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Guideline: Potassium Intake for Adults and Children. Geneva: World Health Organization; 2012.

Cover of Guideline: Potassium Intake for Adults and Children

Guideline: Potassium Intake for Adults and Children.

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Introduction

Scope and purpose

The objective of this guideline is to provide recommendations on the consumption of potassium for adults and children. It is important to establish nutrient guidelines so that nutrition interventions can be developed in a logical, systematic, and scientific manner taking into account the best available evidence. The recommendations in this guideline can be used by programme and policy planners to assess current potassium intake levels relative to a benchmark and develop measures to increase potassium intake, where necessary, through public health interventions including, but not limited to, food and product labelling, consumer education, and the establishment of Food-Based Dietary Guidelines (FBDG). This guideline does not provide guidance on specific food intake because such dietary guidelines should be based on the overall dietary goals, which take into consideration all required nutrients. It should be used in conjunction with the guideline on sodium intake and other nutrient guidelines to guide public health nutrition programme and policy development.

This guideline provides a global, evidence-informed recommendation on potassium intake for:

  • adults (≥16 years of age) for the reduction of blood pressure and risk of cardiovascular disease, stroke and coronary heart disease;
  • children (2–15 years of age) for the control of blood pressure.

It does not provide recommendations for individuals with impaired urinary potassium excretion from a medical condition or drug therapy.

The guideline will help Member States and their partners to make informed decisions on appropriate nutrition actions to reduce noncommunicable diseases (NCDs). It is intended for a wide audience, including policy-makers and their expert advisers, and technical and programme staff in organizations involved in the design, implementation and scaling-up of nutrition actions for public health.

This document presents the key recommendations and a summary of the supporting evidence. Further details of the evidence base are provided in Annex 1 and other documents listed in the references.

Background

NCDs are the leading cause of death globally, killing more people each year than all other causes combined (14). The major NCDs currently account for approximately 60% of all deaths and 43% of disease burden globally, and these levels are expected to continue to rise (2, 15). In 2008, 29 million NCD-related deaths (almost 80%) occurred in low and middle-income countries. In those countries, 29% of NCD-related deaths were in people under 60 years of age; in contrast, in high-income countries, only 13% of the NCD-related deaths were premature. In 2005, cardiovascular disease alone accounted for 30% of all deaths; the equivalent of infectious disease, nutritional deficiency, and maternal and perinatal conditions combined (2).

Hypertension is considered a major risk factor for cardiovascular diseases, particularly coronary heart disease and stroke. Suboptimal systolic blood pressure (>115 mmHg) is estimated to contribute to 49% of all coronary heart disease and 62% of all stroke (12). Thus, the burden of morbidity and mortality from hypertension and related NCDs is currently one of the most urgent public health problems globally. Although NCDs disproportionately affect adults, they and their risk factors are now being detected more frequently in paediatric populations. Diet-related NCDs are chronic, and take years or decades to manifest; delaying the onset of these diseases could improve lives and result in substantial cost savings (13). Blood pressure during childhood has a significant association with blood pressure during adulthood, meaning that children with increased blood pressure are at high risk for hypertension and its related morbidities as adults (16). Additionally, elevated blood pressure in childhood contributes to cardiovascular disease pathology during childhood itself (17). Thus, addressing during childhood the problem of elevated blood pressure and other risk factors for NCDs that could manifest later in life is crucial to combat NCDs.

Potassium is an essential nutrient needed for maintenance of total body fluid volume, acid and electrolyte balance, and normal cell function (18). Normally, most ingested potassium is excreted via the urine. Under conditions of extreme heat and intense physical activity that result in a high sweat production, potassium losses in sweat are increased and appreciable. However, acclimation occurs rapidly, and potassium losses via sweat are reduced quickly. Thus, most individuals can replace needed potassium through food consumption without the need for supplements or specially formulated products (19-21). Potassium is commonly found in a variety of unrefined foods, especially fruits and vegetables. Food processing reduces the amount of potassium in many food products, and a diet high in processed foods and low in fresh fruits and vegetables is often lacking in potassium (22). Data from around the world suggest that the population average potassium consumption in many countries is below 70–80mmol/day, the value recommended by the 2002 Joint World Health Organization/Food and Agriculture Organization of the United Nations (WHO/FAO) Expert Consultation (8). Few countries report an average consumption of 90 mmol/ day, which is recommended in countries such as Belgium, Mexico, Spain and the United Kingdom of Great Britain and Northern Ireland (23-26). No countries report an average population consumption of 120 mmol/day, which is recommended in countries such as Bulgaria, Canada, the Republic of Korea and the United States of America (USA) (9, 10, 27-29). Women consistently have lower levels of potassium intake than men, but both groups commonly consume a level that is below current recommendations.

