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Cited by 1,218Sodium Intake and HealthBlood Pressure and Hypertension StudiesNutritional Studies and Diet

Global Sodium Consumption and Death from Cardiovascular Causes

Open access
Mozaffarian, Dariush, Fahimi, Saman, Singh, Gitanjali M., Micha, Renata, Khatibzadeh, Shahab, Engell, Rebecca E., Lim, Stephen, Danaei, Goodarz +2 more·2014·New England Journal of Medicine
DOI 10.1056/nejmoa1304127
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Abstract

BACKGROUND: High sodium intake increases blood pressure, a risk factor for cardiovascular disease, but the effects of sodium intake on global cardiovascular mortality are uncertain. METHODS: We collected data from surveys on sodium intake as determined by urinary excretion and diet in persons from 66 countries (accounting for 74.1% of adults throughout the world), and we used these data to quantify the global consumption of sodium according to age, sex, and country. The effects of sodium on blood pressure, according to age, race, and the presence or absence of hypertension, were calculated from data in a new meta-analysis of 107 randomized interventions, and the effects of blood pressure on cardiovascular mortality, according to age, were calculated from a meta-analysis of cohorts. Cause-specific mortality was derived from the Global Burden of Disease Study 2010. Using comparative risk assessment, we estimated the cardiovascular effects of current sodium intake, as compared with a reference intake of 2.0 g of sodium per day, according to age, sex, and country. RESULTS: In 2010, the estimated mean level of global sodium consumption was 3.95 g per day, and regional mean levels ranged from 2.18 to 5.51 g per day. Globally, 1.65 million annual deaths from cardiovascular causes (95% uncertainty interval [confidence interval], 1.10 million to 2.22 million) were attributed to sodium intake above the reference level; 61.9% of these deaths occurred in men and 38.1% occurred in women. These deaths accounted for nearly 1 of every 10 deaths from cardiovascular causes (9.5%). Four of every 5 deaths (84.3%) occurred in low- and middle-income countries, and 2 of every 5 deaths (40.4%) were premature (before 70 years of age). The rate of death from cardiovascular causes associated with sodium intake above the reference level was highest in the country of Georgia and lowest in Kenya. CONCLUSIONS: In this modeling study, 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day. (Funded by the Bill and Melinda Gates Foundation.).

AI snapshot

Written from a shortened version of the paper’s full text (it is longer than we read).

TL;DR

This is the supplementary appendix to Mozaffarian et al. (NEJM 2014), documenting the methods and results of a global comparative risk assessment of sodium consumption and cardiovascular mortality. It reports that in 2010, 1.65 million CVD deaths (9.5% of all CVD deaths) worldwide were attributed to sodium intake above a 2.0 g/d reference level.

Key findings

  • Global mean sodium intake in 2010 was 4.0 g/d (95% UI 3.9–4.0); sodium above 2 g/d was attributed to 1,648 thousand CVD deaths (95% UI 1,095–2,223), or 9.5% of total CVD deaths (95% UI 6.4–12.8) (Table S4).
  • Among premature CVD deaths (before age 70), 17.8% globally were attributed to sodium above the reference level (95% UI 12.3–23.1); the proportion was highest in upper-middle-income countries (21.6%), similar in lower-middle-income (15.3%) and high-income (15.8%) countries, and lowest in low-income countries (12.5%) (Text S8).
  • Among the 30 most populous nations, the highest absolute sodium-associated CVD mortality was in Ukraine (1,540 deaths/million adults/year; 95% UI 1,017–2,099), Russia (1,316; 873–1,781), and Egypt (570; 370–761); the US had 284/million (184–394), or 6.3% of CVD deaths (4.1–8.7%), while the highest proportional burdens were in China (15.3%; 10.5–20.2), the Philippines (15.2%), and Myanmar (15.1%) (Text S9).
  • In a de novo meta-analysis of 103 randomized trials (107 comparisons; 6,970 subjects), each 100 mmol/d sodium reduction lowered systolic BP by 3.74 mm Hg (95% CI 2.29–5.18) in white normotensives at age 50, with larger reductions per year of age (0.105 mm Hg; 95% CI 0.047–0.164), among Blacks (+2.49 mm Hg; 0.13–4.85), and among hypertensives (+1.87 mm Hg; 0.12–3.63) (Text S1, Figure S2).

Methods

  • Design: comparative risk assessment combining country-, age-, and sex-specific sodium intake, blood pressure, relative risks, and cause-specific mortality to estimate population-attributable fractions above a reference intake of 2.0 ± 0.2 g/d, with no further benefit quantified below 115 mm Hg systolic BP (Text S7).
  • Data: sodium intake from 24-hour urinary and dietary surveys (1,348 age- and sex-specific data points from 63 countries, 40% nationally representative, covering 74% of the world's adult population) pooled with DisMod3; BP from 786 country-years and 5.4 million participants; mortality from the 2010 GBD study across 187 countries (Text S1, S5, S6; Table S1).
  • Analysis: de novo inverse-variance-weighted meta-regression of sodium reduction on systolic BP; age-specific relative risks of BP on CVD interpolated from two pooling projects (99 cohorts, 1.38 million participants, 65,000 CVD events); uncertainty propagated via 1,000 simulation draws (Text S1, S2, S7).

