Key result
Moderate sodium intake shows no association with increased CV risk, which rises above 5 g/day.
Why the study?
Current blood pressure guidelines recommend population-wide low sodium intake despite a lack of high-quality evidence that it reduces cardiovascular events compared with moderate intake.
Does low sodium intake (<2.3 g/day) reduce cardiovascular disease compared to moderate intake?
Does low sodium intake (<2.3 g/day) reduce cardiovascular disease compared to moderate intake?
This review challenges universal low sodium guidelines, arguing that moderate intake (2.3-4.6 g/day) does not increase cardiovascular risk and that reduction targets should focus on populations consuming >5 g/day.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry's vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst.”
“Current evidence indicates that most people around the world consume a moderate range of dietary sodium (3 to 5 g/day), that this level of intake is associated with the lowest risk of cardiovascular disease and mortality, and that the risk of adverse health outcomes increases when sodium intakes exceeds 5 g/day or is below 3 g/day.”
“Weak research on dietary sodium should not generate strong conclusions on a major public health policy”
Challenges low-sodium guideline targets below 2.3 g/day; leaves optimal intake open for randomized trials.
Several blood pressure guidelines recommend low sodium intake (<2.3 g/day, 100 mmol, 5.8 g/day of salt) for the entire population, on the premise that reductions in sodium intake, irrespective of the levels, will lower blood pressure, and, in turn, reduce cardiovascular disease occurrence. These guidelines have been developed without effective interventions to achieve sustained low sodium intake in free-living individuals, without a feasible method to estimate sodium intake reliably in individuals, and without high-quality evidence that low sodium intake reduces cardiovascular events (compared with moderate intake). In this review, we examine whether the recommendation for low sodium intake, reached by current guideline panels, is supported by robust evidence. Our review provides a counterpoint to the current recommendation for low sodium intake and suggests that a specific low sodium intake target (e.g. <2.3 g/day) for individuals may be unfeasible, of uncertain effect on other dietary factors and of unproven effectiveness in reducing cardiovascular disease. We contend that current evidence, despite methodological limitations, suggests that most of the world's population consume a moderate range of dietary sodium (2.3-4.6g/day; 1-2 teaspoons of salt) that is not associated with increased cardiovascular risk, and that the risk of cardiovascular disease increases when sodium intakes exceed 5 g/day. While current evidence has limitations, and there are differences of opinion in interpretation of existing evidence, it is reasonable, based upon observational studies, to suggest a population-level mean target of <5 g/day in populations with mean sodium intake of >5 g/day, while awaiting the results of large randomized controlled trials of sodium reduction on incidence of cardiovascular events and mortality.
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O’Donnell et al. (2020) conducted a review in Cardiovascular disease. Low sodium intake vs. Moderate sodium intake (2.3-4.6 g/day) was evaluated on Cardiovascular disease occurrence. Current evidence suggests that moderate dietary sodium intake (2.3-4.6 g/day) is not associated with increased cardiovascular risk, whereas risk increases when sodium intake exceeds 5 g/day.
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