Dietary Reference Intakes for Sodium and Potassium (2019) / Chapter Skim
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9 Sodium: Dietary Reference Intakes for Toxicity
9 Sodium: Dietary Reference Intakes for Toxicity
Pages 245-262
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From page 245... ...
The UL is intended to provide guidance on intake levels that are safe; it is not intended to serve as an intake goal. The Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease (Guiding Principles Report)
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From page 246... ...
As such, the approach to establish the sodium UL in this report differs from the approach taken in the 2005 DRI Report. For instance, evidence on the relationships between sodium intake and blood pressure, stroke, coronary heart disease, left ventricular mass, bone-related indicators, and kidney disease was reviewed in the 2005 DRI Report as potentially informing the UL, but it is now considered in the context of establishing sodium Chronic Disease Risk Reduction Intakes (CDRRs; see Chapter 10)
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From page 247... ...
From these efforts, the committee identified a collection of case reports on deaths attributed to high levels of sodium intake. The committee also compiled reported adverse effects of the sodium trials included in the Agency for Healthcare Research and Quality's sys tematic review, Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks (AHRQ Systematic Review)
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From page 248... ...
Case reports provide evidence that acute ingestion of large doses of sodium, including rapid ingestion of salt in liquid solution, can lead to death. Collectively, the case reports provide information about limits of biological homeostatic controls related to sodium, but they do not necessarily reflect the toxicological effects of habitually elevated intake levels suitable for establishing a sodium UL.
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From page 249... ...
Several of the smaller studies did not report marked differences in adverse events between the high- and low-sodium intervention periods (crossover trials) or groups (parallel randomized controlled trials)
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From page 250... ...
adults, ≤ 60 years of age, with SBP ≥ 135 but < 160 mm Hg, receiving antihypertensive medication Todd et al., 2010 4 34 New Zealand adults, 20–65 years of age, with BP > 130/85 or treated with antihypertensive therapy Todd et al., 2012 4 23 normotensive New Zealand adults, 24–61 years of age Singer et al., 1991 4 21 British adults, mean 53.9 ± 2.5 years of age, with hypertension, treated with a converting enzyme inhibitor and a diuretic
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From page 251... ...
sodium experienced side effects Bloating did not change, but reporting of other symptoms reduced after content of high-sodium period was reduced from 5,750–4,600 mg/d (250–200 mmol/d) sodiumj 104 N/A 195 All participants completed study without adverse effects continued
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From page 252... ...
Puska et al., 1983 6 72 Finnish adults, 30–50 years of age, free from major health problems, not undergoing antihypertensive treatment at baselinem Knuist et al., 1998 NR 361 nulliparous, Dutch women, mean 28 years of age, who had a rise in BP, excessive weight gain, or edema identified during a prenatal visit
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From page 253... ...
SODIUM: DRIs FOR TOXICITY 253 Mean Achieved Urinary Sodium Excretion by Sodium Intake Group, mmol/d Low Moderate Highb Description of Adverse Events 105 N/A 125/175k Sodium interventions did not have deleterious effects on metabolic parameters of glucose tolerance or plasma lipids Urinary calcium excretion decreased significantly during the sodium bicarbonate period, but increased during the sodium chloride period 99 N/A 140 Sodium reduction was associated with a significant decrease in the rate of headaches No between-group differences in number of individuals reporting other adverse eventsn 99 N/A 145 Significant improvements in the Psychological General Well-Being scale observed in the sodium-reduction group 102o N/A 161p Reports of transient unsteadiness and faintness increased in the low-sodium group and decreased in the high-sodium group 37 N/A 161 Lower sodium group reported they felt happier, had less depression, and used fewer analgesics Both groups reported slight improvements in mild and severe muscle cramps 122 N/A 146 2 participants in the low-sodium group dropped out because of elevated serum creatinine levels 1 participant in the high-sodium group withdrew because of headache 83r N/A 126r No differences in measures of insulin, glucose, and blood lipids 52 N/A 134 HDL-C slightly reduced in the low-sodium groups compared with the normal-sodium groups No significant difference in the change in total cholesterol to HDL-C ratio between sodium groups 77 NA 167 2 participants in the low-sodium group developed hypertension and began antihypertensive treatments 1 participant in the low-sodium group developed significant polyuria 84 N/A 124 No difference in obstetric outcomes continued
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From page 254... ...
To convert the mmol value to milligrams, multiply the excretion or intake level by 23.0. ACE = angiotensin-converting enzyme; BP = blood pressure; DASH = Dietary Approaches to Stop Hypertension; DBP = diastolic blood pressure; HDL-C = high-density lipoprotein-cholesterol; mm Hg = millimeter mercury; N/A = not applicable; SBP = systolic blood pressure; TOHP = Trials of Hypertension Prevention.
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From page 255... ...
rBetween-group difference in urinary sodium excretion was reported to be 38 mmol. Base line urinary sodium excretion was 93 mmol/d in the low-sodium group and 98 mmol/d in the high-sodium group.
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From page 256... ...
Interpretation of the reported adverse events would likely differ if participants consumed the 500 mL of tomato juice as a single bolus without food, as opposed to consuming portions over the course of the day with food. Furthermore, the derivation of a UL is driven by the identification of an indicator of toxicological adverse effects.
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From page 257... ...
, headache incidence was 47, 41, and 39 percent for the high-, intermediate-, and low-sodium periods of the control diet arm, and 43, 38, and 36 percent for the high-, intermediate-, and low-sodium periods of the DASH diet arm. In models adjusted for age, sex, race, site, systolic blood pressure, body mass index, smoking, and carryover effects, there were no significant differences between the DASH diet and control diet within sodium level.
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From page 258... ...
Therefore, this latter DRI value will cover the range of intakes associated with headache. THE COMMITTEE'S CONCLUSION REGARDING THE TOLERABLE UPPER INTAKE LEVELS FOR SODIUM Extreme intakes of sodium, especially ingested as a massive acute dose, have been shown to cause severe adverse effects, including death.
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From page 259... ...
As per the guidance provided in the Guiding Principles Report, the expanded DRI model now focuses the UL on characterizing toxicological risk attributable to excessive intake and the new DRI category on characterizing the relationship between intake and chronic disease risk. In the expanded DRI model, there may be scenarios in which chronic disease risk is reduced by increasing intake of a nutrient or other food substance (see Chapter 2, Figure 2-1)
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From page 260... ...
1984. Is low salt dietary advice a useful therapy in hypertensive patients with poorly controlled blood pressure?
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From page 261... ...
2017. Guiding prin ciples for developing Dietary Reference Intakes based on chronic disease.
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From page 262... ...
2012. Dietary sodium loading in normotensive healthy volunteers does not increase arterial vascular reactivity or blood pressure.
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