Limitations

  • Stated in the paper: 24-hour urine collections and diet questionnaires estimate population mean intakes reasonably but poorly measure individual intakes, which could bias or substantially underestimate associations with disease risk; limited information from clinical CVD event studies precludes strong conclusions about more substantial sodium reduction (e.g., to 1.5 or 1.0 g/d); and other physiologic benefits of sodium reduction beyond BP were not incorporated, which could lead to underestimation of attributable deaths (Text S3).
  • Evident from the text: this document is the supplementary appendix rather than the main article, so the primary results, figures, and discussion of the published paper are not included here; several key inputs (e.g., the sodium intake estimates and the BP–CVD pooling analyses) are drawn from previously published work rather than generated de novo in this analysis.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1056/nejmoa1304127

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 64 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the final meta-regression, for a white, normotensive population at age 50, each 100 mmol/d sodium reduction lowered systolic blood pressure by 3.74 mm Hg (95%CI: 2.29, 5.18).

    “In other words, for a white, normotensive population at age 50, each 100 mmol/d sodium reduction lowered systolic BP by 3.74 mm Hg (95%CI: 2.29, 5.18).”
    Quote in the paperSubstantial claim
  • Findingown data

    In sensitivity analyses using all 169 randomized comparisons, there were joint interactions by age, hypertension, and race (P-interaction<0.001, 0.004, and 0.007, respectively).

    “Similar findings were seen when using all 169 randomized comparisons, with joint interactions by age, hypertension, and race (P-interaction<0.001,0.004, and 0.007, respectively).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Evaluated using inverse-variance weighted meta-regression, each 100 mmol/d reduction in sodium lowered blood pressure by 3.82 mm Hg (95% CI: 3.08, 4.55).

    “Evaluated using inverse-variance weighted meta-regression, each 100 mmol/d reduction lowered BP by 3.82 mm Hg (95% CI: 3.08, 4.55).”
    Quote in the paperSubstantial claim
  • Findingown data

    For every year above or below age 50, the systolic blood pressure reduction from a 100 mmol/d sodium reduction was 0.105 mm Hg (95%CI: 0.047, 0.164) larger or smaller, respectively.

    “For every year above or below age 50, there was 0.105 mm Hg (95%CI: 0.047, 0.164) larger or smaller BP reduction, respectively”
    Quote in the paperSubstantial claim
  • Findingown data

    In sensitivity analyses using all 169 randomized comparisons, for every year above or below age 50, there was 0.124 mm Hg (95%CI: 0.079, 0.169) larger or smaller blood pressure reduction, respectively.

    “For every year above or below age 50, there was 0.124 mm Hg (95%CI: 0.079, 0.169) larger or smaller BP reduction, respectively.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 28
  • Classified as probably not a substantial claim. 42
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    In the meta-regression, there were significant independent interactions of the sodium reduction effect on blood pressure with age, hypertensive status, and race (P-interaction<0.001, 0.036, and 0.039, respectively), but not with study duration (P-interaction=0.88).

    “We identified significant independent interaction by age (Figure S2), hypertensive status, and race (P-interaction<0.001,0.036, and 0.039, respectively), but not study duration (P-interaction=0.88).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the primary analysis of 107 randomized group comparisons, there was strong evidence for a linear effect of sodium reduction on blood pressure (P linearity<0.001) and no significant evidence for a nonlinear effect (P nonlinearity=0.58).

    “In the primary analysis of 107 randomized group comparisons, there was strong evidence for a linear effect (P linearity<0.001)and no significant evidence for a nonlinear effect (P nonlinearity=0.58)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In sensitivity analyses using all 169 randomized comparisons, blood pressure reduction was 1.90 mm Hg greater among hypertensives (95%CI: 0.61, 3.20) and 2.49 mm Hg greater among Blacks (95%CI: 0.68, 4.30).

    “Further, BP reduction was 1.90 mm Hg greater among hypertensives (95%CI: 0.61, 3.20), and 2.49 mm Hg greater among Blacks (95%CI: 0.68, 4.30).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the final meta-regression, there was 2.49 mm Hg greater systolic blood pressure reduction among Blacks (95%CI: 0.13, 4.85) and 1.87 mm Hg greater reduction among hypertensives (95%CI: 0.12, 3.63).

    “Additionally, there was 2.49 mm Hg greater reduction among Blacks (95%CI: 0.13, 4.85), and 1.87 mm Hg greater reduction among hypertensives (95%CI: 0.12, 3.63).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    A meta-analysis of prospective cohorts found that higher sodium intake was associated with higher risk of total stroke (10 cohorts; RR=1.24, 95%CI: 1.08, 1.43), stroke death (3 cohorts; RR=1.63, 95%CI: 1.27, 2.10), and CHD death (3 cohorts; RR=1.32, 95%CI: 1.13, 1.53), but not total CHD (6 cohorts; RR=1.04, 95%CI: 0.86, 1.24).

