Key result
A critical review of the literature suggests that the U-shaped association between sodium intake and mortality reported in a recent meta-analysis requires careful methodological scrutiny before acceptance.
This commentary highlights the need to critically evaluate methodological issues and the totality of evidence before accepting a U-shaped association between sodium intake and mortality.
Considerable attention has been devoted to interpretation of cohort analyses used to study the relationship between sodium (Na) intake and cardiovascular disease (CVD).Reports have included analyses from individual studies, systematic reviews of the literature, and meta-analyses.Recently, Graudal et al. published a meta-analysis and concluded, "Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes." 1 Before accepting this statement, one should consider the quality of the underlying studies, the appropriateness of pooling the data, study-specific methodological issues, results of cohort studies not included in Graudal et al.'s meta-analysis, evidence from randomized controlled trials (RCTs), and the consistency of Graudal et al.'s conclusion with those of other investigators.
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Whelton et al. (2014) conducted a review in Cardiovascular disease. Sodium intake was evaluated on Mortality and health outcomes. A critical review of the literature suggests that the U-shaped association between sodium intake and mortality reported in a recent meta-analysis requires careful methodological scrutiny before acceptance.
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