Dietary Reference Intakes for Sodium and Potassium

As essential nutrients, sodium and potassium contribute to the fundamentals of physiology and pathology of human health and disease. In clinical settings, these are two important blood electrolytes, are frequently measured and influence care decisions. Yet, blood electrolyte concentrations are usually not influenced by dietary intake, as kidney and hormone systems carefully regulate blood values. Over the years, increasing evidence suggests that sodium and potassium intake patterns of children and adults influence long-term population health mostly through complex relationships among dietary intake, blood pressure and cardiovascular health. The public health importance of understanding these relationships, based upon the best available evidence and establishing recommendations to support the development of population clinical practice guidelines and medical care of patients is clear. This report reviews evidence on the relationship between sodium and potassium intakes and indicators of adequacy, toxicity, and chronic disease. It updates the Dietary Reference Intakes (DRIs) using an expanded DRI model that includes consideration of chronic disease endpoints, and outlines research gaps to address the uncertainties identified in the process of deriving the reference values and evaluating public health implications.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE TO REVIEW THE DIETARY REFERENCE INTAKES FOR SODIUM AND POTASSIUM
• Reviewers
• Preface
• Summary
  • THE COMMITTEE'S TASK AND APPROACH
  • DIETARY REFERENCE INTAKES FOR POTASSIUM
  • DIETARY REFERENCE INTAKES FOR SODIUM
  • RESEARCH NEEDS AND FUTURE DIRECTIONS
• Part I
  • 1. Introduction
    • STUDY OVERVIEW AND STATEMENT OF TASK
    • DESIGN AND APPROACH TO THE STUDY
    • ORGANIZATION OF THIS REPORT
    • REFERENCES
  • 2. Applying the Guiding Principles Report
    • BACKGROUND
    • THE COMMITTEE'S INTERPRETATION OF THE GUIDING PRINCIPLES REPORT
    • THE CHRONIC DISEASE RISK REDUCTION INTAKE IN CONTEXT OF THE OTHER DRI CATEGORIES
    • SUMMARY
    • REFERENCES
  • 3. Methodological Considerations
    • RELEVANT BIOLOGICAL ROLES OF POTASSIUM AND SODIUM
    • METHODS FOR ESTIMATING POTASSIUM AND SODIUM INTAKE
    • INTERACTIONS OF POTASSIUM AND SODIUM
    • EVIDENCE ON SUBPOPULATIONS
    • SUMMARY
    • REFERENCES
• Part II
  • 4. Potassium: Dietary Reference Intakes for Adequacy
    • POTASSIUM ADEQUATE INTAKE LEVELS ESTABLISHED IN THE 2005 DRI REPORT
    • REVIEW OF POTENTIAL INDICATOR OF POTASSIUM ADEQUACY
    • DIETARY REFERENCE INTAKES OF POTASSIUM ADEQUACY
    • SUMMARY OF UPDATED POTASSIUM ADEQUATE INTAKE VALUES
  • 5. Potassium: Dietary Reference Intakes for Toxicity
    • POTASSIUM TOLERABLE UPPER INTAKE LEVELS IN THE 2005 DRI REPORT
    • REVIEW OF POTENTIAL INDICATORS OF TOXICOLOGICAL ADVERSE EFFECTS OF EXCESSIVE POTASSIUM INTAKE
    • THE COMMITTEE'S CONCLUSION REGARDING THE TOLERABLE UPPER INTAKE LEVEL FOR POTASSIUM
    • REFERENCES
  • 6. Potassium: Dietary Reference Intakes Based on Chronic Disease
    • REVIEW OF CHRONIC DISEASE INDICATORS
    • THE COMMITTEE'S CONCLUSION REGARDING CHRONIC DISEASE RISK REDUCTION INTAKES FOR POTASSIUM