    “A meta-analysis of prospective cohorts found that higher sodium intake was associated with higher risk of total stroke (10 cohorts; RR=1.24, 95%CI: 1.08, 1.43), stroke death (3 cohorts; RR=1.63, 95%CI: 1.27, 2.10), and CHD death (3 cohorts; RR=1.32, 95%CI: 1.13, 1.53), but not total CHD (6 cohorts; RR=1.04, 95%CI: 0.86, 1.24).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The final age patterns of systolic blood pressure effects on cardiovascular disease mortality were similar to prior estimated patterns, but with a slightly less steep age effect at younger ages.

    “The final age patterns were similar to prior estimated patterns, 17 but with slightly less steep age effect at younger ages (resulting in modestly smaller estimated burdens at younger ages).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Worldwide, there were 968,873 deaths from coronary heart disease (95% CI, 624,459 to 1,344,883).

    “Worldwide 3830 4.0 (3.9, 4.0) 134 (125, 144) 968873 (624459, 1344883) 944251 (636186, 1262834) 389569 (268284, 508400) 2302693 (1548094, 3072643) 667 (416, 947) 493 (326, 671) 247 (168, 327) 1407 (923, 1915) 15.1 (9.9, 20.8) 18.7 (12.6, 24.9) 12.7 (8.7, 16.8) 14.0 (9.5, 18.6)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In high-income countries, the mean systolic blood pressure was 134 mm Hg (95% CI, 125 to 143).

    “High income countries ‡ 763 3.9 (3.3, 4.5) 134 (125, 143) 188949 (127179, 255552) 103023 (68736, 137625) 76863 (53289, 100973) 368835 (249204, 494150) 250 (168, 339) 68 (46, 91) 15 (10, 19) 49 (33, 66) 10.5 (7.1, 14.3) 10.3 (6.9, 13.8) 10.7 (7.4,13.9) 10.5 (7.1, 14.0)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among men, mean sodium consumption was 4.1 g/day (95% UI, 4.0 to 4.2).

    “Men 1890 4.1 (4.0, 4.2) 135 (126, 145) 441 (287, 610) 420 (281, 564) 159 (109, 209) 1020 (685, 1370) 600 (380, 845) 417 (274, 568) 196 (133, 261) 1213 (794, 1654) 11.7 (7.6, 16.2) 14.7 (9.8, 19.9) 9.9 (6.7, 13.2) 10.9 (7.4,14.7)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included national surveys and data sources are representative of global sodium consumption.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Worldwide, there were 2,302,693 deaths from all cardiovascular causes (95% CI, 1,548,094 to 3,072,643).

    “Worldwide 3830 4.0 (3.9, 4.0) 134 (125, 144) 968873 (624459, 1344883) 944251 (636186, 1262834) 389569 (268284, 508400) 2302693 (1548094, 3072643) 667 (416, 947) 493 (326, 671) 247 (168, 327) 1407 (923, 1915) 15.1 (9.9, 20.8) 18.7 (12.6, 24.9) 12.7 (8.7, 16.8) 14.0 (9.5, 18.6)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Effect modification by race/ethnicity and sex were assessed but were not found to be statistically significant.

    “Effect modification by race/ethnicity and sex were assessed but were not found to be statistically significant.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among men worldwide, there were 1,389,040 deaths from all cardiovascular causes (95% CI, 943,713 to 1,842,748).

    “Men 1890 4.1 (4.0, 4.2) 135 (126, 145) 608640 (400856, 832649) 562870 (382468, 745655) 217531 (151058, 282235) 1389040 (943713, 1842748) 849 (543, 1185) 589 (392, 794) 278 (191, 365) 1715 (1135, 2318) 16.9 (11.2, 23.1) 20.9 (14.2, 27.8) 14.2 (9.8, 18.7) 15.7 (10.7, 20.8)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In upper-middle-income countries, the mean systolic blood pressure was 136 mm Hg (95% CI, 126 to 146).

    “Upper-middle income countries 1530 3.6 (2.9, 4.3) 136 (126, 146) 420467 (288203, 556701) 531624 (366051, 699117) 167546 (118468, 215493) 1119637 (772721, 1471311) 275 (189, 365) 174 (120, 229) 16 (11, 20) 73 (51, 96) 15.6 (10.7, 20.6) 18.5 (12.7, 24.2) 18.1 (12.9, 23.2) 17.2 (12.0, 22.5)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among adults aged 69 years or younger worldwide, there were 917,136 deaths from all cardiovascular causes (95% CI, 646,780 to 1,176,572).

    “Age <=69 y 3300 4.0 (3.9, 4.0) 126 (118, 133) 386246 (268366, 499623) 380812 (272319, 485086) 150078 (106095, 191863) 917136 (646780, 1176572) 117 (81, 152) 116 (83, 147) 46 (32, 58) 278 (196, 357) 22.1 (15.3, 28.6) 30.3 (21.7, 38.7) 20.4 (14.4,26.1) 24.5 (17.4,31.4)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Worldwide, the mean systolic blood pressure among adults was 134 mm Hg (95% CI, 125 to 144).

    “Worldwide 3830 4.0 (3.9, 4.0) 134 (125, 144) 968873 (624459, 1344883) 944251 (636186, 1262834) 389569 (268284, 508400) 2302693 (1548094, 3072643) 667 (416, 947) 493 (326, 671) 247 (168, 327) 1407 (923, 1915) 15.1 (9.9, 20.8) 18.7 (12.6, 24.9) 12.7 (8.7, 16.8) 14.0 (9.5, 18.6)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Worldwide, there were 944,251 deaths from stroke (95% CI, 636,186 to 1,262,834).

