Cited by 1,173Sodium Intake and HealthBlood Pressure and Hypertension StudiesNutritional Studies and Diet

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Salt intakes around the world: implications for public health

Brown, I. J, Tzoulaki, I., Candeias, V., Elliott, P.·2009·International Journal of Epidemiology

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Abstract

BACKGROUND: High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption. METHODS: Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985-87) and INTERMAP (1996-99) studies, and recent dietary and urinary sodium data from observational or interventional studies--identified by a comprehensive search of peer-reviewed and 'grey' literature--presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data. RESULTS: Sodium intakes around the world are well in excess of physiological need (i.e. 10-20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods ( approximately 75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources. CONCLUSIONS: Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide. If policies for salt reduction at the population level are to be effective, policy development and implementation needs to target the main source of dietary sodium in the various populations.

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Mineral content in French type bread with sodium replacement using fluorescence spectrometry X-rays by energy dispersive
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“A recent review of studies evaluating sodium intake in many countries has shown that in most populations, the mineral consumption is above 2,300 mg day, and particularly in China and Japan, the average was above 4,600 mg day (Brown et al., 2009).”
Background
REDUÇÃO DAS CONCENTRAÇÕES DE CLORETO DE SÓDIO NA ALIMENTAÇÃO VISANDO A HOMEOSTASE DA PRESSÃO ARTERIAL
Martelli, A. (2014) · Revista Eletrônica em Gestão Educação e Tecnologia Ambiental · doi:10.5902/2236117012486 · Cited by 6
Salt intake, blood pressure, and socioeconomic disparities among government employees in Sri Lanka: a cross-sectional study
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“As with reductions in SBP, a population-wide 2 mmHg reduction in DBP has been predicted to result in a 17 per cent decrease in the prevalence of hypertension as well as a 6 per cent reduction in the risk of ischaemic heart disease (IHD) and a 15 per cent reduction in the risk of stroke and transient ischaemic attacks.…”
Background
Association between estimated glomerular filtration rate and sodium excretion in urine of African descendants in Brazil: a population-based study
Santos, E. M. D., Brito, D. J. D. A., França, A. K. D. C. T., Lages, J. S., dos Santos, A. M., & Filho, N. S. (2018) · Brazilian Journal of Nephrology · doi:10.1590/2175-8239-jbn-3864 · Cited by 8
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“In view of different cultural habits and dietary preferences, dietary Na intake and the major contributory sources vary among populations(6).”
BackgroundMethod
Geo-chemical investigation of groundwater salinity status in selected coastal areas of south western Nigeria
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“Moreover, increase in salt dietary intake has been reported as one of the causes of cardiovascular diseases responsible for 62% of strokes and 49% of coronary heart disease (Legetic and Campbell 2011; Brown et al. 2009).”
Background
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Parniakov, O., Mikhrovska, M., Toepfl, S., Roselló‐Soto, E., Pinto, C. A., Saraiva, J. A., & Barba, F. J. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-817226-1.00006-0 · Cited by 6
Low-Salt Intake during Mating or Gestation in Rats Is Associated with Low Birth and Survival Rates of Babies
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Improved Nutrition: Key to Solving the Populationwide Blood Pressure Problem
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High-salt diet drives depression-like behavior in mice by inducing IL-17A production
