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Global Sodium Consumption and Death from Cardiovascular Causes
Open accessAbstract
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.).
Overview
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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.
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Claims the paper makes
0 of 64 cited sources checked · 0 supported · 0 flagged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For a white, normotensive population at age 50, 100 mmol/d lower sodium intake reduced systolic BP by 3.39 mm Hg (95%CI: 2.31, 4.47).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When we evaluated premature CVD deaths (before age 70), nearly 1 in 5 (17.8%) globally in 2010 were attributed to sodium intake above the reference level (95% uncertainty interval: 12.3 to 23.1%) (Table S4).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S8. Premature Cardiovascular Mortality Attributed to Sodium Consumption > 2 g/d
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- 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.
- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Lower-middle income countries 1210 3.4 (2.6, 4.1) 135 (125, 145) 221 (147, 301) 169 (114, 224) 80 (54, 106) 470 (314, 631) 182 (121, 249) 70 (47, 93) 9 (6, 12) 39 (26, 52) 10.1 (6.7, 13.8) 11.0 (7.5, 14.5) 11.1 (7.5, 14.7) 10.6 (7.1, 14.1)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Rests on an assumption: The included national surveys and data sources are representative of global sodium consumption.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Adjusting for total blood cholesterol and, where available, HDL and non-HDL cholesterol, diabetes, weight, alcohol consumption, and smoking did not materially change these findings.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > P interaction by age <0.001
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 28
- Probably not a substantial claim. 42
- The quote only partly states this claim. 1
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S2. Effects of Blood Pressure on Deaths from Cardiovascular Diseases
What the sources say
- Not checked yetcites [17] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: The included national surveys and data sources are representative of global sodium consumption.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effect modification by race/ethnicity and sex were assessed but were not found to be statistically significant.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“56.1% in Myanmar”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S9. National Cardiovascular Mortality Attributed to Sodium Consumption > 2 g/d
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
- Also stated in: § Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010.
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“†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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
What the sources say
- Not checked yetcites [1]
- Not checked yetcites [2]
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
What the sources say
- Not checked yetcites [1]
- Not checked yetcites [2]
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Two recent Cochrane meta-analyses evaluated randomized trials of sodium reduction and BP.1,2”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
What the sources say
- Not checked yetcites [1]
- Not checked yetcites [2]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“One assessed 28 longer-term trials published through 2005; 1”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
What the sources say
- Not checked yetcites [1]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S1. Effect of Sodium Reduction on Systolic Blood Pressure in Randomized Controlled Trials.
What the sources say
- Not checked yetcites [2]
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S6. Cause-Specific Mortality by Country, Age, and Sex in 2010
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Cause-specific fractions within each age-sex group were constrained to sum to total mortality based on draws from the uncertainty distributions.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S6. Cause-Specific Mortality by Country, Age, and Sex in 2010
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Recommended maximum intakes in major dietary guidelines ranged from 1200 to 2400 mg/d.[19][20][21][22][23][24]”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S4. Setting Reference Levels of Sodium Consumption
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
What the sources say
- Not checked yetcites heart.bmj.com/content/99/11/820.2.full
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“A recent meta-analysis reported higher mortality with sodium reduction in trials of heart failure patients.35”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
What the sources say
- Not checked yetcites [35] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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]”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did not incorporate these other potential benefits into our analysis, which could lead to underestimation of the attributable deaths.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: CVD benefits extend down to a systolic blood pressure of 115 mm Hg, but no further.
In the paper
“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”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S4. Setting Reference Levels of Sodium Consumption
What the sources say
- Not checked yetcites [17] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We also required demonstration of at least theoretical feasibility based on observed national mean consumption levels in at least 2-3 countries globally.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S4. Setting Reference Levels of Sodium Consumption
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We also found strong evidence that BP-lowering reduces CHD and stroke.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S2. Effects of Blood Pressure on Deaths from Cardiovascular Diseases
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
What the sources say
- Not checked yetcites [27] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S3. Consideration of Causal Effects of Sodium Reduction on CVD
What the sources say
- Not checked yetcites [27] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, we considered consistency of our identified reference intakes with major dietary guidelines.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S4. Setting Reference Levels of Sodium Consumption
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“No further benefits were quantified for estimated systolic BP reductions below 115 mm Hg. 17”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Text S7. Modelling the Burdens of Cardiovascular Diseases Attributed to Sodium Consumption
What the sources say
- Not checked yetcites [17] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- The authors state this as an assumption: CVD benefits extend down to a systolic blood pressure of 115 mm Hg, but no further.
In the paper
“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”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > P interaction by age <0.001
What the sources say
- Not checked yetcites [14] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Models were validated using out-of-sample predictive validity tests in which 30% of data was withheld from initial model fits.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Lowest age-standardized national mean intakes 40 1480 mg/d Kenya 1600 mg/d Rwanda 1660 mg/d Malawi”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
What the sources say
- Not checked yetcites [40]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“614 mg/d * Lower systolic BP and lower age-BP slopes in ecologic studies 37”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
What the sources say
- Not checked yetcites [37] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Trends in age-specific relative risks from pooled analyses were compared to trends in original cohort data to ensure validity of pooled results.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of SBP on CVD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Absolute CVD Mortality Attributed to Sodium Intake > 1g/day in 2010
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Absolute CVD Mortality Attributed to Sodium Intake > 1g/day in 2010
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Effects of sodium on SBP
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“BP levels were adjusted for regression dilution bias based on serial measures over time.”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“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”
§ Global Sodium Consumption and Cardiovascular Mortality -Supplementary Materials > Table S6. Global Cardiovascular Deaths Attributed to Sodium Consumption >1 g/d in 2010.
What the sources say
- Not checked yetcites [14] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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”
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?
In the citing paper
“Overall, while adverse effects of rapid sodium reduction cannot be excluded, and true optimal lower limits remain uncertain, the sum of evidence suggests that optimal levels of sodium intake are ~2000 mg/d193, 200-204 and could be lower.304”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [304]
In the citing paper
“Sodium raises BP in a dose-dependent fashion, with stronger effects among older individuals, hypertensives, and Blacks.304”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [304]
In the citing paper
“Based on a target consumption level of 2000 mg/d, 1.65 million annual global cardiovascular deaths are estimated to be attributable to excess sodium intake.304”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [304]
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
MajorTable 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
“190 (121, 266) 378 (251, 510) 1080 (75, 141) 676 (455, 899)”
Two tables give different worldwide adult populations
MinorTable 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.
“Both sexes overall 4430000000 4.0 (3.9, 4.0)”
“Worldwide 3830 4.0 (3.9, 4.0) 134 (125, 144) 968873”
Citations
Cites
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Cited by
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Self-citation
Metadata
- 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
- 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
- bronze
- doi.org
- 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.
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