    “Worldwide 3830 4.0 (3.9, 4.0) 134 (125, 144) 968873 (624459, 1344883) 944251 (636186, 1262834) 389569 (268284, 508400) 2302693 (1548094, 3072643) 667 (416, 947) 493 (326, 671) 247 (168, 327) 1407 (923, 1915) 15.1 (9.9, 20.8) 18.7 (12.6, 24.9) 12.7 (8.7, 16.8) 14.0 (9.5, 18.6)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among women worldwide, there were 913,653 deaths from all cardiovascular causes (95% CI, 604,381 to 1,229,896).

    “Women 1930 3.8 (3.7, 3.9) 133 (123, 143) 360233 (223604, 512234) 381382 (253718, 517179) 172039 (117227, 226165) 913653 (604381, 1229896) 486 (290, 708) 397 (260, 547) 217 (145, 289) 1100 (711, 1512) 13.4 (8.6, 18.6) 16.4 (11.0, 22.1) 11.2 (7.7, 14.9) 12.4 (8.4,16.5)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among adults aged 70 years or older worldwide, there were 1,385,557 deaths from all cardiovascular causes (95% CI, 935,956 to 1,850,724).

    “Age 70+ y 524 4.1 (4.0, 4.1) 143 (131, 155) 582627 (388554, 785664) 563439 (381418, 752761) 239491 (165985, 312299) 1385557 (935956, 1850724) 1115 (744, 1504) 1078 (730, 1441) 458 (318, 598) 2652 (1791, 3542) 11.1 (7.5, 15.1) 12.4 (8.4,16.5) 13.1 (9.1, 17.0) 12.0 (8.1, 16.0)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of CVD deaths attributed to sodium in Myanmar, stroke accounted for 56.1%.

    “56.1% in Myanmar”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In lower-middle-income countries, the mean systolic blood pressure was 135 mm Hg (95% CI, 125 to 145).

    “Lower-middle income countries 1210 3.4 (2.6, 4.1) 135 (125, 145) 318785 (215531, 429630) 247748 (170046, 323944) 116497 (79724, 151518) 683030 (465301, 905093) 263 (178, 355) 102 (70, 134) 14 (9, 18) 56 (38, 75) 14.6 (9.9, 19.7) 16.1 (11.1, 20.9) 16.1 (11.1, 21.1) 15.4 (10.4,20.3)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Worldwide, there were 389,569 deaths from other cardiovascular causes (95% CI, 268,284 to 508,400).

    “Worldwide 3830 4.0 (3.9, 4.0) 134 (125, 144) 968873 (624459, 1344883) 944251 (636186, 1262834) 389569 (268284, 508400) 2302693 (1548094, 3072643) 667 (416, 947) 493 (326, 671) 247 (168, 327) 1407 (923, 1915) 15.1 (9.9, 20.8) 18.7 (12.6, 24.9) 12.7 (8.7, 16.8) 14.0 (9.5, 18.6)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    In Australia and New Zealand, the mean systolic blood pressure was 130 mm Hg (95% CI, 121 to 139).

    “Australia / New Zealand 17.4 3.4 (3.3, 3.6) 130 (121, 139) 3245 (1720, 5152) 1192 (720, 1780) 819 (563, 1091) 5256 (3222, 7580) 384 (195, 623) 144 (86, 218) 98 (67, 132) 626 (377, 915) 12.3 (7.5, 18.0) 14.7 (9.4,20.5) 10.1 (6.8, 13.7) 11.2 (7.3, 15.3)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In lower-middle-income countries, there were 683,030 deaths from all cardiovascular causes (95% CI, 465,301 to 905,093).

    “Lower-middle income countries 1210 3.4 (2.6, 4.1) 135 (125, 145) 318785 (215531, 429630) 247748 (170046, 323944) 116497 (79724, 151518) 683030 (465301, 905093) 263 (178, 355) 102 (70, 134) 14 (9, 18) 56 (38, 75) 14.6 (9.9, 19.7) 16.1 (11.1, 20.9) 16.1 (11.1, 21.1) 15.4 (10.4,20.3)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    In Canada and the United States, the mean systolic blood pressure was 127 mm Hg (95% CI, 120 to 134).

    “Canada / U.S. 226 3.6 (3.5, 3.7) 127 (120, 134) 58866 (31531, 92075) 16406 (10071, 23947) 19620 (13221, 26242) 94891 (57955, 137168) 511 (259, 825) 141 (85, 208) 163 (109, 220) 815 (483, 1207) 12.9 (7.8, 18.9) 15.8 (10.1, 22.0) 10.9 (7.2, 14.7) 11.9 (7.8, 16.4)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In 2010, the number of CVD deaths attributed to sodium was higher among men (350,729; 95% UI 229,946 to 481,039) than among women (162,172; 95% UI 103,765 to 223,734).

