Chapter 36 physiology and pathophysiology of sodium retention. Among a cohort of older adults in the health abc study, this study finds that food frequency questionnaireassessed sodium intake was not. Loop diuretics interfere with the renal capacity to concentrate urine resulting in less reabsorption of free water and in the production of hypotonic urine. However, the precise relationship between dietary salt intake and mortality in patients with type 2 diabetes has not been previously explored. Lowering blood pressure through populationwide salt intake reduction is cost effective.
Reduced dietary sodium intake has been recommended for at least a half century. To develop methods of estimating sodium intake in freeliving persons, we gave normal volunteers mean sodium intakes of 65, 110, and 200 meqday. Subjects usual sodium intake was estimated by using multiple 24hour dietary recalls. High salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease. Sodium intake and blood pressure among us children and adolescents yang, 2012 results from the nhanes national health and nutrition examination survey were used to determine whether there was a correlation in diets ranging from 1,334 to 8,177 mg of sodium day and blood pressure. Initially, the rationale was to blunt an ageassociated rise in blood pressure and prevent hypertension. In a subsequent study of 3000 treated hypertensive patients in whom pretreatment 24hour sodium intake measured after advice to refrain from excess salt intake for 5 days and baseline pra were measured, there was a stepwise, significant, and independent relation between level of sodium measured in 24hour urine and subsequent strokes and heart. Salt intake not associated with mortality or risk of. Salt intake in the united states recommended daily salt intake. Association between dietary factors and mortality from. The combination of very low dietary sodium intake in heart failure and exaggerated losses due to natriuretic diuretic therapy might lead to progressive depletion of wholebody sodium. Reducing salt intake has been identified as one of the most costeffective measures countries can take to improve the health of their population.
Reduced salt intake for heart failure jama network. Dietary salt intake and blood pressure jama jama network. Strategies to reduce dietary sodium intake springerlink. Objective to assess the association of a governmentled, multisectoral, and populationbased intervention with reduced salt intake and blood pressure in shandong province, china. Weight loss, sodium reduction, increased physical activity, and limited alcohol intake are established recommendations that reduce blood pressure bp. Dietary salt intake and blood pressure jama network. Salt intake assessed by 24 h urinary sodium excretion in a. American medical association jama, european researchers followed 3,681 men and women for an average of about eight years. These resources can also help you find ways to reduce sodium in your diet. Dietary salt intake and mortality in patients with type 2.
Sodium intake and prevalence of hypertension, coronary heart. To determine whether weight loss or reduced sodium intake is effective in the treatment of older persons with hypertension. The world health organization proposed noncommunicable diseaserelated targets, including 30 percent reduction in salt sodium intake to reduce risk of hypertension. The 20152020 dietary guidelines for americans recommend that americans consume less than 2,300 mg of.
Recent data on sodium intake show that populations around the world are consuming much more sodium than. Mean daily sodium intake in mg for men and women in the u. Urinary sodium and potassium excretion and risk of. Dietary salt intake survey in the republic of moldova was to establish current baseline average consumption of salt sodium, potassium and iodine through 24hour urinary excretion testing among a random sample of the adult population aged 1869 years, and to assess the knowledge, attitudes, practices and behaviour around dietary salt in. Even intelligent and bright people have shallow awareness of their salt intake. Curbing obesity can both reduce risk of hypertension and lower cardiovascular risk.
Average daily salt intake in male and female americans, as ascertained from 24hour dietary recall, 20052006. Effects of comprehensive lifestyle modification on blood. Nov 23, 2011 the study, published in the journal of the american medical association jama, found that moderate salt intake is associated with the lowest risk of cardiovascular events, whereas higher intake. Flawed science on sodium from jama the nutrition source. Salt and sodium intake in china global health jama jama. Salt intake was not associated with mortality or risk for cardiovascular disease cvd and health failure hf in older adults based on selfreported estimated sodium intake, according to a study published online by jama internal medicine. In patients with nonsodiumsensitive hypertension, on the other hand, blood pressure decreased during the night, independent of the amount of sodium intake.
