Sodium Intake in Populations Assessment of Evidence (2013) / Chapter Skim
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3 Sodium Intake and Intermediate Markers for Health Outcomes
3 Sodium Intake and Intermediate Markers for Health Outcomes
Pages 39-56
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From page 39... ...
. This chapter first summarizes evidence and findings on sodium intake and intermediate markers for health outcomes reviewed in that report (IOM, 2005)
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From page 40... ...
The committee summarizes new evidence for blood pressure as an indirect indicator of risk of CVD in this chapter, but does not include its assessment of this indicator in its comprehensive evidence review and analysis of sodium intake and direct health outcomes in Chapter 4.
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From page 41... ...
A wide statistically normal distribution in measured blood pressure was seen among individuals at both intake levels. The standard deviation of the distribution change, however, was similar for both distributions, suggesting that the variability in blood pressure responses to reduced sodium intake likely occurred in response to factors unrelated to sodium intake.
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From page 42... ...
cross-sectional study, identified the presence of cytochrome P450 3A polymorphisms in a group of Japanese adults. Blood pressure response to sodium intake, estimated by spot analysis of 24-hour urinary sodium excretion, was found to be associated with the frequency of expression of two allelic variants: a heterozygous modifier of blood pressure, and a homozygous variant in carriers that resulted in greater sensitivity to salt intake compared to noncarriers.
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From page 43... ...
Additional evidence from intervention studies consistently supported a dose-response relationship between dietary sodium intake and blood pressure in both normotensive and hypertensive individuals. Taken together, the panel concluded that reducing sodium intake therefore lowers blood pressure and thereby should decrease risk of CVD (IOM, 2005, pp.
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From page 44... ...
The report further concluded that even a modest reduction in blood pressure from reducing sodium intake would have significant public health benefits. New Evidence Associating Sodium Intake with Health Outcomes Blood Pressure Response to Sodium Intake in Population Subgroups A unique population identified in the INTERSALT study, the Yanomami Indians, exhibits consistently low systolic and diastolic blood pressures within the population and over their lifetimes (De Jesus Mancilha-Carvalho and De Souza e Silva, 2003)
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From page 45... ...
Hypertensive participants significantly reduced blood pressure in a stepwise fashion at all sodium intake levels for both the control and DASH diets. Among nonhypertensive participants, significant reductions in systolic blood pressure were found at all levels for those on the control diet but only between the low versus high levels for those on the DASH diet.
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From page 46... ...
Both groups were assessed for mean blood pressure and urinary sodium excretion at baseline, 18, and 36 months. Analyses of data on the change in blood pressure corresponding with urinary sodium excretion showed a significant dose-response trend in decreasing systolic blood pressure that was strongest for participants who maintained a low sodium intake.
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From page 47... ...
This study, which included participants who were normotensive as well as prehypertensive and hypertensive, also found no correlation between sodium intake and either systolic or diastolic blood pressure, although an inverse correlation was found between calcium intake and blood pressure. Several intervention studies in normotensive population groups examined blood pressure response to variations in dietary sodium intake but study findings were inconsistent.
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From page 48... ...
None of the interventions was found to be significantly associated with either systolic or diastolic blood pressure response despite an increase in urinary sodium corresponding with increased sodium intake. To examine the influence of dietary sodium on nighttime blood pressure "dipping" in salt-sensitive compared to salt-resistant young adults (18-40 years of age, n=41)
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From page 49... ...
EVIDENCE ASSOCIATING SODIUM INTAKE WITH BIOMARKERS OF PROGRESSION OF PRIOR KIDNEY DISEASE The progression of chronic kidney disease (CKD) appears to be related to dietary sodium intake, either through effects on blood pressure or other mechanisms.
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From page 50... ...
More recently, other studies have emerged linking dietary sodium intake with intermediate markers of kidney disease, such as urinary proteinuria.
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From page 51... ...
The IOM report Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (IOM, 2005) suggested that the inverse relationship between renin and sodium intake appears to be curvilinear and it occurs at levels less than 2,300 mg per day.
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From page 52... ...
2005. Increased sodium intake corre lates with greater use of antihypertensive agents by subjects with chronic kidney disease.
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From page 53... ...
2003. Sodium intake and blood pressure in healthy individuals.
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From page 54... ...
2006. An in-depth review of the evidence linking dietary salt intake and progression of chronic kidney disease.
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From page 55... ...
2012. Guideline: Sodium intake for adults and chil dren.
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