Dietary Reference Intakes for Sodium and Potassium (2019) / Chapter Skim
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The unique nature of potassium and sodium -- that is, the coexistence of their essentiality with a relationship to adverse health effects, including chronic disease risk -- necessitated a new approach to the review of intake recommendations for these nutrients within the Dietary Reference Intakes (DRIs) context.
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A 2017 National Academies of Sciences, Engineering, and Medicine (the National Academies) report, Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease (Guiding Principles Report)
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In contrast, reference values for the DRI based on chronic disease are generally intended to be established only when the body of the evidence is sufficient to do so. In particular, the Guiding Principles Report recommended at least a moderate strength of evidence for both the causal and intake–response relationships between nutrient and chronic disease risk.3 In the context of this DRI review of potassium and sodium, the committee has called the specific category of DRIs based on chronic disease reference value the Chronic Disease Risk Reduction Intake (CDRR)
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The committee's findings, conclusions, and resulting DRIs for potassium and sodium are presented in the following sections, organized by the steps in the DRI framework outlined above. DIETARY REFERENCE INTAKES FOR POTASSIUM Step 1: Review and Selection of Indicators Indicators to Establish Potassium DRIs for Adequacy The committee's review of the evidence on potential indicators to inform the potassium DRIs for adequacy revealed the following: • There is no sensitive biomarker that can be used to characterize the distribution of potassium requirements in the apparently healthy population.
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The committee concludes that there is insufficient evidence of potassium toxicity risk within the apparently healthy population to establish a potassium Tolerable Upper Intake Level (UL)
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An intake– response relationship with dose of supplemental potassium could not be established. The committee concludes that, although there is moderate strength of evidence for a causal relationship between potassium supple mentation and reductions in blood pressure, heterogeneity across studies, lack of evidence for an intake–response relationship, and lack of supporting evidence for benefit of potassium on cardiovas cular disease prevents the committee from establishing a potassium Chronic Disease Risk Reduction Intake (CDRR)
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UL CDRR Infants 0–6 months 400 NDb NDc 7–12 months 860a NDb NDc Children 1–3 years 2,000a NDb NDc 4–8 years 2,300a NDb NDc Males 9–13 years 2,500a NDb NDc 14–18 years 3,000a NDb NDc 19–30 years 3,400 a ND b NDc 31–50 years 3,400a NDb NDc 51–70 years 3,400 a ND b NDc > 70 years 3,400a NDb NDc Females 9–13 years 2,300a NDb NDc 14–18 years 2,300a NDb NDc 19–30 years 2,600 a ND b NDc 31–50 years 2,600a NDb NDc 51–70 years 2,600 a ND b NDc > 70 years 2,600a NDb NDc Pregnancy 14–18 years 2,600a NDb NDc 19–30 years 2,900a NDb NDc 31–50 years 2,900 a ND b NDc Lactation 14–18 years 2,500a NDb NDc 19–30 years 2,800 a ND b NDc 31–50 years 2,800a NDb NDc NOTE: AI = Adequate Intake; CDRR = Chronic Disease Risk Reduction Intake; mg/d = m illigrams per day; ND = not determined; UL = Tolerable Upper Intake Level. aUpdated DRI value, as compared to the 2005 DRI Report.
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• Despite moderate strength of evidence that potassium supplementation re duces blood pressure, particularly among adults with hypertension, a potas sium Chronic Disease Risk Reduction Intake cannot be established because of heterogeneity across studies, lack of an intake–response relationship, and low or insufficient strength of evidence for related chronic disease endpoints. Steps 3 and 4: Characterization of Risk and Implications for Public Health A comparison of the updated potassium AI values to distributions of potassium intakes in the United States and Canada revealed slight d ifferences across population groups reviewed.
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Caution against high intake through supplemental potassium is warranted for certain population groups, particularly those with or at high risk for compromised kidney function. DIETARY REFERENCE INTAKES FOR SODIUM Step 1: Review and Selection of Indicators Indicators to Establish Sodium DRIs for Adequacy The committee's review of the evidence on potential indicators to inform the sodium DRIs for adequacy revealed the following: • There is no sensitive biomarker that can be used to characterize the distribution of sodium requirements in the apparently healthy population.
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Current evidence does not characterize the type, severity, duration, and frequency of headaches reported. The committee concludes that there is insufficient evidence of s odium toxicity risk within the apparently healthy population to establish a sodium Tolerable Upper Intake Level (UL)
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. Step 2: Establishing Sodium Dietary Reference Intake Values Establishing the Sodium AIs To establish the sodium AIs, the committee reviewed the range of sodium intakes that have been assessed in sodium reduction trials included in the AHRQ Systematic Review.
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Further reductions in sodium intake below the CDRR have demonstrated a lowering effect on blood pressure, but the effect on chronic disease risk could not be characterized. Although there was insufficient evidence to establish a CDRR based on trials conducted in children and adolescents, there is evidence of blood pressure and cardiovascular disease risk tracking from early childhood into adulthood.
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aUpdated DRI value, as compared to the 2005 DRI Report. bNot determined owing to lack of a toxicological indicator specific to excessive sodium intake.
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for adults 19 years of age and older is based on the lowest levels of sodium intakes evaluated in randomized controlled trials for which there was no evidence of deficiency, evidence from the best-designed balance study, and insufficient evidence of harmful effects from observational studies. Sodium AIs for children and adolescents were extrapolated based on sedentary Estimated Energy Requirements.
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and Canadian populations consuming sodium at levels above the CDRR, opportunities exist to find novel solutions to reduce population sodium intakes, including technical innovations to decrease sodium in the food supply. Regarding potassium, the evidence on the relationships with chronic disease endpoints was of insufficient strength to establish a CDRR.
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