Conflicting Evidence on Health Effects Associated with Salt Reduction Calls for a Redesign of the Salt Dietary Guidelines

Progress in Cardiovascular Diseases

Volumn 61, Issue 1, 2018, Pages 20-26

  Graudal, Niels ^a   Jürgens, Gesche ^b  

^a University of Copenhagen   (Denmark)

^b ZEALAND UNIVERSITY HOSPITAL   (Denmark)

Author keywords

And mortality; Blood pressure; Lipids; Renin angiotensin aldosterone; Salt

Indexed keywords

ADULT; BLOOD PRESSURE; CONTROLLED STUDY; DIASTOLIC BLOOD PRESSURE; DIETARY INTAKE; FEMALE; HUMAN; HYPERTENSION; LIPID BLOOD LEVEL; MALE; MORTALITY; OBSERVATIONAL STUDY; PROSPECTIVE STUDY; RANDOMIZED CONTROLLED TRIAL; RENIN ANGIOTENSIN ALDOSTERONE SYSTEM; REVIEW; RISK BENEFIT ANALYSIS; SALT INTAKE; SYSTOLIC BLOOD PRESSURE; BLOOD; DASH DIET; DIET THERAPY; DIETARY REFERENCE INTAKE; EVIDENCE BASED MEDICINE; PATHOPHYSIOLOGY; RISK FACTOR; SODIUM RESTRICTION; STANDARDS;

HORMONE; LIPID;

BLOOD PRESSURE; DIET, SODIUM-RESTRICTED; DIETARY APPROACHES TO STOP HYPERTENSION; EVIDENCE-BASED MEDICINE; HORMONES; HUMANS; HYPERTENSION; LIPIDS; RECOMMENDED DIETARY ALLOWANCES; RENIN-ANGIOTENSIN SYSTEM; RISK FACTORS; SODIUM CHLORIDE, DIETARY;

EID: 85048011899     PISSN: 00330620     EISSN: 18731740     Source Type: Journal    
DOI: 10.1016/j.pcad.2018.04.008     Document Type: Review

References (51)

