The prevalence of hypertension among adult Filipinos aged 20 years and above increased from 16% in 2003 to 21% in 2008  to 28% in 2013 , highlighting the need to reduce sodium intake. The present study identified processed foods that can be targeted for reformulation to achieve reduced salt intake. Important sources of sodium were 13 foods in the processed food group and 2 foods in the minimally processed group, which together accounted for 99.4% of the variance in sodium intake of the entire population. In the processed foods group, the greatest contributors were the following: instant noodles and foods in the following categories: Processed Soup, Sauces & Flavor Enhancers (traditional fermented fish & seafood sauces, table salt); Processed Fish, Meat & Poultry Products (dried/smoked fish & seafood, canned & processed meat/fish/seafood, salted eggs); Baked Products (white bread, pan de sal); Other Noodles & Pasta (wheat and egg noodles); Rice, Cereal & Starch Products (crispy cereal chips and extruded snacks); Fats, Oils & Products (butter, margarine); Milk Products (cheese); Non-alcoholic Beverages (chocolate-based drinks).
Instant noodles. Estimated per capita consumption of instant noodles in 2008 was 2.86 kg/year  or approximately 8 g/day, contributing 158 mg Na/day. In 2017, instant noodles was the top noodle product consumed in the Philippines (consumed by 70.12% of households) . Households consumed an average of 0.05 kg instant noodles per week or 2.69 kg a year. Rural households consumed greater amounts at 2.78 kg per year. During the same period, 27.6% of households reported substituting instant noodles for rice. The most frequent reason for substitution (reported by 18.43% of respondents) was that it is more affordable than rice . Instant noodles contain ≈ 1975 mg Na/100 g . Wheat and egg noodles (commonly called pancit canton) contain ≈ 1006 mg Na/100 g .
Processed soup, sauces and flavor enhancers. Within this category, table salt and traditional fermented fish/seafood sauces were the significant contributors to sodium intake. In 2008, coarse salt was the most commonly consumed condiment in the Philippines, with 64.9% of households consuming an average of 3 grams salt per day , equivalent to 1200 mg Na. Philippine shrimp paste contains 13–14 g Na/100 g . The percentage of households consuming these traditional fermented foods in 2008  was: bagoong isda (fermented anchovy), ginamos (fermented shrimp) – 10.1%; patis (fish sauce) – 6.1%; bagoong alamang (shrimp paste) – 4.7%. In a study among 1789 women, Lee found that salty condiments added during cooking or at the table accounted for 76.3% of sodium intake . The most significant source of sodium was table salt, contributing 53.3% for women who consumed < 4600 mg/day of sodium and 66.5% for women who consumed higher amounts of sodium.
Pros and cons of indigenous fermented sauces
Traditional fermented salted products, while contributing significantly to sodium intake of Filipinos, are an important part of the food culture in the Philippines. Commonly used indigenous sauces are fermented fish and seafood sauces (patis or fish sauce, bagoong or fish/shrimp paste), soy sauce. These products are generally produced with high levels of salt, up to 25% for fish sauces and 11 to 25% for soy sauce  . High levels of salt and low pH are important to suppress the growth of pathogenic microorganisms and enable bacterial degradation of proteins, carbohydrates, and nucleic acids. In spite of their high sodium content, these fermented sauces were shown to have functional effects. Japanese style fermented soy sauce (shoyu) showed antiallergic, antimicrobial, antihypertensive, and anticarcinogenic effects  . Fermented foods contain live microorganisms and therefore comprise a good source of probiotics. Lactic acid bacteria were found in fermented fish (ranging from 3.48 to 5.43 log cfu/g) while aerobic bacteria were found in fish sauce (ranging from 4.92 to 5.53 log cfu/g ). Fermentation-derived microorganisms have the potential to influence gut microbiota diversity, structure, and function and increase the amount of nutrients such as vitamins and other bioactive molecules produced from microbial metabolism that are not present in the original food . These bacteria may also secrete anti-microbial agents, degrade anti-nutritive compounds, produce short-chain fatty acids from indigestible carbohydrates, and contribute to immune homeostasis   . A study on the composition of shrimp pastes produced in some parts of the Philippines showed these foods were good sources of omega-3 fatty acids, iron, zinc, and calcium . Due to their extensive use, fortification of condiments and seasonings is also seen as a cost-effective intervention to address micronutrient deficiencies in Southeast Asia  . Studies in young children and adult women suggested that fortification of sauces (fish sauce, soy sauce) can effectively address iron and iodine deficiencies  .
Processed fish, meat, poultry products. Foods that contributed significantly to sodium intake were dried/smoked fish and seafood, canned/processed meat, fish & seafood, and salted eggs. In 2008, consumption of fish and fish products was 110 grams per capita. Canned sardines (containing approximately 521 mg Na/100g)  was consumed by 15.3% of households with mean consumption of 8 grams per capita per day . Dried and smoked fish was consumed by 20.5% of households . Dried fish contains ≈ 7000 mg Na per 100 g . Filipinos aged 60 + years ate the most fish and fish products (15.6% of total food consumption), followed by those aged 20 to 59 years (14.7% of total consumption) .
Consumption of meat and meat products in 2008 was 83 grams per capita. The Family Income and Expenditure Survey (FIES) showed that household food expenditures on meats increased by 4 to 5 percentage points from 1965 to 2000. The biggest growth in expenditure was for processed meats, increasing by 2.7% during the same period . In 2003, processed meat products (hotdogs, meatloaf, sausages) represented nearly 30% of per capita meat intake .
Limitations of the study
The study examined only 2008 national food consumption data. Data from multiple successive surveys should be examined since the market for processed foods is dynamic, with products constantly being introduced, reformulated, or taken out. In spite of this, the present study is the currently the only one that identifies sodium-contributing foods for development of population sodium reduction initiatives. The consumption of processed foods among Filipinos has increased over time. For instance, the demand for instant noodles in the Philippines increased from 3400 million servings in 2016 to 4470 million servings in 2020 . For processed meat, the average volume per person is expected to amount to 3.9 kg in 2021 and the market is expected to grow annually by 1.89% from 2021 to 2025 . During this pandemic, sodium intake is expected to increase further. Food relief packs distributed nationwide by the Department of Social Welfare and Development contain rice, corned beef, sardines, and chocolate energy drink or coffee . Corned beef, sardines, and chocolate beverage are among the foods identified in this study which significantly contribute to the variance in sodium intake of Filipinos.