    “Men 1890 4.1 (4.0, 4.2) 135 (126, 145) 141759 (90540, 200057) 155960 (101566, 215349) 53010 (35364, 71415) 350729 (229946, 481039) 175 (110, 250) 130 (84, 181) 56 (37, 76) 361 (232, 501) 3.2 (2.0, 4.5) 4 (2.7, 5.7) 2.7 (1.8, 3.7) 3.0 (2.0, 4.1)”
    • Also stated in: § Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010. · plain
      “Women 1930 3.8 (3.7, 3.9) 133 (123, 143) 60836 (36859, 88324) 72842 (46625, 102611) 28493 (18793, 38612) 162172 (103765, 223734) 69 (41, 101) 58 (37, 82) 28 (18, 38) 154 (97, 215) 1.7 (1.1, 2.5) 2 (1.4,3.1) 1.5 (1.0, 2.0) 1.6 (1.1, 2.2)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Findingown data

    In 2010, the number of CVD deaths attributed to sodium was highest in upper-middle income countries (318,948; 95% UI 211,777 to 433,431) and lowest in low income countries (15,586; 95% UI 10,215 to 21,053).

    “Upper-middle income countries 1530 3.6 (2.9, 4.3) 136 (126, 146) 111296 (73805, 151905) 160781 (106299, 218745) 46871 (31673, 62781) 318948 (211777, 433431) 73 (48, 100) 53 (35, 72) 4 (3, 6) 21 (14, 29) 4.1 (2.7, 5.7) 6 (3.7, 7.6) 5.1 (3.4,6.8) 4.9 (3.3, 6.6)”
    • Also stated in: § Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010. · plain
      “Low income countries 323 2.9 (2.2, 3.6) 138 (127, 149) 5330 (3494, 7184) 7286 (4770, 9846) 2970 (1950, 4023) 15586 (10215, 21053) 16 (11, 22) 11 (7, 15) 1 (1, 2) 5 (3, 7) 1.9 (1.2, 2.5) 2 (1.3, 2.6) 1.5 (1.0, 2.1) 1.8 (1.2, 2.4)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In multivariable meta-regression including age, race, and hypertensive status, effects of dietary sodium on BP were independently modified by each (P-interaction<0.001, 0.036, and 0.039, respectively).

    “In multivariable meta-regression including age, race, and hypertensive status, effects of dietary sodium on BP were independently modified by each (P-interaction<0.001,0.036, and 0.039, respectively).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Findingnone given

    In 2010, there were 14,669,000 total CVD deaths globally, comprising 6,963,000 CHD deaths, 5,798,000 stroke deaths, and 1,909,000 other CVD deaths.

    “†In 2010 globally, there were 14,669,000 total CVD deaths, 6,963,000 CHD deaths, 5,798,000 stroke deaths, and 1,909,000 other CVD deaths.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In Central Asia and Eastern and Central Europe, there were 441,413 deaths from all cardiovascular causes (95% CI, 296,196 to 591,093).

    “Central Asia/ Eastern and Central Europe 273 4.5 (4.3, 4.8) 141 (130, 152) 251467 (165609, 343346) 148235 (101650, 197200) 41711 (28993, 54192) 441413 (296196, 591093) 1973 (1278, 2725) 1170 (786, 1582) 301 (207, 395) 3445 (2274, 4668) 19.0 (12.8, 25.3) 23.5 (16.5, 30.6) 15.7 (11.0, 20.3) 17.4 (12.1, 22.6)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In low-income countries, the mean systolic blood pressure was 138 mm Hg (95% CI, 127 to 149).

    “Low income countries 323 2.9 (2.2, 3.6) 138 (127, 149) 40672 (28523, 52598) 61856 (43956, 79206) 28664 (20411, 36903) 131191 (92891, 168707) 126 (88, 163) 96 (68, 123) 13 (9, 16) 41 (29, 52) 14.2 (9.9, 18.3) 16.2 (11.5, 20.9) 14.8 (10.6, 19.1) 15.2 (10.8, 19.6)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In 2010, mean sodium consumption was higher among men (4.1 g/day) than among women (3.8 g/day).

    “Men 1890 4.1 (4.0, 4.2) 135 (126, 145) 141759 (90540, 200057) 155960 (101566, 215349) 53010 (35364, 71415) 350729 (229946, 481039) 175 (110, 250) 130 (84, 181) 56 (37, 76) 361 (232, 501) 3.2 (2.0, 4.5) 4 (2.7, 5.7) 2.7 (1.8, 3.7) 3.0 (2.0, 4.1)”
    • Also stated in: § Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010. · plain
      “Women 1930 3.8 (3.7, 3.9) 133 (123, 143) 60836 (36859, 88324) 72842 (46625, 102611) 28493 (18793, 38612) 162172 (103765, 223734) 69 (41, 101) 58 (37, 82) 28 (18, 38) 154 (97, 215) 1.7 (1.1, 2.5) 2 (1.4,3.1) 1.5 (1.0, 2.0) 1.6 (1.1, 2.2)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In East and Southeast Asia, there were 882,479 deaths from all cardiovascular causes (95% CI, 601,939 to 1,159,361).

