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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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Recommendations and remarks

Recommendations

  • WHO recommends an increase in potassium intake from food for reduction of blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults (strong recommendation1 ). WHO suggests a potassium intake of at least 90 mmol/day (3510 mg/day) for adults (conditional recommendation2).
  • WHO suggests an increase in potassium intake from food to control3 blood pressure in children (conditional recommendation). The recommended potassium intake of at least 90 mmol/day should be adjusted downward for children, based on the energy requirements of children relative to those of adults.

Remarks

  • For this recommendation, “adults” includes all individuals ≥16 years of age.
  • For this recommendation, “children” includes all individuals 2–15 years of age.
  • The recommendation for children does not address the recommended period of exclusive breastfeeding (0–6 months) or the period of complementary feeding with continued breastfeeding (6–24 months).
  • These recommendations apply to all individuals, with or without hypertension (including pregnant and lactating women) except for those with impaired urinary potassium excretion.
  • These recommendations do not address the optimal ratio of sodium to potassium; however, if this guideline and the WHO guideline on sodium consumption are achieved, the molar ratio of sodium to potassium would be approximately one to one. To maintain this molar ratio at higher levels of sodium consumption, the recommended level of intake of ≥90 mmol/day potassium should be increased.
  • These recommendations complement the WHO guideline on sodium consumption and should not be interpreted to replace or supersede that guideline. Public health interventions should aim to increase potassium intake through foods (Annex 2), and to simultaneously reduce sodium intake.
  • The recommended level of intake of ≥90 mmol/day is a conditional recommendation for adults because there is limited evidence regarding the precise level that will result in maximum health benefits. The recommendation is informed by moderate and high-quality evidence that consuming potassium at ≥90 mmol/day will provide a health benefit. However, the recommendation recognizes that the value may change if there are additional high-quality trials that determine the precise level of potassium intake that achieves the most favourable reduction in blood pressure and risk of cardiovascular disease, stroke and coronary heart disease, without a negative effect on other health outcomes such as blood lipids and catecholamine levels.
  • The recommendation to increase potassium intake in children is conditional, because few studies in children have considered the effects of increased potassium on blood pressure, blood lipids, catecholamine levels, and other possible adverse effects. The recommendation is based on a limited amount of low-quality direct evidence from children, and moderate-quality indirect evidence from adults. Because renal function is fully developed early in childhood, an adult population is an appropriate proxy population for informing guidelines for children. This recommendation recognizes that there is a need for high-quality RCTs, to verify the effects of potassium intake on blood pressure and potential adverse effects in children. An adjustment in intake, based on energy requirement, is recommended because the relatively high energy intake on a per body-weight basis during periods of rapid growth implies a risk that the recommended level of potassium intake could be too low if adjustments to the adult recommended value are made on a per body-weight basis. Every country should determine the requirement of various age categories of the paediatric population relative to adults 20–50 years of age, to adjust the recommended minimum intake value of 90 mmol/day. If country-specific data are not available, data from another country with similar population demographics and dietary habits can be used to make this adjustment.
  • These recommendations recognize that non-acclimated individuals engaged in intense physical activities (especially at high temperatures) for extended periods of time, resulting in the production of large volumes of sweat, should consume higher levels of potassium to replace potassium losses via sweat. For most individuals, sufficient potassium to replace such losses can be consumed through food, without the need for specially formulated food and beverage products.
  • It is recommended that potassium be consumed through food. Because of the safety of consumption of increased potassium via food, no upper limit has been considered.

Footnotes

1

A strong recommendation is one for which the guideline development group is confident that the desirable effects of adherence outweigh the undesirable effects. The recommendation can be either in favour of or against an intervention. Implications of a strong recommendation are as follows: for patients, most people in their situation would desire the recommended course of action, only a small proportion would not; for clinicians, most patients should receive the recommended course of action, and adherence to this recommendation is a reasonable measure of good-quality care; for policy-makers, the recommendation can be adopted as a policy in most situations.

2

A conditional recommendation is one for which the guideline development group concludes that the desirable effects of adherence probably outweigh the undesirable effects, but the group is not confident about the trade-off. The reason for not being confident could be the absence of high-quality evidence; the presence of imprecise estimates of benefit or harm; uncertainty or variation on how certain individuals will value the outcome; small benefits; and benefits that are not worth the costs (including the costs of implementing the recommendation). Implications of a conditional recommendation are as follows: for patients, most people in their situation would want the recommended course of action, but many would not; for clinicians, patients may need help to make a decision in relation to the recommendation that is consistent with their own values; for policy-makers, there is a need for debate and involvement of stakeholders in deciding whether to adopt the recommendation as policy.

3

“Control” for this recommendation refers to the prevention of a deleterious rise in blood pressure with age.

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: NBK132453

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