1. McCarron, D.A., Kazaks, A.G., Geerling, J.C., et al. Normal range of human dietary sodium intake: a perspective based on 24-hour urinary sodium excretion worldwide. Am J Hypertens 26 (2013), 1218–1223.
2. Oliver, J.W., Cohen, E.L., Neel, J.V., Blood pressure, sodium intake, and sodium related hormones in the Yanomamo Indians, a ‘no-salt’ culture. Circulation 52 (1975), 146–151.
3. Dahl, L.K., Possible role of salt intake in the development of essential hypertension. Int J Epidemiol 34 (2005), 967–972.
4. Graudal, N., Hubeck-Graudal, T., Jürgens, G., Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride. Cochrane Database of Systematic Reviews(Issue 4), 2017 (Art. No: CD004022).
5. Ofran, Y., Lavi, D., Opher, D., et al. Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol/L): a disorder linked to female gender and psychiatric disorders. J Intern Med 256 (2004), 525–528.
6. Geerling, J.C., Loewy, A.D., Central regulation of sodium appetite. Exp Physiol 93 (2008), 177–209.
7. Brunner, H.R., Laragh, J.H., Baer, L., et al. Essential hypertension: renin and aldosterone, heart attack and stroke. N Engl J Med 286 (1972), 441–449.
8. Institute of Medicine, Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate. 2005, National Academies Press, Washington, DC, 379–380.
9. Dietary Guidelines for the Americans, https://health.gov/dietaryguidelines/2015/guidelines/, 2015-2020.
10. Graudal, N., Jürgens, G., Baslund, B., Alderman, M.H., Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis. Am J Hypertens 27 (2014), 1129–1137.
11. Cogswell, M.E., Mugavero, K., Bowman, B.A., et al. Dietary sodium and cardiovascular disease risk - measurement matters. N Engl J Med 375 (2016), 580–586.
12. Cobb, L.K., Anderson, C.A., Elliott, P., et al. Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes: a science advisory from the American Heart Association. Circulation 129 (2014), 1173–1186.
13. Johnson, A.G., Nguyen, T.V., Davis, D., Blood pressure is linked to salt intake and modulated by the angiotensinogen gene in normotensive and hypertensive elderly subjects. J Hypertens 19 (2001), 1053–1060.
14. MacGregor, G.A., Markandu, N.D., Sagnella, G.A., et al. Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet 2 (1989), 1244–1247.
15. Sacks, F.M., Svetkey, L.P., Vollmer, W.M., et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med 344 (2001), 3–10.
16. Bruun, N.E., Skøtt, P., Nielsen, M.D., et al. Normal renal tubular response to changes of sodium intake in hypertensive man. J Hypertens 8 (1990), 219–227.
17. Graudal, N.A., Hubeck-Graudal, T., Jurgens, G., McCarron, D.A., The significance of duration and dose of sodium reduction intervention in normotensive and hypertensive individuals. A meta-analysis. Adv Nutr 6 (2015), 169–177.
18. Appel, L.J., Moore, T.J., Obarzanek, E., et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH collaborative research group. N Engl J Med 336 (1997), 1117–1124.
19. Cappuccio, F.P., MacGregor, G.A., Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens 9 (1991), 465–473.
20. Whelton, P.K., He, J., Cutler, J.A., et al. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA 277 (1997), 1624–1632.
21. Sacks, F.M., Campos, H., Dietary therapy in hypertension. N Engl J Med 362 (2010), 2102–2112.
22. Kaiser, J., Industry groups petition for data on salt and hypertension. Science, 300, 2003, 1350.
23. He, F.J., Li, J., MacGregor, G.A., Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev(Issue 4), 2013 (Art. No: CD004937).
24. WHO, Sodium Intake for Adults and Children. 2012, WHO, Geneva, Switzerland.
25. Aburto, N.J., Ziolkovska, A., Hooper, L., et al. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ, 346, 2013, f1326.
26. Frieden, T.R., Sodium reduction—saving lives by putting choice into consumer's hands. JAMA 316 (2016), 579–580.
27. Mozaffarian, D., Fahimi, S., Singh, G.M., et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med 37 (2014), 624–634.
28. Jackson, S.L., Cogswell, M.E., Zhao, L., et al. Association between urinary sodium and potassium excretion and blood pressure among adults in the United States: National Health and Nutrition Examination Survey, 2014. Circulation 137 (2018), 237–246.
29. Mente, A., O'Donnell, M.J., Rangarajan, S., et al. Association of urinary sodium and potassium excretion with blood pressure. N Engl J Med 371 (2014), 601–611.
30. McCarron, D.A., What determines human sodium intake: policy or physiology?. Adv Nutr 5 (2014), 578–584.
31. O'Donnell, M.J., Yusuf, S., Mente, A., et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA 306 (2011), 2229–2238.
32. Fan, L., Tighiouart, H., Levey, A.S., et al. Urinary sodium excretion and kidney failure in nondiabetic chronic kidney disease. Kidney Int 86 (2014), 582–588.
33. Adler, A.J., Taylor, F., Martin, N., et al. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database Syst Rev, 12, 2014, CD009217.
34. Bibbins-Domingo, K., Chertow, G.M., Coxson, P.G., et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 362 (2010), 590–599.
35. Strazzullo, P., D'Elia, L., Kandala, N.B., Cappuccio, F.P., Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ, 339, 2009, b4567.
36. Poggio, R., Gutierrez, L., Matta, M.G., et al. Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies. Public Health Nutr 18 (2015), 695–704.
37. IOM. (Institute of Medicine), Sodium Intake in Populations: Assessment of Evidence. 2013, National Academies Press, Washington, DC.
38. Thomas, M.C., Moran, J., Forsblom, C., et al. The association between dietary sodium intake, ESRD, and all-cause mortality inpatients with type 1 diabetes. Diabetes Care 34 (2011), 861–866.
39. Phister, R., Michels, G., Sharp, S.J., et al. Estimated urinary sodium excretion and risk of heart failure in men and women in the EPIC-Norfolk study. Eur J Heart Fail 16 (2014), 394–402.
40. O'Donnell, M., Mente, A., Rangarajan, S., et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med 371 (2014), 612–623.
41. Mente, A., O'Donnell, M., Rangarajan, S., et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. Lancet 388:10043 (2016), 465–475.
42. Lerchl, K., Rakova, N., Dahlmann, A., et al. Agreement between 24-hour salt ingestion and sodium excretion in a controlled environment. Hypertension 66 (2015), 850–857.
43. Olde Engberink, R.H.G., van den Hoek, T.C., van Noordenne, N.D., et al. Use of a single baseline versus multiyear 24-hour urine collection for estimation of long-term sodium intake and associated cardiovascular and renal risk. Circulation 136 (2017), 917–926.
44. Cook, N.R., Appel, L.J., Whelton, P.K., Lower levels of sodium intake and reduced cardiovascular risk. Circulation 129 (2014), 981–989.
45. Cook, N.R., Appel, L.J., Whelton, P.K., Sodium intake and all-cause mortality over 20 years in the trials of hypertension prevention. J Am Coll Cardiol 68 (2016), 1609–1617.
46. Cogswell ME, Loria CM, Terry AL, et al. Estimated 24-hour urinary sodium and potassium excretion in US adults. JAMA (doi:10.1001/jama.2018.1156).
47. Folkow, B., On bias in medical research; reflections on present salt- cholesterol controversies. Scand Cardiovasc J 45 (2011), 194–197.
48. Graudal, N., A radical sodium reduction policy is not supported by randomized controlled trials or observational studies: grading the evidence. Am J Hypertens 29 (2016), 543–548.
49. Graudal, N., Reducing salt intake at the population level: is it really a public health priority?. Nephrol Dial Transplant 31 (2016), 1398–1403.
50. Teicholz, N., The scientific report guiding the US dietary guidelines: is it scientific?. BMJ, 351, 2015, h4962.
51. National Academy of Medicine, Redesigning the Process for Establishing the Dietary Guidelines for Americans. 2017, National Academy of Sciences, Washington.