    “East / Southeast Asia 1360 4.1 (3.9, 4.3) 132 (123, 142) 250096 (161233, 345123) 491383 (332314, 655272) 141000 (99043, 181571) 882479 (601939, 1159361) 467 (294, 655) 887 (590, 1201) 268 (187, 348) 1622 (1089, 2165) 18.9 (12.5, 25.8) 23.3 (16.0, 30.8) 16.0 (11.1, 20.9)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    These two Cochrane meta-analyses did not evaluate whether blood-pressure-lowering effects were linear across a wide range of sodium reduction or simultaneously quantify potential heterogeneity owing to age, hypertensive status, race, and duration of intervention.

    “Additionally, these meta-analyses did not evaluate whether BPlowering effects were linear across a wide range of sodium reduction or simultaneously quantify potential heterogeneity owing to age, hypertensive status, race, and duration of intervention, which could each modify effects of sodium on BP.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1]

      Not checked in the free run.

    • cites [2]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In one of the meta-analyses used to identify trials of sodium reduction, none of the subjects were on anti-hypertensives; in the other meta-analysis, trials in which subjects were taking anti-hypertensives were not excluded but this characteristic was not coded, precluding formal evaluation of heterogeneity.

    “In one of the meta-analyses used to identify trials of sodium reduction, none of the subjects were on anti-hypertensives; in the other meta-analysis, trials in which subjects were taking anti-hypertensives were not excluded but this characteristic was not coded, precluding formal evaluation of heterogeneity.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1]

      Not checked in the free run.

    • cites [2]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Two recent Cochrane meta-analyses evaluated randomized trials of sodium reduction and blood pressure.

    “Two recent Cochrane meta-analyses evaluated randomized trials of sodium reduction and BP.1,2”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1]

      Not checked in the free run.

    • cites [2]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One of the two Cochrane meta-analyses assessed 28 longer-term trials published through 2005.

    “One assessed 28 longer-term trials published through 2005; 1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The other Cochrane meta-analysis assessed many more (n=167) trials but also included trials testing only small (<20 mmol/d reduction) or brief duration (<2 weeks) sodium reduction interventions that might not validly inform longer-term effects.

    “the other, many more (n=167) trials but also those testing only small (<20 mmol/d reduction) or brief duration (<2 weeks) sodium reduction interventions that might not validly inform longer-term effects. 2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Statistical modeling strategies estimated cause-specific mortality, including different permutations of covariates and assessment of model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs.

    “Statistical modeling strategies estimated cause-specific mortality, including different permutations of covariates and assessment of model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Cause-specific fractions within each age-sex group were constrained to sum to total mortality based on draws from the uncertainty distributions.

    “Cause-specific fractions within each age-sex group were constrained to sum to total mortality based on draws from the uncertainty distributions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recommended maximum intakes in major dietary guidelines ranged from 1200 to 2400 mg/d.

    “Recommended maximum intakes in major dietary guidelines ranged from 1200 to 2400 mg/d.[19][20][21][22][23][24]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [19] source

      Not checked in the free run.

    • cites [20] source

      Not checked in the free run.

    • cites [21] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Due to duplication of reported data across at least 2 of the heart failure trials, the veracity of the data has been questioned; and the investigators were unable to produce confirmatory records, leading to the retraction of the meta-analysis.

    “In addition, due to duplication of reported data across at least 2 of the trials, the veracity of the data has been questioned; and the investigators were unable to produce confirmatory records, leading to the retraction of the meta-analysis”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites heart.bmj.com/content/99/11/820.2.full

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent meta-analysis reported higher mortality with sodium reduction in trials of heart failure patients.

    “A recent meta-analysis reported higher mortality with sodium reduction in trials of heart failure patients.35”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several prior reports have extensively reviewed the evidence for cardiovascular disease effects of dietary sodium, including strengths and limitations of various studies and implications for causality.

    “Several prior reports have extensively reviewed the evidence for CVD effects of dietary sodium, including strengths and limitations of various studies and implications for causality.[19][20][21][22][23][24][25][26]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [19] source

      Not checked in the free run.

    • cites [20] source

      Not checked in the free run.

    • cites [21] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Other potential benefits of sodium reduction were not incorporated into the analysis, which could lead to underestimation of attributable deaths.

    “We did not incorporate these other potential benefits into our analysis, which could lead to underestimation of the attributable deaths.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    We found convincing evidence that sodium reduction lowered blood pressure and that blood-pressure-lowering reduces CHD and stroke, at least to sodium intakes of 2 g/d and systolic blood pressure levels of 115 mm Hg, without compelling evidence for physiologic harms.

    “In sum, we found convincing evidence that sodium reduction lowered BP and that BP-lowering reduces CHD and stroke, at least to sodium intakes of 2 g/d and systolic BP levels of 115 mm Hg; without compelling evidence for physiologic harms.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: CVD benefits extend down to a systolic blood pressure of 115 mm Hg, but no further.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Based on all available evidence, a reference consumption level of 1.0±0.1 g/d was previously identified for the main GBD analysis evaluating all health effects including gastric cancer.

    “Based on all available evidence, we had previously identified a reference consumption level of 1.0±0.1 g/d for our main GBD analysis evaluating all health effects including gastric cancer.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The heart failure trials reporting higher mortality with sodium reduction largely came from a single Italian center, typically included very high doses of diuretics (e.g., furosemide 500+ mg/d) that were not titrated based on subsequent volume status, with resulting marked azotemia in patients randomized to sodium reduction.

