Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population
Abstract
Objective High sodium intake increases the risk of cardiovascular diseases and may also be associated with higher rates of stomach cancer, asthma disorders and infections. In Finland, cross-sectional population surveys to monitor cardiovascular risk factors have been carried out since the 1970s. The main aim of this paper is to present trends in urinary sodium and potassium excretion from 1979 to 2002.Design Cross-sectional population surveys on cardiovascular risk factors.Setting Surveys were carried out in Finland in 1979, 1982, 1987 and 2002 in four geographical areas: North Karelia, the Kuopio area, Southwestern Finland and the Helsinki area.Subjects For each survey a random sample stratified by age and sex was drawn from the population register. In this analysis, participants of urine collection subsamples aged 25-64 years (n = 4648) were included.Interventions A 24-h urinary collection was carried out in subsamples (n = 2218-2487) in connection with population risk factor surveys. Urinary sodium and potassium concentrations were analyzed in the same laboratory throughout, using a flame photometer in 1979, 1982 and 1987 and an ion-selective electrode in 2002.Results Between 1979 and 2002 urinary sodium excretion in Finland decreased from over 220 to less than 170 mmol/day among men and from nearly 180 to less than 130 mmol/day among women. Although potassium excretion decreased somewhat as well, the decrease in sodium-potassium molar ratio was also significant.Conclusions The 24-h urinary sodium excretion in Finland has decreased significantly during the last 20 years. However, excretion levels are still considerably higher than recommendations. A further decrease in sodium intake remains a goal for the Finnish food industry and consumers.Sponsorship All surveys were funded by the National Public Health Institute in Finland.
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The lowest mean intake level associated with both lower systolic blood pressure and lower age-blood-pressure slope in ecologic studies was 614 mg/d.
“The lowest mean intake level associated with both lower systolic BP and lower age-BP slope in ecologic studies was 614 mg/d.37”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [37]
A mean sodium intake of 614 mg/d is associated with lower systolic BP and lower age-BP slopes in ecologic studies.
“614 mg/d * Lower systolic BP and lower age-BP slopes in ecologic studies 37”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [37]
Cites
Cancer Incidence in Five Continents
Doll, R., Muir, C. S., & Waterhouse, J. A. H. (1970) · Springer eBooks · doi:10.1007/978-3-642-85851-2 · Cited by 8,485 · see citing works
Cancer Incidence in Five Continents
(1966) · doi:10.1007/978-3-642-85849-9 · Cited by 5,936 · see citing works
Sacks, F. M., Svetkey, L. P., Vollmer, W. M., Appel, L. J., Bray, G. A., Harsha, D., Obarzanek, E., Conlin, P. R., Miller, E. R., Simons-Morton, D. G., et al. (2001) · New England Journal of Medicine · doi:10.1056/nejm200101043440101 · Cited by 5,638 · see citing works
Diet, nutrition and the prevention of chronic diseases
Joint, W. (2002) · Medical Entomology and Zoology · Cited by 4,889 · see citing works
Diet, Nutrition, and the Prevention of Chronic Diseases
Zimmermann, M. B. (1994) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/60.4.644a · Cited by 2,137 · see citing works
CORONARY HEART DISEASE IN SEVEN COUNTRIES
(1971) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.1971.tb50629.x · Cited by 1,842 · see citing works
He, F. J., & MacGregor, G. A. (2002) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001459 · Cited by 810 · see citing works
Coronary Heart Disease in Seven Countries.
