Sodium Intake in Populations Assessment of Evidence (2013) / Chapter Skim
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A number of scientific bodies and professional health organizations, including the American Heart Association, the American Medical Association, and the American Public Health Association, support reducing dietary sodium intake, and the 2010 Dietary Guidelines for Americans includes as a goal to "reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 years of age and older and those of any age who are frican A A merican or have hypertension, diabetes, or chronic kidney disease." A substantial body of evidence supports these efforts to reduce sodium intake.
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In approaching its task, the committee first conducted a broad search of the published literature through 2012 to identify relevant scientific publications on sodium and direct health outcomes. The committee was unable to identify studies published prior to 2003 that provided data on how the frequency of direct health outcomes was associated with changes in dietary sodium.
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The evidence for an effect of sodium intake on health outcomes reviewed by the committee included a broad range of population groups and methodological approaches. All of the evidence on the health outcomes related to CVD, stroke, and mortality was observational, mostly prospective cohort studies, whereas the evidence on health outcomes related to heart failure included randomized clinical trials (RCTs)
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Findings and Conclusions for Cardiovascular Disease, Stroke, and Mortality General U.S. Population Finding 1: The committee found that the results from studies linking dietary sodium intake with direct health outcomes were highly variable in methodological quality, particularly in assessing sodium intake.
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. In contrast, the committee found no evidence for benefit and some evidence suggesting risk of adverse health outcomes associated with sodium intake levels in ranges approximating 1,500 to 2,300 mg per day in other diseasespecific population subgroups, specifically those with diabetes, chronic kidney disease (CKD)
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A Tolerable Upper Intake Level for sodium was set at 2,300 mg per day based on evidence showing associations between high sodium intakes and risk of high blood pressure and consequent risk of CVD, stroke, and mortality. Given this background, overall, the committee found that the available evidence on associations between sodium intake and direct health outcomes is consistent with population-based efforts to lower excessive dietary sodium intakes, but it is not consistent with recommendations that encourage lowering of dietary sodium in the general population to 1,500 mg per day.
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Methodological problems in assessing sodium intake make this particularly challenging. FUTURE RESEARCH TO ADDRESS GAPS IN DATA AND METHODOLOGY The committee identified a number of data and methods gaps in studies on sodium intake and risk of adverse health outcomes among population groups.
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Analyses of interactions with antihypertensive medication and blood pressure in studies examining associations between sodium intake and health outcomes. In addition, the committee identified a need for RCT research, and observational and mechanistic studies, particularly in population subgroups.
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population, as well as associations between sodium intake and caloric intake in both short-term and longitudinal studies.
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