Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network.
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TLDR
In September 2018 the E.S.A.N. agreed a statement confirming the support to the implementation of national and regional programmes of moderate reduction in salt intake, as recommended by the World Health Organization.Abstract:
The publication in the last few years of a number of prospective observational studies suggesting a J-shaped association between levels of salt (sodium) consumption and cardiovascular outcomes has opened a debate on the pertinence of population-wide salt reduction policies to reduce cardiovascular disease burden, and some have even questioned the global World Health Organization guidelines, that recommend a 30% reduction in salt consumption by 2025, aiming at an ideal target of no more than 5 g of salt consumption per day. In September 2018 the European Salt Action Network (E.S.A.N.), after appraising the quality of publications questioning the appropriateness of population salt reduction, discussed the scientific evidence and identified the pitfalls of recent data. The new evidence was deemed inadequate and, in places, biased by flawed methodology. These were identified in the biased assessment of sodium intake from spot urine and the use of the Kawasaki formula, the biased assessment of the sodium–outcome relationships in prospective observational studies using spot urine samples, the impact of reverse causality in such studies, the inadequate analytical approaches to data analysis, the lack of biological plausibility and the lack of precision in assessing long-term salt consumption, as recently demonstrated in studies using more stringent quality features in their study designs. On the basis of such appraisal, the E.S.A.N. agreed a statement confirming the support to the implementation of national and regional programmes of moderate reduction in salt intake, as recommended by the World Health Organization.read more
Citations
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Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials.
Liping Huang,Liping Huang,Kathy Trieu,Sohei Yoshimura,Bruce Neal,Bruce Neal,Mark Woodward,Norm R C Campbell,Qiang Li,Daniel T. Lackland,Alexander A. Leung,Cheryl A.M. Anderson,Graham A. MacGregor,Feng J. He +13 more
TL;DR: The magnitude of blood pressure lowering achieved with sodium reduction showed a dose-response relation and was greater for older populations, non-white populations, and those with higher blood pressure.
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Sudhir Raj Thout,Joseph Alvin Santos,Briar McKenzie,Kathy Trieu,Claire Johnson,Rachael McLean,JoAnne Arcand,Norman R.C. Campbell,Jacqui Webster +8 more
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Mariana Basso Pinton,Bibiana Alves dos Santos,José M. Lorenzo,Alexandre José Cichoski,Caroline Pagnossim Boeira,Paulo Cezar Bastianello Campagnol +5 more
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References
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Effect of lower sodium intake on health: systematic review and meta-analyses
Nancy J Aburto,Anna Ziolkovska,Lee Hooper,Paul Elliott,Francesco P. Cappuccio,Joerg J Meerpohl +5 more
TL;DR: High qualityEvidence in non-acutely ill adults shows that reduced sodium intake reduces blood pressure and has no adverse effect on blood lipids, catecholamine levels, or renal function, and moderate quality evidence in children shows that a reduction in sodium intake reducing blood pressure.
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Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events
Andrew Mente,Sumathy Rangarajan,Matthew J. McQueen,Xingyu Wang,Lisheng Liu,Hou Yan,Shun Fu Lee,Prem Mony,Anitha Devanath,Annika Rosengren,Patricio Lopez-Jaramillo,Rafael Diaz,Alvaro Avezum,Fernando Lanas,Khalid Yusoff,Rafał Ilow,Noushin Mohammadifard,Sadi Gulec,Afzalhussein Yusufali,Lanthe Kruger,Rita Yusuf,Jephat Chifamba,Conrad Kabali,Gilles R. Dagenais,Scott A. Lear,Koon K. Teo,Salim Yusuf,Abstr Act +27 more
TL;DR: An estimated sodium intake between 3g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake.
Journal ArticleDOI
Association of Urinary Sodium and Potassium Excretion with Blood Pressure
Andrew Mente,Sumathy Rangarajan,Matthew J. McQueen,Paul Poirier,Andreas Wielgosz,Howard Morrison,Wei Li,Xingyu Wang,Chen Di,Prem Mony,Anitha Devanath,Annika Rosengren,Aytekin Oguz,Katarzyna Zatońska,Afzalhussein Yusufali,Patricio Lopez-Jaramillo,Alvaro Avezum,Noor Hassim Ismail,Fernando Lanas,Thandi Puoane,Rafael Diaz,Roya Kelishadi,Romaina Iqbal,Rita Yusuf,Jephat Chifamba,Rasha Khatib,Koon K. Teo,Salim Yusuf +27 more
TL;DR: The association of estimated intake of sodium and potassium, as determined from measurements of excretion of these cations, with blood pressure was nonlinear and was most pronounced in persons consuming high-sodium diets, persons with hypertension, and older persons.
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Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events
Martin O'Donnell,Salim Yusuf,Andrew Mente,Peggy Gao,Johannes F.E. Mann,Koon K. Teo,Matthew J. McQueen,Peter Sleight,Arya M. Sharma,Antonio L. Dans,Jeffrey L. Probstfield,Roland E. Schmieder +11 more
TL;DR: The precise relationship between sodium and potassium intake and cardiovascular (CV) risk remains uncertain, especially in patients with CV disease or diabetes mellitus, and Cox proportional hazards multivariable models were used to determine the association.
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