Reduced potassium consumption has been associated with hypertension and cardiovascular diseases, and appropriate consumption levels could be protective against these conditions (8). A recent meta-analysis including 11 cohort studies reported an inverse association between potassium intake and risk of stroke (30). Additionally, two meta-analyses of trials comparing increased potassium to lower potassium intake found that increased potassium intake lowers blood pressure (4, 31). These results were further supported by a systematic review without a meta-analysis, which concluded that increased potassium intake results in decreased blood pressure in adults (3). Thus, a public health intervention aimed at increasing potassium intake from food could be a cost-effective strategy to reduce the burden of NCD morbidity and mortality. Moreover, increasing potassium consumption from food in the population is safe; in individuals without renal impairment caused by medical conditions or drug therapy, the body is able to efficiently adapt and excrete excess potassium via the urine when consumption exceeds needs (18, 32, 33). Intervention trials including potassium consumption as high as 400 mmol/day from food for several weeks and 115 mmol/day for up to a year have not reported any adverse effects (32, 33). There have been some isolated reports of acute toxicity from extremely high potassium intake in supplement form (34), but no reports of toxicity of potassium from consumption in food.

The function of potassium in the body is closely related to that of sodium (18, 35). As sodium consumption rises, increased consumption of potassium may be even more beneficial because, in addition to other benefits, it can mitigate the negative effects of elevated sodium consumption on blood pressure (4). Some studies have reported that the ratio of the two nutrients is an important factor in cardiovascular disease and mortality (36, 37). Additionally, there is evidence from randomized controlled trials (RCTs) that a combination of increased potassium and decreased sodium intake can be effective in reducing blood pressure, cardiovascular mortality and medical expenses (38, 39).

Justification

Much of the human and social impact caused each year by NCD-related morbidity and mortality could be averted through interventions that are well understood, cost effective and feasible (14). As explained above, there is no evidence of adverse effects from increased potassium intake from foods in individuals with unimpaired potassium excretion, and increased potassium intake has been associated with reduced blood pressure and cardiovascular disease outcomes in cohort and intervention trials. Hence, intervening to increase dietary potassium consumption could make a positive change to blood pressure and cardiovascular outcomes. Most populations around the world consume sodium at levels far exceeding physiological needs and current recommendations (40); therefore, public health interventions to combat NCDs and their risk factors should be informed by guidance on potassium consumption, combined with reduced sodium consumption. Although the evidence for the safety of potassium intake from food is not disputed, there are some inconsistencies in the literature about the potential beneficial effect of increased potassium on blood pressure and cardiovascular outcomes. One meta-analysis of studies of individuals with hypertension reported no significant effect of increased potassium intake on blood pressure (41). Therefore, a systematic evaluation of all available epidemiological evidence to inform the generation of this guideline was warranted.

Considering this background, the 32nd Session of the Codex Committee on Nutrition and Food for Special Dietary Uses (held in Santiago, the Republic of Chile on 1–5 November 2010) made a special request to WHO to consider establishing a guideline for daily potassium intake for adults and children. Member States also requested WHO to develop a guideline on potassium intake to inform public policy. Therefore, the WHO Department of Nutrition for Health and Development, in collaboration with other departments of WHO Headquarters and regional offices, developed the following guideline on potassium consumption for adults and children.

Copyright © 2012, World Health Organization.

All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob).

Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html).

Bookshelf ID: NBK132451

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