The role of dietary salt in metabolism and energy balance: Insights beyond cardiovascular disease

Abstract

Dietary salt (NaCl) is essential to an organism's survival. However, today's diets are dominated by excessive salt intake, which significantly impacts individual and population health. High salt intake is closely linked to cardiovascular disease (CVD), especially hypertension, through a number of well-studied mechanisms. Emerging evidence indicates that salt overconsumption may also be associated with metabolic disorders. In this review, we first summarize recent updates on the mechanisms of salt-induced CVD, the effects of salt reduction and the use of salt substitution as a therapy. Next, we focus on how high salt intake can impact metabolism and energy balance, describing the mechanisms through which this occurs, including leptin resistance, the overproduction of fructose and ghrelin, insulin resistance and altered hormonal factors. A further influence on metabolism worth noting is the reported role of salt in inducing thermogenesis and increasing body temperature, leading to an increase in energy expenditure. While this result could be viewed as a positive metabolic effect because it promotes a negative energy balance to combat obesity, caution must be taken with this frame of thinking given the deleterious consequences of chronic high salt intake on cardiovascular health. Nevertheless, this review highlights the importance of salt as a noncaloric nutrient in regulating whole-body energy homeostasis. Through this review, we hope to provide a scientific framework for future studies to systematically address the metabolic impacts of dietary salt and salt replacement treatments. In addition, we hope to form a foundation for future clinical trials to explore how these salt-induced metabolic changes impact obesity development and progression, and to elucidate the regulatory mechanisms that drive these changes, with the aim of developing novel therapeutics for obesity and CVD.

Reducing Dietary Sodium Intake among Young Adults in Ghana: A Call to Action

“…Current studies provide strong evidence supporting the correlation between sodium intake and blood pressure levels; they also indicate that excessive consumption of sodium is linked to various other negative health conditions, including metabolic, gastrointestinal, and bone disorders [22][23][24][25][26]. Research suggests that a high intake of sodium can disrupt metabolism through mechanisms such as leptin resistance, overproduction of fructose and ghrelin, and insulin resistance [23].…”

“…Current studies provide strong evidence supporting the correlation between sodium intake and blood pressure levels; they also indicate that excessive consumption of sodium is linked to various other negative health conditions, including metabolic, gastrointestinal, and bone disorders [ 22 , 23 , 24 , 25 , 26 ]. Research suggests that a high intake of sodium can disrupt metabolism through mechanisms such as leptin resistance, overproduction of fructose and ghrelin, and insulin resistance [ 23 ]. In a cohort study conducted by Takase et al [ 24 , 25 ], it was observed that increased salt intake correlated with a higher number of metabolic disorders and an elevated risk of developing metabolic syndrome.…”

Recent Advances in Understanding Peripheral and Gut Immune Cell-Mediated Salt-Sensitive Hypertension and Nephropathy

“…In the last 20 years, attention has increasingly been paid to the role of innate immune cells and their proinflammatory responses in salt-sensitive hypertension. 51,52 As previously reviewed, 53,54 innate and adaptive immunometabolism has been found to be impacted by sodium intake. Immunometabolism involves understanding of how the metabolic processes within immune cells influence their function and how immune responses, in turn, impact cellular metabolism.…”

“…55 Various studies have linked salt intake with energy balance and regulation of other hormones. 54 Studies on immunometabolism have primarily focused on TH17 cells and T regulatory cells, which rely on the SGK1 (Serum/ Glucocorticoid Regulated Kinase 1)-FOXO1 (Forkhead box protein O1) axis, thus increasing susceptibility to autoimmune diseases. [56][57][58] Macrophage metabolism and homeostasis have also been shown to be impacted by sodium via mitochondrial-dependent pathways.…”

Reducing Dietary Sodium and Improving Human Health 2.0

“…A higher intake of sodium may lead to other conditions beyond CVD, targeting several organ systems (e.g., the kidney, brain, bone, gastrointestinal tract, immune system, as reviewed by Vinitha et al [27]), or inducing metabolic changes that may impact the gut microbiome [28], energy balance, and obesity development (reviewed by Wu et al [29]).…”