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Santos, J. A., Bolton, K. A., Rosewarne, E., Trieu, K., Tanna, G. L. D., Woodward, M., Webster, J. L., & Grimes, C. A. (2022) · Nutrition Journal · doi:10.1186/s12937-022-00823-8 · Cited by 5
Twenty-four hour urinary sodium and potassium excretion in adult population of Slovenia: results of the Manjsoli.si/2022 study
Kugler, S., Blaznik, U., Rehberger, M., Zaletel, M., Korošec, A., Somrak, M., Oblak, A., Pravst, I., Hribar, M., Kušar, A., et al. (2024) · Public Health Nutrition · doi:10.1017/s1368980024001605 · Cited by 5
Three-Year Safety and Effectiveness of Fixed-Dose Losartan/Hydrochlorothiazide Combination Therapy in Japanese Patients with Hypertension Under Clinical Setting (PALM-1 Extension Study)
Kita, T., Yokota, N., Ichiki, Y., Ayabe, T., Etoh, T., Tamaki, N., Kato, J., Eto, T., & Kitamura, K. (2012) · Clinical and Experimental Hypertension · doi:10.3109/10641963.2012.666606 · Cited by 5
“Salt intake in the Japanese population is relatively high, and practical salt restriction is extremely difficult in Japan (9,10).”
Background
An Experimental Demonstration of a Multi-element Flame Photometer: Determination of Salt Concentration in Soy Sauce
Chu, H. T., & Taylor, S. E. (2015) · International Journal of Chemistry · doi:10.5539/ijc.v8n1p25 · Cited by 5
Titanium Implant Impairment and Surrounding Muscle Cell Death Following High-Salt Diet: An In Vivo Study
Lecocq, M., Félix, M., Linares, J., Chaves‐Jacob, J., Decherchi, P., & Dousset, E. (2016) · PLoS ONE · doi:10.1371/journal.pone.0146873 · Cited by 5
“In industrialized population, average of sodium chloride (NaCl) uptake excels twice as much as the maximal recommended intake of 85 mmol sodium (Na) per day (nearly 5g NaCl/day) [2,3].”
Background
Dietary patterns and prevalence of multimorbidity in women in southern Brazil
Stürmer, J., Franken, D. L., Ternus, D. L., Henn, R. L., da Costa, J. S. D., Olinto, M. T. A., & Paniz, V. M. V. (2022) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002023 · Cited by 5
Hubungan Tingkat Konsumsi Garam terhadap Kejadian Hipertensi di Asia Tenggara
Shafrina, A. A., Sulastri, D., & Burhan, I. R. (2022) · Jurnal Ilmu Kesehatan Indonesia · doi:10.25077/jikesi.v2i3.452 · Cited by 5
Estimation of Salt Intake in Normotensive and Hypertensive Children: The Role of Body Weight
Kos, M., Nađ, T., Stanojević, L., Lukić, M., Stupin, A., Drenjančević, I., Pušeljić, S., Cvetko, E. D., Mihaljević, Z., Dumancic, D., et al. (2023) · Nutrients · doi:10.3390/nu15030736 · Cited by 8
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Background
Sodium intake according to NOVA food classification in Brazil: trends from 2002 to 2018
Nilson, E. A. F., Andrade, G. C., Claro, R. M., Louzada, M. L. D. C., & Levy, R. B. (2024) · Cadernos de Saúde Pública · doi:10.1590/0102-311xen073823 · Cited by 5
“Meanwhile, in most Latin American countries, in Japan, and in China, the main sources of sodium are salt and salt-based condiments added to dishes 26 .”
Background
Sodium and potassium excretion are related to bone mineral density in women with coeliac disease
Turner, K., Clifton, P. M., & Keogh, J. B. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2014.04.001 · Cited by 5
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Result
A cross-national comparative study of blood pressure levels and hypertension prevalence in Canada and Hungary
Steiner, S., Helis, E., Chen, L., Turton, P., Leenen, F. H. H., Sonkodi, S., Sonkodi, B., D’Angelo, M. S., & Jg, F. (2012) · Journal of Hypertension · doi:10.1097/hjh.0b013e3283589ec3 · Cited by 6
Time to refine the use of urinary iodine to assess iodine intakes in populations
Dary, O. (2011) · British Journal Of Nutrition · doi:10.1017/s0007114511005514 · Cited by 5
“However, in many countries discretional use of salt (cooking and table salt) is increasingly being replaced by salt from processed foods((3)).”
Background
Lower sodium intake reduces blood pressure in adults and children, but is not associated with a reduced risk of all CVD or all cause mortality