Withdrawal of antihypertensive medication was attempted after 3 months of intervention. Sodium intake and prevalence of hypertension, coronary. In brief patients with type 2 diabetes have an increased risk for cardiovascular and chronic kidney disease. Salt and sodium intake remains high in china for the. Equally well established is the association of increasing blood pressure and cardiovascular morbidity and mortality. Authors karen b desalvo 1, richard olson 1, kellie o casavale 1. Added sugar intake and cardiovascular diseases mortality. High blood pressure can raise your risk of having a heart attack or stroke.
Objective many guidelines recommend that patients with type 2 diabetes should aim to reduce their intake of salt. The average sodium intake per day over the 6 years of survey period was 4,934. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health. The aim of this study was to quantify dietary sodium intake in a cohort of selfreferred patients with. Dietary sodium intake and subsequent risk of cardiovascular. Abstractthe positive relation of sodium intake and blood pressure, first recognized a century ago, has been well established in ecological, epidemiological, and experimental human studies. May, 2012 excess sodium intake has an important, if not predominant, role in the pathogenesis of elevated blood pressure, one of the most important modifiable determinants of cardiovascular disease cvd. In the united states, the recommended upper limit of dietary salt intake for blacks, people with hypertension, and adults older than 40 years of age is 3. Eating too much sodium can lead to high blood pressure hypertension.
Sodium intake and blood pressure among us children and. The only way to quantitate salt intake is to measure urinary sodium. Elevated sodium intake has been associated with a number of ncds including hypertension, cardiovascular disease and stroke, and decreasing sodium intake may reduce blood pressure and the risk of associated ncds 4, 5. In china, hypertension prevalence is rising and salt intake is high 12 gpersond. To assess the association between usual dietary sodium intake and blood pressure among us children and adolescents, overall and by weight status. May 04, 2011 unreliable measurement of sodium intake. Indeed, the pharmacological capacity to reduce blood pressure has produced one of the. Sodium intake for adults and children world health organization. Sources of sodium in your diet all across the united states, high sodium intake is a major problem. At this low level of response it is possible that simply asking for volunteers would produce the same results. High sodium intake is linked to high blood pressure, which is known to cause.
May 10, 2011 although the jama article may have its flaws, continuing to urge salt or sodium reduction to reduce risk of heart disease risk is like trying to move a shoe in the road, when a large truck is blocking the way. Urinary sodium and potassium excretion, mortality, and. Salt and hypertension the american journal of medicine. The intake was randomly varied about each mean by an sd of 12. Study calls sodium intake guidelines into question. Sodium reduction and weight loss in the treatment of. Salt, blood pressure, and human health hypertension. Conflicting evidence on health effects associated with. Association of a provincewide intervention with salt intake.
The article by hofman et al 1 in the same issue, which states a causal relationship between sodium and blood pressure, deals with a more controlled population infants. Guideline recommendations on salt consumption in patients with heart. Learn about the difference between sodium and salt, why reducing sodium intake is important, what you can do to reduce sodium consumption, and more. Objective the gold standard method for measuring population sodium intake is based on a 24 h urine collection carried out in a random population sample. The study investigators base their main findings on a single measurement of sodium collected at the start of the studyspecifically the amount of sodium that study participants excreted in their urine over a 24 hour period. The sodium portion of salt is responsible for its health concerns. Importance epidemiologic studies have suggested that higher intake of added sugar is associated with cardiovascular disease cvd risk factors. Superimposed hypertension further increases the risk and is associated with increased dietary sodium intake. Research design and methods six hundred and thirtyeight patients attending a single diabetes clinic were followed in a prospective cohort.
