powder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaking Soda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKetchup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (18.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarbeque Sauce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSoy Sauce *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18 (16.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (22.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJerk Seasoning Marinade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (14.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (18.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePowdered Jerk Seasoning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (17.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGarlic Salt ***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (17.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnion Powder**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (8.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBouillon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (Fisher\u0026rsquo;s exact)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eMSG\u0026thinsp;=\u0026thinsp;monosodium glutamate (seasoning salt)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThree of the seven restaurants reported having nutrition profiles, however these were not made available to the study team. Low salt options were offered by five of the seven restaurants surveyed, and six implemented steps to reduce the salt content in their menu. These steps included using natural seasonings, utilising low-sodium products, and implementing low-sodium measures directly related to the portion size of items being prepared (See Table S3 in the appendix). Six restaurants also reported offering catering services, and five offered customised meals with lower sodium. Customised meals were based on customer requests and the establishments\u0026rsquo; standard formulation and procedures.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOnly seven of the twenty-nine chain restaurants approached participated in the survey. Among the seven restaurants, the food items most frequently sold were chicken, fish, and soup. Salt and salty seasonings or sauces were often used in food preparation, with sea salt, table salt, and soy sauce being the most used. Low salt options and measures to reduce salt content were implemented by some restaurants, but these were limited to individual customer requests.\u003c/p\u003e\u003cp\u003eThe finding that only 24% of the restaurants approached participated in the study may reflect the willingness of the food industry to provide data for health research to assess and improve the food environment. However, if a reduction in sodium levels in restaurant foods is to be achieved, restaurants will need to provide required data and participate in efforts to adjust food preparation to use less salt. This is an important component of the recommendations from the WHO SHAKE package, specifically, surveillance to measure and monitor the sodium content of foods and harnessing the industry to promote sodium reduction in the reformulation of recipes and meals (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFood prepared outside the home is a major source of sodium intake and has become increasingly popular in recent years. This is partly due to individuals\u0026rsquo; limited availability of time for meal preparation and rapid urbanization, making restaurant foods more convenient (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Restaurant foods are generally higher in sodium content when compared with similar versions of home-made foods because of their varied sources of sodium or portion sizes of meals sold (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). According to a 2022 Food and Agriculture Organization (FAO) report, Jamaica has experienced increased consumption of fast foods, especially in urban areas (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). While food consumption patterns and habits of Jamaicans outside the home may not be established from the data in this study, the results obtained provide some insight regarding the types of foods eaten away from home and methods of preparation as supplied by the participating restaurants using the foods most consumed.\u003c/p\u003e\u003cp\u003eIn the United States, the National Health and Nutrition Examination Survey (NHANES) reported that food items prepared in restaurants contributed more to sodium intake than equivalent store-bought foods (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). When compared with their store-bought counterparts, food categories commonly sold, such as poultry, fish/seafood, and soup, had higher proportions of sodium (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This suggests that menu items with higher sodium content that are frequently sold should be targeted for sodium reduction.