(1971) · Annals of Internal Medicine · doi:10.7326/0003-4819-74-6-1026_8 · Cited by 758 · see citing works
Nordic Nutrition Recommendations 2012
(2008) · Nord · doi:10.6027/nord2014-002 · Cited by 629 · see citing works
The Effect of Weight Loss on the Sensitivity of Blood Pressure to Sodium in Obese Adolescents
Rocchini, A. P., Key, J., Bondie, D., Chico, R., Moorehead, C., Katch, V., & Martin, M. (1989) · New England Journal of Medicine · doi:10.1056/nejm198908313210905 · Cited by 621 · see citing works
Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study
Tuomilehto, J. O., Jousilahti, P., Rastenytė, D., Moltchanov, V., Tanskanen, A. J., Pietinen, P., & Nissinen, A. M. (2001) · The Lancet · doi:10.1016/s0140-6736(00)04199-4 · Cited by 592 · see citing works
Self-citationEffect of Reduced Dietary Sodium on Blood Pressure
Midgley, J. (1996) · JAMA · doi:10.1001/jama.1996.03530440070039 · Cited by 544 · see citing works
Randomized trials of sodium reduction: an overview
Cutler, J., Follmann, D. A., & Allender, P. (1997) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/65.2.643s · Cited by 523 · see citing works
Dietary Sodium Intake and Subsequent Risk of Cardiovascular Disease in Overweight Adults
He, J. (1999) · JAMA · doi:10.1001/jama.282.21.2027 · Cited by 503 · see citing works
Graudal, N. A., Galloe, A. M., & Garred, P. (1998) · JAMA · doi:10.1001/jama.279.17.1383 · Cited by 486 · see citing works
Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland
Vartiainen, E. A., Puska, P., Pekkanen, J., Toumilehto, J., & Jousilahti, P. (1994) · BMJ · doi:10.1136/bmj.309.6946.23 · Cited by 438 · see citing works
Cardiovascular risk factor changes in Finland, 1972–1997
Vartiainen, E. A., Jousilahti, P., Alfthan, G., Sundvall, J., Pietinen, P., & Puska, P. (2000) · International Journal of Epidemiology · doi:10.1093/ije/29.1.49 · Cited by 401 · see citing works
Self-citationDietary Salt, Nitrate and Stomach Cancer Mortality in 24 Countries
Joossens, J. V., Hill, M. J., Elliott, P., Stamler, R., Stamler, J., Lesaffre, E. M. E. H., DYER, A., Nichols, R., & Kesteloot, H. (1996) · International Journal of Epidemiology · doi:10.1093/ije/25.3.494 · Cited by 357 · see citing works
Dietary sodium intake and mortality: the National Health and Nutrition Examination Survey (NHANES I)
Alderman, M. H., Cohen, H. W., & Madhavan, S. (1998) · The Lancet · doi:10.1016/s0140-6736(97)09092-2 · Cited by 347 · see citing works
Alderman, M. H., Madhavan, S., Cohen, H. W., Sealey, J. E., & Laragh, J. H. (1995) · Hypertension · doi:10.1161/01.hyp.25.6.1144 · Cited by 292 · see citing works
Sodium Intake and Risk of Death From Stroke in Japanese Men and Women
Nagata, C., Takatsuka, N., Shimizu, N., & Shimizu, H. (2004) · Stroke · doi:10.1161/01.str.0000130425.50441.b0 · Cited by 268 · see citing works
The North Karelia project : 20 year results and experiences
Puska, P., Tuomilehto, J., Nissinen, A. M., & Vartiainen, E. A. (1995) · Cited by 221 · see citing works
Self-citationSalt intake and stroke: a possible direct effect.
