Recommendations

• WHO recommends a reduction in sodium intake to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults (strong recommendation¹). WHO recommends a reduction to <2 g/day sodium (5 g/day salt) in adults (strong recommendation).
• WHO recommends a reduction in sodium intake to control² blood pressure in children (strong recommendation). The recommended maximum level of intake of 2 g/day sodium in adults should be adjusted downward based on the energy requirements of children relative to those of adults.

Remarks

• These recommendations apply to all individuals, with or without hypertension (including pregnant or lactating women), except for individuals with illnesses or taking drug therapy that may lead to hyponatraemia or acute build-up of body water, or require physician-supervised diets (e.g. patients with heart failure and those with type I diabetes). In these subpopulations, there may be a particular relationship between sodium intake and the health outcomes of interest (10, 11). Hence, these subpopulations were not considered in the review of the evidence and generation of the guideline.
• For this recommendation, “adults” includes individuals ≥16 years of age.
• For this recommendation, “children” includes individuals 2–15 years of age inclusive.
• 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 were based on the totality of evidence regarding the relationship between sodium intake and blood pressure, all-cause mortality, cardiovascular disease, stroke and coronary heart disease, as well as potential adverse effects on blood lipids, catecholamine levels and renal function. The evidence regarding the relationship between sodium intake and blood pressure was of high quality, whereas the evidence regarding sodium intake and all-cause mortality, cardiovascular disease, stroke and coronary heart disease was of lower quality. Therefore, these recommendations should be reviewed when more evidence on the relationship between sodium intake and all-cause mortality and cardiovascular disease outcomes becomes available.
• These recommendations recognize that salt reduction and salt iodization are compatible. Monitoring of salt intake and salt iodization at country level is needed so that salt iodization can be adjusted over time, depending on observed salt intake in the population, so that individuals consuming the recommended amount of sodium will continue to consume sufficient iodine.
• These recommendations complement the WHO guideline on potassium consumption and should not be interpreted to replace or supersede that guideline. Public health interventions should aim to reduce sodium intake and simultaneously increase potassium intake through foods.
• These recommendations do not address the optimal sodium to potassium ratio; however, if this guideline and the WHO guideline on potassium intake are achieved, the molar ratio of sodium to potassium would be approximately one to one.
• The recommended intake level in children is lower than that of adults when children’s energy requirements are less than adults. The adjustment of recommended sodium intake based on energy requirements is recommended because of the positive association between energy requirements and sodium intake. Each country should determine the energy requirements of various age categories of the paediatric population relative to adults approximately 20–50 years of age, to lower the recommended maximum intake value of 2 g/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.

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

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