    “However, these trials, largely reported from a single Italian center, typically also included very high doses of diuretics (e.g., furosemide 500+ mg/d) that were not titrated based on subsequent volume status, with resulting marked azotemia in the patients randomized to sodium reduction.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The selection of reference levels required demonstration of at least theoretical feasibility based on observed national mean consumption levels in at least 2-3 countries globally.

    “We also required demonstration of at least theoretical feasibility based on observed national mean consumption levels in at least 2-3 countries globally.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The paper found strong evidence that blood-pressure-lowering reduces coronary heart disease and stroke.

    “We also found strong evidence that BP-lowering reduces CHD and stroke.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    These prior pooling projects pooled individual-level data across multiple prospective studies, together totaling 99 cohorts, 1.38 million participants, and 65,000 cardiovascular events, with consistent adjustment for confounders and accounting for regression dilution bias based on serial measures of blood pressure over time.

    “These studies pooled individual level data across multiple prospective studies, together totaling 99 cohorts, 1.38 million participants, and 65,000 cardiovascular events; with consistent adjustment for confounders and accounting for regression dilution bias based on serial measures of BP over time.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [14] source

      Not checked in the free run.

    • cites [15] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Consistent ecologic and experimental evidence indicates that long-term high sodium intakes induce additional adverse physiologic effects beyond blood pressure; these were not incorporated into our estimates, which might underestimate attributable disease burdens.

    “We also found consistent ecologic and experimental evidence that long-term high intakes induce additional adverse physiologic effects beyond BP; these were not incorporated into our estimates, which might underestimate attributable disease burdens.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Beta blockers had a larger effect above and beyond that due to blood-pressure reduction only for preventing recurrent CHD events in patients with a history of CHD, and only limited to the first few years after acute myocardial infarction.

    “Beta blockers had a larger effect above and beyond that due to BP reduction only for preventing recurrent CHD events in patients with a history of CHD, and also only limited to the first few years after acute myocardial infarction.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The proportional (relative risk) reductions in CHD and stroke events were similar in people with and without pre-existing CVD and regardless of blood-pressure levels prior to treatment (down to 110 mm Hg systolic and 70 mm Hg diastolic).

    “In addition, the proportional (relative risk) reductions in CHD and stroke events were similar in people with and without pre-existing CVD and regardless of BP levels prior to treatment (down to 110 mm Hg systolic and 70 mm Hg diastolic).27”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The selection of reference levels considered consistency with major dietary guidelines.

    “Finally, we considered consistency of our identified reference intakes with major dietary guidelines.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    No further benefits were quantified for estimated systolic blood pressure reductions below 115 mm Hg.

    “No further benefits were quantified for estimated systolic BP reductions below 115 mm Hg. 17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

    • The authors state this as an assumption: CVD benefits extend down to a systolic blood pressure of 115 mm Hg, but no further.

  • Classified as probably not a substantial claim.

    Premisecitation

    The main findings from one pooling project were based on individual-level data across 61 prospective observational studies including 958,074 participants, 12.7 million person-years of follow-up, 34,000 coronary heart disease deaths, and 12,000 stroke deaths.

    “based on individual-level data across 61 prospective observational studies including 958,074 participants, 12.7 million person-years of follow-up, 34,000 coronary (ischemic) heart disease (IHD) deaths, and 12,000 stroke deaths.14”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Cause-specific total mortality by country, age, and sex was modeled using CODEm, validated using out-of-sample predictive validity tests in which 30% of data was withheld.

    “Models were validated using out-of-sample predictive validity tests in which 30% of data was withheld from initial model fits.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The lowest age-standardized national mean sodium intakes are 1480 mg/d in Kenya, 1600 mg/d in Rwanda, and 1660 mg/d in Malawi.

    “Lowest age-standardized national mean intakes 40 1480 mg/d Kenya 1600 mg/d Rwanda 1660 mg/d Malawi”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Trends in age-specific relative risks from pooled analyses were compared to trends in original cohort data to ensure validity of pooled results.

    “Trends in age-specific relative risks from pooled analyses were compared to trends in original cohort data to ensure validity of pooled results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    DisMod3 was assessed for convergence of Markov chain Monte Carlo iterations and validated using goodness-of-fit tests and out-of-sample predictive validity tests, in which 10-20% of data were held-out of the model.

    “DisMod3 was assessed for convergence of Markov chain Monte Carlo iterations and validated using goodness-of-fit tests and out-of-sample predictive validity tests, in which 10-20% of data were held-out of the model.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    24-hour urinary measurements of sodium were considered the gold-standard and regression methods were developed to adjust dietary sodium consumption data to the equivalent of urinary sodium measures.

    “We considered 24-hour urinary measurements of sodium as the gold-standard and developed regression methods to adjust dietary sodium consumption data to the equivalent of urinary sodium measures.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Only randomized controlled feeding trials with duration of at least one week, mean sodium reduction of at least 20 mmol/d, and balanced concurrent interventions were included in the meta-analysis of sodium reduction on SBP.

    “Only randomized controlled feeding trials with duration of at least one week, mean sodium reduction of at least 20 mmol/d, and balanced concurrent interventions were included.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    BP levels were adjusted for regression dilution bias based on serial measures over time.