We surveyed 342 gila bend papago indians and 375 nonindians from july to september 1983. Low sodium intake cardiovascular health benefit or risk. The good news is that cutting down on sodium can help lower. Methodswe obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24hour. Compelling evidence for public health action to reduce salt. Sodium intakes around the world paul elliott and ian brown background document prepared for the forum and technical meeting on reducing salt intake in populations paris 57th october 2006 1. Study evaluates association between urinary salt excretion.
Flaws in the new study, from the young age of the participants to the. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. The utility of overnight urine collections in assessing. Sodium intake for adults and children who world health. Sodium, commonly consumed as sodium chloride table salt, is a major component of our food supply. Estimates are based on self reports and are considered underestimates of mean daily sodium intake for the u. There are few data available on dietary sodium intake in type 2 diabetes. A high level of sodium 440 mgl in the water supply of gila bend, ariz, caused concern because of apparently elevated rates of hypertension in gila bend papago indians. During this embargo period individuals granted access to articles may read them, discuss their findings. Effects of exposure to salty drinking water in an arizona. National health programs organization and administration. In the united states, the quantity of sodium is typically. Total diet studies include weighed food intake and laboratory analysis of prepared foods representing dietary intake, using a standardized design. However, because participant burden is high, response rates are typically low with less than one in four agreeing to provide specimens.
Children and adolescents aged 8 to 18 years n 6235 who participated in nhanes 20032008 comprised the sample. Sodium targets in the national school lunch program. Dietary sodium intake in type 2 diabetes clinical diabetes. Apr 01, 2014 it is unclear what degree of sodium restriction is optimal. Dietary sodium content, mortality, and risk for cardiovascular. Twentyfourhour and night urinary sodium excretion were measured. Although sodium can be consumed in nonchloride forms sodium bicarbonate ie, baking soda and monosodium glutamate msg, salt provides approximately 90 percent of dietary sodium. Cirrhosis 100 100 100 100 10 nn n n100 10 10 10 10 n figure 1 concept of effective arterial blood volume and effect of. Preventing cardiovascular disease in the americas by reducing dietary salt intake. However, the association between sodium intake and clinical cvd remains less clear, and this relationship has not been investigated in patients with ckd. The study appears in the february 16 issue of jama. To assess the association of a governmentled, multisectoral, and populationbased intervention with reduced salt intake and blood pressure in shandong province, china.
Given the current food environment, educational efforts such as clinician counseling are useful. Sodium is a mineral, and most of the sodium in our foods comes from salt. Elevated sodium intake has been associated with a number of ncds including hypertension. This study included 3,757 patients with ckd from 7 locations in the u. High sodium or salt intake can lead to chronic comorbidities. It seeks a gradual and sustained drop in dietary salt intake to reach national targets or the. Association of a provincewide intervention with salt. Sep 01, 2015 daily sodium intake for koreans has gradually increased from 2007 to 2010, but since 2011, the figure has dropped. Nonpharmacologic interventions are frequently recommended for treatment of hypertension in the elderly, but there is a paucity of evidence from randomized controlled trials in support of this recommendation. Dietary sodium intake and cardiovascular mortality. Reducing salt intake to recommended levels could prevent 2. Backgroundthe optimal range of sodium intake for cardiovascular health is controversial.
Provincial and territorial progress report on reducing sodium intake of canadians 2012 average intake of 2,300 mg sodium day by 2016. Few prospective studies have examined the association of added sugar intake with cvd mortality. Potassium improved blood pressure in teen girls, salt had no. A new study from europe published in the may 4 journal of the american medical association shows that taking in less salt may increase the risk of heart disease and has little effect on the development of high blood pressure. Conflicting evidence on health effects associated with salt. Sodium intake as a risk factor for cardiovascular disease jama. Sodium s role in processed foods pdf icon pdf 867k reducing sodium in your diet. The findings contradict results of many other studies showing that less salt prevents heart disease. In fact, the majority of the sodium americans consumemore than 70%is found in. Policy statement on dietary salt reduction pahowho. Importance high salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease. The first thing to know is that the salt you use at the dinner table is. Salt in the diet acute coronary syndromes jama jama network.
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