\u003c/p\u003e\u003cp\u003eOnly three of the seven restaurants surveyed reported having nutrition profiles, and six offered customised meals. For consumers who want to make healthier food choices, information would not be readily available, as less than half of the restaurants surveyed would be able to provide details on the nutritional content of their menu items. Therefore, consumers must rely primarily on personal nutrition knowledge. However, by providing customised menu options, restaurants can facilitate customers making healthier, low-sodium meal choices tailored to suit their needs. This could potentially boost sales by providing valued added options which could attract patrons with higher purchasing power.\u003c/p\u003e\u003cp\u003eAll restaurants surveyed used high-sodium-containing seasonings. The establishments did not provide specific ingredients and quantities used in their meal preparation; however, the use of multiple varieties of high-sodium seasonings highlights this as a consistent practice of the food industry. Restaurant meals are typically high in sodium content because of their portion sizes or varied sodium sources (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). To determine the overall contribution to the sodium content of these meals, the details of the ingredients used, and their quantities are critical. Meals containing multiple sources of highly salted seasonings used in their preparation are more likely to be high in sodium than those without (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Restaurants could consider using salt substitutes or enhancers such as calcium or potassium chloride, as is the practice of some leading Canadian fast-food chains, where more than 60% of their meals contain these ingredients (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). A similar commitment of food industry stakeholders to reduce sodium by using lower sodium seasonings or salt substitutes would help to reduce sodium consumption in Jamaica.\u003c/p\u003e\u003cp\u003eSince much of the population consumes food outside the home, public education is critical in equipping them to make informed choices while eating out and create a demand for information surrounding nutrition content. The availability of healthier low-sodium alternatives in the local food landscape is beneficial and may contribute to the overall goal of achieving a population-wide sodium reduction. However, as previous studies have shown, restaurants may not voluntarily reduce the sodium content of foods, and efforts may be inconsistent (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). One reason for this is that the promotion of low-sodium or healthier foods by restaurants may be perceived as having a reverse effect and reduce sales of the respective menu items. Laws requiring labelling of menu items may be necessary to effect change (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Some studies suggest that customers value taste over health where restaurant meals are concerned (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). As an alternative, restaurants may opt to reduce sodium content gradually without alerting the public to such changes (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). A reduction in sodium of up to 20% may not be detectable by consumers and would provide restaurants with the opportunity to reduce sodium content and help in retraining consumers\u0026rsquo; taste buds over time (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile most of the restaurants surveyed used high-sodium seasonings, low-sodium options were available to their customers. An effective population-wide sodium reduction strategy will require public education to equip consumers with the knowledge required to make better choices. Interventions must include partnerships between the government and the local food industry, as their contribution to population health and well-being is integral. Consistent exposure to foods high in sodium influences a person\u0026rsquo;s preference and demand for these types of meals (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e); therefore, reducing the exposure may affect consumers\u0026rsquo; overall demand for high-sodium foods. Policies regulating the food industry and its contribution to overall sodium intake and sodium in the food supply may be necessary to harness their commitment and reduce the overall impact of NCDs on the Jamaican population.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere are some limitations for this study. The sample size was small, and the response rate was low; therefore, the information obtained may not be generalisable to all restaurants in Jamaica; however, this study provides useful preliminary data. This study did not include stand-alone (non-chain) food establishments, which form an important part of the local food industry. The information obtained from chain restaurants represents an initial foray in the understanding of the food landscape in Jamaica and will serve as an impetus for further studies. In addition, specific ingredients and portion sizes were not provided; therefore, detailed data on sodium and nutrient contents were not available for the restaurants.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Ethics Committees of the University of the West Indies and the Ministry of Health and Wellness (MOHW) - CREC-MN.153 2020/2021; MOHW \u0026ndash; 2021/05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was supported by a research grant from the National Health Fund (Jamaica) (Grant # HSF 597).