Perry, I. J., & Beevers, D. G. (1992) · PubMed · Cited by 207 · see citing works
Changes in Diet in Finland from 1972 to 1992: Impact on Coronary Heart Disease Risk
Pietinen, P., Vartiainen, E. A., Seppänen, R., Aro, A., & Puska, P. (1996) · Preventive Medicine · doi:10.1006/pmed.1996.0053 · Cited by 196 · see citing works
Self-citationPressure-independent contribution of sodium to large artery structure and function in hypertension
Safar, M. E. (2000) · Cardiovascular Research · doi:10.1016/s0008-6363(99)00426-5 · Cited by 178 · see citing works
Harmful effects of dietary salt in addition to hypertension
de Wardener, H. E., & MacGregor, G. A. (2002) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001374 · Cited by 176 · see citing works
Khaw, K., Bingham, S. A., Welch, A. A., Luben, R., O'Brien, E. T., Wareham, N. J., & Day, N. (2004) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/80.5.1397 · Cited by 156 · see citing works
Blood pressure levels in the 41 populations of the WHO MONICA Project
Hk, W., Tuomilehto, J. O., Kuulasmaa, K., Domarkiene, S., Čepaitis, Ž., Molarius, A., Sans, S., Dobson, A. J., Keil, U., & Rywik, S. L. (1997) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1000531 · Cited by 149 · see citing works
Self-citationReference Values for Analytes of 24-H Urine Collections Known to Be Complete
Bingham, S. A., Williams, R., Cole, T. J., et al. (1988) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1177/000456328802500603 · Cited by 138 · see citing works
Schmieder, R. E., & Messerli, F. H. (2000) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001044 · Cited by 114 · see citing works
Reinivuo, H., Valsta, L. M., Laatikainen, T. K., Tuomilehto, J. O., & Pietinen, P. (2006) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1602431 · Cited by 111 · see citing works
Self-citationTrends in blood pressure levels and control of hypertension in Finland from 1982 to 1997
Kastarinen, M. J., Salomaa, V. V., Vartiainen, E. A., et al. (1998) · Journal of Hypertension · doi:10.1097/00004872-199816090-00019 · Cited by 101 · see citing works
Non-pharmacological treatment of hypertension in primary health care
Kastarinen, M. J., Puska, P., Korhonen, M. J., Mustonen, J. N., Salomaa, V. V., Sundvall, J., Tuomilehto, J. O., Uusitupa, M. I. J., & Nissinen, A. M. (2002) · Journal of Hypertension · doi:10.1097/00004872-200212000-00031 · Cited by 86 · see citing works
Self-citationBlood pressure and its correlates in an African tribe in urban and rural environments.
Poulter, N., Khaw, K., Hopwood, B. E., et al. (1984) · Journal of Epidemiology & Community Health · doi:10.1136/jech.38.3.181 · Cited by 67 · see citing works
Community-based prevention of hypertension in North Karelia, Finland.
Tuomilehto, J., Puska, P., Nissinen, A. M., Jt, S., Tanskanen, A. J., Pietinen, P., & Wolf, E. (1984) · PubMed · Cited by 46 · see citing works
Self-citationPopulation Study of Blood Pressure and Associated Factors in St Lucia, West Indies
Khaw, K., & Rose, G. (1982) · International Journal of Epidemiology · doi:10.1093/ije/11.4.372 · Cited by 45 · see citing works
Ovesen, L., Boeing, H., & for the EFCOSUM Group (2002) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1601424 · Cited by 42 · see citing works
Experimental evidence for blood pressure-independent vascular effects of high sodium diet
Simon, G. H. (2003) · American Journal of Hypertension · doi:10.1016/j.amjhyper.2003.07.019 · Cited by 37 · see citing works
Community control of hypertension— experiences from Finland
Nissinen, A. M., Kastarinen, M. J., & Tuomilehto, J. O. (2004) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001696 · Cited by 33 · see citing works
Self-citationPotentiometric analysis for sodium and potassium in biological fluids.
Langhoff, E., & Steiness, I. (1982) · Clinical Chemistry · doi:10.1093/clinchem/28.1.170 · Cited by 29 · see citing works
Sodium Excretion and Blood Pressure of West and East Finns
Karvonen, M. J., & Punsar, S. (1977) · Acta Medica Scandinavica · doi:10.1111/j.0954-6820.1977.tb16872.x · Cited by 24 · see citing works
Tuomilehto, J., Karppanen, H., Tanskanen, A. J., et al. (1980) · Journal of Epidemiology & Community Health · doi:10.1136/jech.34.3.174 · Cited by 22 · see citing works
Self-citationKhaw, K., & Barrett-Connor, E. L. (1990) · American Journal of Hypertension · doi:10.1093/ajh/3.6.505 · Cited by 21 · see citing works
Labelling salt in food: if yes, how?