    “BP levels were adjusted for regression dilution bias based on serial measures over time.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The main findings from one of the two pooling projects are based on individual-level data across 61 prospective observational studies including 958,074 participants, 12.7 million person-years of follow-up, 34,000 coronary (ischemic) heart disease (IHD) deaths, and 12,000 stroke deaths.

    “This Figures shows the main findings from one of these two pooling projects, based on individual-level data across 61 prospective observational studies including 958,074 participants, 12.7 million person-years of follow-up, 34,000 coronary (ischemic) heart disease (IHD) deaths, and 12,000 stroke deaths.14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

65 of 65

  • The authors state this as an assumption.

    The dose-response relationship between blood pressure and cardiovascular disease is log-linear until a blood pressure level of 115 mm Hg.

    “Based on the evidence, we assumed a log-linear dose-response between BP and CVD until a BP level of 115 mm Hg”

  • The authors state this as an assumption.

    Above a blood pressure level of 115 mm Hg, blood pressure has no further contribution to cardiovascular disease risk.

    “after which we assumed no further contribution to risk.”

  • The authors state this as an assumption.

    CVD benefits extend down to a systolic blood pressure of 115 mm Hg, but no further.

    “In our analysis, we assumed CVD benefits down to a systolic BP of 115 mm Hg, but no further.16”

  • The authors state this as an assumption.

    The effects of sodium consumption on BP and the effects of BP on each disease outcome are log-normally distributed.

    “based on log normal distributions characterized by each risk estimate and its 95% confidence interval.”

  • The authors state this as an assumption.

    The distribution of sodium consumption for each country-age-sex group is characterized by its mean and standard error.

    “We drew 1,000 times from the distribution of sodium consumption for each country-age-sex group as characterized by its mean and standard error.”

  • The paper relies on this without support.

    The associations between sodium intake and cardiovascular outcomes observed in prior studies are causal.

    “Mean intakes associated with better outcomes”

  • The paper relies on this without support.

    The included national surveys and data sources are representative of global sodium consumption.

    “Data were from 56 national surveys Sibling history Data represented 1,557 survey years from 61 countries”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • East/Southeast Asia CVD components exceed their total

    Major

    Table S4 lists 190, 378, and 1080 thousand deaths for the three CVD subtypes, but reports 676 thousand for all CVD. The components sum to 1648 thousand; the discrepancy is far beyond rounding.

    Reported 676 · recomputed 1648

  • Two tables give different worldwide adult populations

    Minor

    Table S7 gives 4,430 million adults for both sexes overall, whereas Table S6 gives 3,830 million for the worldwide adult population. Both describe adults aged 20 and over in the same analysis.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. He FJ, 2013, Cochrane Database Syst Rev, 4, CD004937
  2. Graudal NA, 2011, Cochrane Database Syst Rev, 11, CD004022
  3. Institute of Medicine. Sodium intake in populations: assessment of evidence. Washington, DC: National Academies Press,2013.

Cited by

Sorted by citations

Related

Authors
Mozaffarian, D., Fahimi, S., Singh, G. M., Micha, R., Khatibzadeh, S., Engell, R. E., Lim, S., Danaei, G., Ezzati, M., & Powles, J.
Affiliations
  • Tufts University (US)
  • Harvard University (US)
  • University of Washington (US)
  • MRC Centre for Environment and Health (GB)
  • University of Cambridge (GB)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2014-08-14
Volume
371
Issue
7
Pages
624-634
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1304127
OpenAlex
W2125436925
Semantic Scholar
313501c1486ca65e8b9076a5e8ee7fbe5e6c6617
Cited by
1,218
References
37
Citations by year
2026: 50 · 2025: 64 · 2024: 83 · 2023: 97 · 2022: 134 · 2021: 135 · 2020: 138 · 2019: 93 · 2018: 104 · 2017: 95 · 2016: 91 · 2015: 103 · 2014: 30
FWCI
99.03
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
  • Hirsla (Landspítali University Hospital) (submittedVersion)
Funders
  • United States Agency for International Development
  • University of Chicago
  • London School of Hygiene and Tropical Medicine
  • University of Cambridge
  • Korea Health Industry Development Institute
  • Stavros Niarchos Foundation
  • Universidade de São Paulo
  • National Research University Higher School of Economics
  • Ministry of Health and Social Solidarity, Greece
  • Hellenic Health Foundation
  • George Institute for Global Health
  • National Institutes of Health (DK007703)
  • Centers for Disease Control and Prevention
  • University of North Carolina at Chapel Hill
  • Russian Academy of Sciences
  • Barts and The London School of Medicine and Dentistry
  • National Cancer Institute (P20CA210305)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK007703., T32DK007703)
  • National Institute of Environmental Health Sciences (P42 ES10349, P42ES010349)
  • Carolina Population Center, University of North Carolina at Chapel Hill
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
sodium intake, cardiovascular mortality, blood pressure, hypertension, attributable mortality, comparative risk assessment, low- and middle-income countries, premature mortality, global burden of disease, dietary salt
MeSH terms
Adult, Aged, Cardiovascular Diseases, Diet, Female, Humans, Male, Middle Aged, Sodium, Sodium, Dietary, Global Health, Sex Distribution

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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