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTM\u003c/strong\u003e wrote the first draft of the manuscript, contributed to data collection, contributed to the data analysis plan, interpreted the data, and revised the manuscript after critical review by co-authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEW\u003c/strong\u003e led data collection, contributed to the interpretation of the data, and critically reviewed the manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSSW\u003c/strong\u003e contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNRB\u003c/strong\u003e contributed to study design and data collection, contributed to the data analysis plan, interpreted the data, and critically reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKWR\u0026nbsp;\u003c/strong\u003econtributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMKTR\u0026nbsp;\u003c/strong\u003econtributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTD\u0026nbsp;\u003c/strong\u003econtributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAG\u0026nbsp;\u003c/strong\u003econtributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJM\u003c/strong\u003e contributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAB\u0026nbsp;\u003c/strong\u003econtributed to study design and data collection, contributed to the interpretation of the data, and critically reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSGA\u0026nbsp;\u003c/strong\u003econtributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSS\u0026nbsp;\u003c/strong\u003econtributed to study design, contributed to the interpretation of the data, and critically reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNYC\u003c/strong\u003e contributed to study design and data preparation, contributed to the interpretation of data, and critically reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTSF\u003c/strong\u003e conceptualized the paper, developed the data analysis plan along with STM and NRB, interpreted the data, contributed to the first draft of the manuscript, and revised the manuscript after critical review by co-authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the Ministry of Health and Wellness and the National Health Fund Jamaica for support received for this study. We would also like to thank the Jamaica Salt Consumption Study field staff, restaurant managers who provided data, CAIHR/ERU administrative staff, and the unit driver for their support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHe FJ, Tan M, Ma Y, MacGregor GA. Salt Reduction to Prevent Hypertension and Cardiovascular Disease. Journal of the American College of Cardiology. 2020;75(6):632-47.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). SHAKE the Salt Habit: The SHAKE Technical Package for Salt Reduction Geneva, Switzerland: WHO; 2016 [Available from: https://iris.who.int/bitstream/handle/10665/250135/9789241511346-eng.pdf.\u003c/li\u003e\n\u003cli\u003eMills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-37.\u003c/li\u003e\n\u003cli\u003eKotchen TA, Cowley AW, Jr., Frohlich ED. Salt in Health and Disease \u0026mdash; A Delicate Balance. The New England journal of medicine. 2013;368(13):1229 -37.\u003c/li\u003e\n\u003cli\u003eSchuldt J, Levings JL, Kahn-Marshall J, Hunt G, Mugavero K, Gunn JP. Reducing sodium across the board: a pilot program in Schenectady County independent restaurants. J Public Health Manag Pract. 2014;20(1 Suppl 1): S31-7.\u003c/li\u003e\n\u003cli\u003eThe Jamaica Health and Lifestyle Writing Team (2022). The Jamaica Health and Lifestyle Survey 2016-17 (JHLS III): Ian Randle; 2024 [Available from: https://www.moh.gov.jm/wp-content/uploads/2024/03/Jamaica-Health-and-Lifestyle-Survey-2016-17-JHLSIII-Electronic.pdf.\u003c/li\u003e\n\u003cli\u003eFerguson TS, Webster-Kerr K, Tulloch-Reid MK, Bennett NR, Ho J, Davidson T, et al. The Jamaica Salt Consumption Study Protocol: Sodium Intake; Sodium Content in Restaurant Foods; Knowledge, Attitudes, and Practices; Spot Urine Sodium Validation. F1000Res. 2022;11:721.\u003c/li\u003e\n\u003cli\u003eAhuja JK, Pehrsson PR, Haytowitz DB, Wasswa-Kintu S, Nickle M, Showell B, et al. Sodium monitoring in commercially processed and restaurant foods. The American journal of clinical nutrition. 2015;101(3):622-31.\u003c/li\u003e\n\u003cli\u003eJostock C, Forde H, Roberts N, Jebb SA, Pechey R, Bandy L. Healthy eating interventions conducted in small, local restaurants and hot food takeaways: a systematic review. Public Health Nutr. 2025;28(1):e24.\u003c/li\u003e\n\u003cli\u003eMaalouf J, Cogswell ME, Gunn JP, Curtis CJ, Rhodes D, Hoy K, et al. Monitoring the sodium content of restaurant foods: public health challenges and opportunities. American journal of public health. 2013;103(9):e21-30.\u003c/li\u003e\n\u003cli\u003eKeast DR, Guenther PM. Sodium Content and Sodium Intake Contributions of Store-Bought and Restaurant-Prepared Foods in Their As-Eaten Form: National Health and Nutrition Examination Survey, 2009-2018. Curr Dev Nutr. 2024;8(10):104455.\u003c/li\u003e\n\u003cli\u003eSantos JA, Sparks E, Thout SR, McKenzie B, Trieu K, Hoek A, et al. The Science of Salt: A global review on changes in sodium levels in foods. Journal of clinical hypertension (Greenwich, Conn). 2019;21(8):1043-56.\u003c/li\u003e\n\u003cli\u003eMandracchia F, Tarro L, Llaurad\u0026oacute; E, Valls RM, Sol\u0026agrave; R. Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis. Nutrients. 2021;13(4).\u003c/li\u003e\n\u003cli\u003ePopkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3-21.\u003c/li\u003e\n\u003cli\u003eDu W, Wang H, Zhang J, Zhang X, Wei N, Li Y, et al. Sodium content of restaurant dishes in China: a cross-sectional survey. Nutr J. 2022;21(1):10.\u003c/li\u003e\n\u003cli\u003eFood and Agriculture Organization (FAO), European Union, CIRAD. Food Systems Profile - Jamaica. Catalysing the sustainable and inclusive transformations of food systems. Montpellier, Brussells: The Food and Agriculture Organization of the United Nations, The French Agricultural Research Centre for International Development, The European Union; 2022.\u003c/li\u003e\n\u003cli\u003eScourboutakos MJ, L\u0026apos;Abb\u0026eacute; MR. Changes in sodium levels in chain restaurant foods in Canada (2010-2013): a longitudinal study. CMAJ Open. 2014;2(4):E343-51.\u003c/li\u003e\n\u003cli\u003eScourboutakos MJ, L\u0026apos;Abb\u0026eacute; MR. Sodium levels in Canadian fast-food and sit-down restaurants. Can J Public Health. 2013;104(1):e2-8.\u003c/li\u003e\n\u003cli\u003eMa J, Lee S, Kim K, Lee YK. Sodium reduction in South Korean restaurants: A Daegu-based intervention project. Asia Pac J Clin Nutr. 2020;29(2):404-13.\u003c/li\u003e\n\u003cli\u003eTrumbo PR, Kirkpatrick KM, Roberts J, Smith P, Zecca P. Perspective: Challenges and Strategies to Reduce the Sodium Content of Foods by the Food Service Industry. Adv Nutr. 2023;14(4):592-8.\u003c/li\u003e\n\u003cli\u003eLevings JL, Gunn JP. From menu to mouth: opportunities for sodium reduction in restaurants. Preventing chronic disease. 2014;11:130237.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chain restaurants, salt/ sodium content, fast-food restaurants, full-service restaurants, high–sodium seasonings, low–salt options","lastPublishedDoi":"10.21203/rs.3.rs-7228602/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7228602/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e Food sold in restaurants is a major contributor to sodium consumption patterns. We report findings on the types of foods sold, preparation methods, and the use of high-sodium seasonings in chain restaurants in Jamaica and discuss the implications for sodium consumption and food policy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eData were collected from chain restaurants (defined as ≥3 stores locally) as part of the Jamaica Salt Consumption Study. Interviewers collected information via questionnaire on restaurant characteristics, menu items, types of seasonings used during food preparation, and availability of low-salt options.\u003c/p\u003e\n\u003cp\u003eOnly 24% of restaurant chains identified participated. Of the 107 menu items identified, the most frequently sold were chicken (21.5%), fish (15.9%), and soup (9.4%). The most common methods of preparation for meat were frying (20.6%), boiling (18.7%), baking (17.8%), and stewing(17.8%). Commonly used high-sodium seasonings included sea salt (37.4%), table salt (17.8%), and soy sauce (16.8%). Six of the restaurant chains implemented salt reduction measures, including portion control and the use of unsalted seasonings and herbs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eMost restaurants evaluated used\u003cstrong\u003e \u003c/strong\u003esalt-containing seasonings but also offered low-salt options. Healthier dietary options and meal preparation methods in restaurants will be a critical part of food policy and for national sodium reduction interventions.\u003c/p\u003e","manuscriptTitle":"Food types, preparation methods, and use of high-sodium seasonings in chain restaurants in Jamaica – Implications for Sodium Consumption and Food Policy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-05 10:35:13","doi":"10.21203/rs.3.rs-7228602/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-09T11:07:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-17T15:21:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-14T00:31:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T16:40:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89072275758894033064212109764869336608","date":"2025-11-10T23:31:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315574341980472584214052334846172810791","date":"2025-11-06T15:36:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169429880244161530176754147386912340939","date":"2025-11-05T13:04:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167694521914393660145695211290891396757","date":"2025-11-02T16:21:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-06T21:50:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-06T21:42:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-04T16:31:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-02T22:16:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2025-08-02T20:28:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2f55a6f8-6324-415e-95cb-efeba6133775","owner":[],"postedDate":"August 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T13:26:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-05 10:35:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7228602","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7228602","identity":"rs-7228602","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}