    • REFERENCES
  • 7. Potassium Dietary Reference Intakes: Risk Characterization and Special Considerations for Public Health
    • RISK CHARACTERIZATION BASED ON POTASSIUM INTAKE LEVELS IN THE U.S. AND CANADIAN POPULATIONS
    • SOURCES OF POTASSIUM IN THE DIET
    • PUBLIC HEALTH IMPLICATIONS AND SPECIAL CONSIDERATIONS
    • REFERENCES
• Part III
  • 8. Sodium: Dietary Reference Intakes for Adequacy
    • SODIUM ADEQUATE INTAKE LEVELS ESTABLISHED IN THE 2005 DRI REPORT
    • REVIEW OF POTENTIAL INDICATORS OF SODIUM ADEQUACY
    • ADDITIONAL EVIDENCE CONSIDERED: POTENTIAL HARMFUL HEALTH EFFECTS OF LOW SODIUM INTAKES
    • DIETARY REFERENCE INTAKES OF SODIUM ADEQUACY
    • SUMMARY OF UPDATED SODIUM ADEQUATE INTAKE VALUES
    • REFERENCES
  • 9. Sodium: Dietary Reference Intakes for Toxicity
    • SODIUM TOLERABLE UPPER INTAKE LEVELS ESTABLISHED IN THE 2005 DRI REPORT
    • REVIEW OF POTENTIAL INDICATORS OF TOXICOLOGICAL ADVERSE EFFECTS OF EXCESSIVE SODIUM INTAKE
    • THE COMMITTEE'S CONCLUSION REGARDING THE TOLERABLE UPPER INTAKE LEVELS FOR SODIUM
    • REFERENCES
  • 10. Sodium: Dietary Reference Intakes Based on Chronic Disease
    • REVIEW AND SELECTION OF CHRONIC DISEASE INDICATORS
    • ASSESSMENT OF INTAKE–RESPONSE FOR CHRONIC DISEASE INDICATORS
    • CHRONIC DISEASE RISK REDUCTION INTAKES FOR SODIUM
    • SUMMARY
    • REFERENCES
    • References in Figures
    • ANNEX 10-1 INDICATORS REVIEWED BUT NOT SELECTED
    • ANNEX 10-1 REFERENCES
    • ANNEX 10-2 EVALUATION OF BLOOD PRESSURE AS A SURROGATE MARKER OF HYPERTENSION AND CARDIOVASCULAR DISEASE FOR SODIUM INTAKE INTERVENTIONS
    • ANNEX 10-2 REFERENCES
  • 11. Sodium Dietary Reference Intakes: Risk Characterization and Special Considerations for Public Health
    • RISK CHARACTERIZATION BASED ON SODIUM INTAKE LEVELS IN THE U.S. AND CANADIAN POPULATIONS
    • THE ROLE OF SODIUM IN THE FOOD SUPPLY AND SOURCES OF SODIUM IN THE DIET
    • PUBLIC HEALTH IMPLICATIONS AND SPECIAL CONSIDERATIONS
    • REFERENCES
• Part IV
  • 12. Knowledge Gaps and Future Directions
    • KNOWLEDGE GAPS AND RESEARCH NEEDS
    • OPPORTUNITIES TO ENHANCE THE DRI PROCESS
    • CONCLUDING REMARKS
    • REFERENCES
• Appendix A. Acronyms and Abbreviations
• Appendix B. Open Session Agendas
• Appendix C. Committee's Assessment of the Agency for Healthcare Research and Quality Systematic Review
• Appendix D. Indicators Not Relevant for Establishing Dietary Reference Intake Values
• Appendix E. Supplemental Literature Searches
• Appendix F. Estimates of Potassium and Sodium Intakes from Breast Milk and Complementary Foods
• Appendix G. Sources of Evidence for Potassium and Sodium Intake Distributions
• Appendix H. Supplemental Risk Characterization Figures
• Appendix I. Committee Member Biographical Sketches
• Appendix J. Dietary Reference Intakes Summary Tables

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2019. Dietary Reference Intakes for sodium and potassium. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25353.

Digital Object Identifier: https://doi.org/10.17226/25353

Library of Congress Control Number: 2019940942

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Printed in the United States of America