Sharp, D. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17564-8 · Cited by 20 · see citing works
Salt sensitivity in experimental animals and man.
Altschul, A. M., AYERS, W., Grommet, J. K., et al. (1981) · PubMed · Cited by 7 · see citing works
Twenty-four hour ambulatory blood pressure monitoring: what is the reference?
Rascher, W. (1998) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1000736 · Cited by 4 · see citing works
Nissinen, A., Pietinen, P., Tuomilehto, J., Tanskanen, A. J., Moisio, S., & Puska, P. (1982) · STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) · Cited by 3 · see citing works
Self-citation
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Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association
Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000659 · Cited by 9,036 · see citing works
Heart disease and stroke statistics-2018 update: a report from the american heart association
Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000558 · Cited by 7,146 · see citing works
A Framework for Public Health Action: The Health Impact Pyramid
Frieden, T. R. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.185652 · Cited by 1,535 · see citing works
Global Sodium Consumption and Death from Cardiovascular Causes
Mozaffarian, D., Fahimi, S., Singh, G. M., Micha, R., Khatibzadeh, S., Engell, R. E., Lim, S., Danaei, G., Ezzati, M., & Powles, J. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1304127 · Cited by 1,218 · see citing works
Salt intakes around the world: implications for public health
Brown, I. J., Tzoulaki, I., Candeias, V., & Elliott, P. (2009) · International Journal of Epidemiology · doi:10.1093/ije/dyp139 · Cited by 1,173 · see citing works
He, F. J., & MacGregor, G. A. (2009) · Journal of Human Hypertension · doi:10.1038/jhh.2008.144 · Cited by 1,123 · see citing works
Powles, J., Fahimi, S., Micha, R., Khatibzadeh, S., Shi, P., Ezzati, M., Engell, R. E., Lim, S. S., Danaei, G., Mozaffarian, D., et al. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003733 · Cited by 940 · see citing works
Reducing population salt intake worldwide: from evidence to implementation
He, F. J., & MacGregor, G. A. (2010) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2009.12.006 · Cited by 625 · see citing works
Whelton, P. K., Appel, L. J., Sacco, R. L., Anderson, C. A. M., Antman, E. M., Campbell, N., Dunbar, S. B., Frohlich, E. D., Hall, J. E., Jessup, M., et al. (2012) · Circulation · doi:10.1161/cir.0b013e318279acbf · Cited by 463 · see citing works
Thomas, M. C., Moran, J., Forsblom, C., Harjutsalo, V., Thorn, L., Ahola, A., Wadén, J., Tolonen, N., Saraheimo, M., Gordin, D., et al. (2011) · Diabetes Care · doi:10.2337/dc10-1722 · Cited by 349 · see citing works
Farquhar, W. B., Edwards, D. G., Jurkovitz, C. T., & Weintraub, W. S. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.12.039 · Cited by 348 · see citing works
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- Authors
- Laatikainen, T., Pietinen, P., Valsta, L., Sundvall, J., Reinivuo, H., & Tuomilehto, J.
- Affiliations
- University of Helsinki (FI)
- Corresponding author
- Laatikainen, T
- Venue
- European Journal of Clinical Nutrition
- Published
- 2006-02-15
- Volume
- 60
- Issue
- 8
- Pages
- 965-970
- ISSN
- 0954-3007 (ISSN-L)
- 1476-5640
- OpenAlex
- W2038111233
- Cited by
- 213
- References
- 48
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 16 · 2021: 6 · 2020: 7 · 2019: 13 · 2018: 7 · 2017: 8 · 2016: 10 · 2015: 18 · 2014: 22 · 2013: 18 · 2012: 21
- FWCI
- 6.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- sodium excretion, sodium intake, potassium excretion, dietary trends, cardiovascular risk factors, Finland, 24-hour urine collection, population survey
- MeSH terms
- Adult, Cardiovascular Diseases, Cross-Sectional Studies, Diet, Female, Finland, Humans, Male, Middle Aged, Potassium, Risk Factors, Sodium, Sodium Chloride, Dietary
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