Salt Restriction for the Prevention of Cardiovascular Disease

Abstract

On the basis of the available studies, it seems likely that a moderate lowering of the daily intake of sodium chloride by the general population from 8 to 12 grams per day (the current value) to 5 to 6 grams per day would be a useful public health measure, with economic benefits as well. The potential risks for certain groups of individuals are foreseeable and controllable. A general reduction of dietary salt intake can only be achieved by reducing the sodium chloride content of industrially processed foods, as these account for 75% to 80% of the sodium chloride consumed daily. Aside from a general reduction of dietary salt intake, further important primary prevention measures for the general population include changes in lifestyle and in dietary habits.

Salt controls endothelial and vascular phenotype

“…As current data reveal an average daily consumption of 3 to 6 g of sodium, corresponding to 7.5 to 15.0 g of salt across populations [99], mostly assigned to the use of processed foods [52], recent global and American guidelines on cardiovascular disease prevention recommend a maximum daily sodium intake of 1.5 to 2.4 g (3.75 to 6.0 g of salt) [34,41,58]. A daily salt restriction to 5-6 g is also recommended by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) [71].…”

Benefit assessment of salt reduction in patients with hypertension: systematic overview

“…In the recently published systematic review and meta-analysis of prospective studies published by Strazzullo et al in 2009 [11], including 19 independent cohort samples with more than 170 000 participants and a follow-up between 3.5 and 19 years, higher salt intake was associated with a significantly greater risk of stroke (pooled relative risk 1.23; 95% confidence interval 1.06-1.43; P ¼ 0.007) and a tendentially higher, though nonsignificant, risk of cardiovascular disease was observed (pooled relative risk 1.14, 95% confidence interval 0.99-1.32; P ¼ 0.07). In a recently published narrative review, multiple studies have shown that the adjusted relative risk reduction in controlled observational studies aiming for reduced sodium intake ranged from 25% over 15 years to 41% over 3 years [45]. The effect of a direct application of a salt reduction in daily life has been demonstrated in an RCT, which investigated the Dietary Approaches for Stop Hypertension (DASH) diet, rich in fruits and vegetables and low-fat diary products in combination with reduced dietary sodium uptake.…”

“…The Swedish Obese Subject Study (SOS) in which more than 1700 patients successfully reduced their body weight by means of bariatric surgery has shown that the initial postsurgical blood pressure reduction was still present after 2 years, but was almost gone 10 years later [50]. In terms of adverse events, Klaus et al [45] gave an overview on possible risks in terms of a dietary salt reduction, suggesting that with a modest dietary salt restriction to 5-6 g/day, short episodes of severe diarrhea or longer episodes of vomiting are not likely to cause sodium deficiency. Even in geriatric patients and pregnant women, Klaus et al [45] deem the benefit as exceeding potential harm.…”

“…None of the RCTs included in the identified systematic reviews was powered to detect a potential benefit indicating that salt-reduced diet decreases unfavorable patient-relevant outcomes. Consequently, evidence for the assumption that salt restriction is associated with a tremendous reduction in cardiovascular outcomes as well, is only based on epidemiological observations [11,41,45]. In the recently published systematic review and meta-analysis of prospective studies published by Strazzullo et al in 2009 [11], including 19 independent cohort samples with more than 170 000 participants and a follow-up between 3.5 and 19 years, higher salt intake was associated with a significantly greater risk of stroke (pooled relative risk 1.23; 95% confidence interval 1.06-1.43; P ¼ 0.007) and a tendentially higher, though nonsignificant, risk of cardiovascular disease was observed (pooled relative risk 1.14, 95% confidence interval 0.99-1.32; P ¼ 0.07).…”

Diet quality among adolescents has deteriorated: a panel study in Niterói, Rio de Janeiro State, Brazil, 2003-2008

“…He et al 33 reported an association between soda consumption and increased sodium intake in this age group. Guidelines to restrict sodium intake are among the most important measures for primary prevention of cardiovascular disease 34 .…”