Excess sodium linked to 1.65 million CV-related deaths in 2010
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Dietary sodium intake in excess of 2 g per day, as recommended by the WHO, was associated with 1.65 million deaths due to CV-related causes in 2010, according to a new report.
Researchers evaluated data collected from prior surveys of sodium consumption, as indicated by urinary excretion and/or estimated dietary intake, from March 2008 to December 2011. The analysis included data from 205 surveys conducted in 66 countries, including 142 that incorporated 24-hour urine collection, 91 that included dietary intake estimations and 28 that utilized both data types. The resulting dataset accounted for 74.1% of adults worldwide. The researchers also performed a meta-analysis of data from 107 randomized interventions that evaluated the impact of reduced sodium intake on BP.
According to the researchers’ estimates, the mean consumption of sodium worldwide was 3.95 g per day in 2010. Consumption ranged according to region, from 2.18 g to 5.51 g per day. Nearly all of 187 evaluated countries — representing 99.2% of the world’s adult population — exceeded the WHO-recommended 2 g per day of sodium intake and 119 countries exceeded the recommendation by more than 1 g per day.
The researchers observed a linear dose-response relationship between reduction in sodium intake and BP (P<.001). Inverse-variance weighted meta-regression indicated a 3.82-mm Hg reduction in BP for every 2.3-g reduction in daily sodium intake. The impact of sodium was more pronounced among older adults vs. younger adults, black adults vs. white adults and those with hypertension vs. those without. A similar dose-response relationship was observed between BP and CV-related mortality.
Using 2 ± 0.2 g sodium per day as a reference level, the researchers estimated that approximately 1.65 million CV-related deaths worldwide, or one of every 10 CV-related deaths, were attributable to excess sodium consumption in 2010. This estimate included 687,000 cases of CHD, 685,000 strokes and 276,000 other issues related to CVD. Forty percent of the deaths occurred in people aged younger than 70 years.
Dariush Mozaffarian
While the researchers acknowledged that this analysis does not prove that a reduction in CV-related mortality would follow from sodium intake restriction, they noted that this research may have underestimated the impact of dietary sodium due to a focus on CV mortality, as opposed to nonfatal CVD, kidney disease and gastric cancer, all of which have been linked to sodium intake.
“Some researchers have argued that it may not be possible to directly extrapolate the effects of sodium on BP to CV risk,” Dariush Mozaffarian, MD, DrPH, from the Friedman School of Nutrition Science and Policy, Tufts University, and colleagues wrote. “However, the effect on CVD is supported by extensive experimental and ecologic evidence, data on CV events from some trials of reduced sodium intake and evidence of the CV benefits of BP-lowering across multiple interventions.”
Disclosure: See the full study for a list of relevant financial disclosures.