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Am J Hypertens. 2014 Sep;27(9):1129-37. doi: 10.1093/ajh/hpu028. Epub 2014 Mar 20.

Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis.

Author information

1
Department of Rheumatology IR4242, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. graudal@dadlnet.dk.
2
Department of Clinical Pharmacology, Bispebjerg University Hospital, Copenhagen Denmark.
3
Department of Rheumatology IR4242, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
4
Albert Einstein College of Medicine, New York.

Abstract

BACKGROUND:

The effect of sodium intake on population health remains controversial. The objective was to investigate the incidence of all-cause mortality (ACM) and cardiovascular disease events (CVDEs) in populations exposed to dietary intakes of low sodium (<115 mmol), usual sodium (low usual sodium: 115-165 mmol; high usual sodium: 166-215 mmol), and high sodium (>215 mmol).

METHODS:

The relationship between individual measures of dietary sodium intake vs. outcome in cohort studies and randomized controlled trials (RCTs) measured as hazard ratios (HRs) were integrated in meta-analyses.

RESULTS:

No RCTs in healthy population samples were identified. Data from 23 cohort studies and 2 follow-up studies of RCTs (n = 274,683) showed that the risks of ACM and CVDEs were decreased in usual sodium vs. low sodium intake (ACM: HR = 0.91, 95% confidence interval (CI) = 0.82-0.99; CVDEs: HR = 0.90, 95% CI = 0.82-0.99) and increased in high sodium vs. usual sodium intake (ACM: HR = 1.16, 95% CI = 1.03-1.30; CVDEs: HR = 1.12, 95% CI = 1.02-1.24). In population representative samples adjusted for multiple confounders, the HR for ACM was consistently decreased in usual sodium vs. low sodium intake (HR = 0.86; 95% CI = 0.81-0.92), but not increased in high sodium vs. usual sodium intake (HR = 1.04; 95% CI = 0.91-1.18). Within the usual sodium intake range, the number of events was stable (high usual sodium vs. low usual sodium: HR = 0.98; 95% CI = 0.92-1.03).

CONCLUSIONS:

Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes.

KEYWORDS:

blood pressure; cardiovascular disease; diet; hypertension; meta-analysis; mortality; salt; sodium chloride; stroke.

PMID:
24651634
DOI:
10.1093/ajh/hpu028
[Indexed for MEDLINE]
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