Alderman, M. H., & Cohen, H. W. (2013) · BMJ Evidence-Based Medicine · doi:10.1136/eb-2013-101385 · Cited by 5
Reduction of sodium intake and problems in the prevention of cardiovascular diseases
Молчанова, О. В., An, B., & Вячеславовна, П. Е. (2018) · Russian Journal of Preventive Medicine · doi:10.17116/profmed201821444 · Cited by 7
Salt and health
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The Short-Term Effects of Roux-en-Y Gastric Bypass on Renal Excretion of Sodium and Its Association with Blood Pressure
López-Martínez, J. E., Chávez-Negrete, A. J., Rodríguez-González, A., Molina-Ayala, M., Villanueva-Recillas, S., Maravilla, P., Reséndiz-Barragán, A. M., Rentería-Palomo, E., & Rojano‐Rodriguez, M. (2019) · Obesity Surgery · doi:10.1007/s11695-019-04134-6 · Cited by 5
Sodium and potassium contents and ratios in pork stews produced with lower amounts of sodium chloride
Lilić, S., Nikolić, D., Lazić, I. B., Borović, B., Baltić, B., Korićanac, V., & Vranić, D. (2019) · IOP Conference Series Earth and Environmental Science · doi:10.1088/1755-1315/333/1/012074 · Cited by 5
Transfer of repeated exposure cost via color–flavor associations
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Effect of Formulation Technology on Characteristics and Prices of Cassava Instant Noodles Seasoning Gluten Free
Herawati, H., Kamsiati, E., & Bachtiar, M. (2020) · IOP Conference Series Earth and Environmental Science · doi:10.1088/1755-1315/519/1/012038 · Cited by 5
“Whereas in household food processing, NaCl is used for several purposes mainly to improve flavor [15].”
Background
Attitudes, knowledge and behaviors about salt consumption according to the perception of a group of women in Paraguay
Benítez, G., Cañete, F., Sequera, G., Turnes, C., Hernegard, S., & Ruoti, M. (2020) · Anales de la Facultad de Ciencias Médicas (Asunción) · doi:10.18004/anales/2020.053.03.95 · Cited by 5
Development and double cross-validation of new spot urine sodium equation to predict 24-h urine sodium in the Malaysian population
Othman, F., Ambak, R., Omar, M. A., Shahar, S., Nor, N. S. M., Ahmad, M. H., Yusoff, M. F. M., Haron, H., Noh, M. F. M., & Aris, T. (2021) · Journal of Health Population and Nutrition · doi:10.1186/s41043-021-00232-3 · Cited by 5
Levels of Salt Reduction in Bread, Acceptability and Purchase Intention by Urban Mozambican Consumers
Jessen, N., Damasceno, A. A. M., Padrão, P., & Lunet, N. (2022) · Foods · doi:10.3390/foods11030454 · Cited by 6
“However, overall high intakes have been found in several populations [21], including in Africa, and particularly in urban settings [22,23].”
Background
Positive relationships between annual changes in salt intake and plasma B-type natriuretic peptide levels in the general population without hypertension and heart diseases
Ohashi, N., Takase, H., Aoki, T., Ishigaki, S., Iwakura, T., Isobe, S., Fujikura, T., Kato, A., & Yasuda, H. (2022) · Hypertension Research · doi:10.1038/s41440-022-00914-3 · Cited by 5
“Asians are known to have higher salt intake than individuals in other regions [21].”
Dietary intakes of hypertensive patients in rural India: Secondary outcomes of a randomised, double-blind, controlled trial
Thout, S. R., Yu, J., Santos, J. A., Hameed, M., & Coyle, D. H. (2023) · Dialogues in Health · doi:10.1016/j.dialog.2023.100109 · Cited by 6
“Salt substitutes are particularly effective for populations where a large portion of dietary sodium comes from salt added during cooking or at the table (discretionary salt use), such as in India [21 – 23].”
Background

Authors: Brown, I. J., Tzoulaki, I., Candeias, V., & Elliott, P.
Affiliations: Imperial College London (GB)
World Health Organization (CH)
Corresponding author: Elliott, P.
ORCID: Brown, I. J
Tzoulaki, I.
Elliott, P.
Venue: International Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 2009-04-07
Volume: 38
Issue: 3
Pages: 791-813
ISSN: 0300-5771 (ISSN-L)
1464-3685
DOI: 10.1093/ije/dyp139
OpenAlex: W2154301407
Cited by: 1,173
References: 157
Citations by year: 2026: 13 · 2025: 31 · 2024: 33 · 2023: 61 · 2022: 66 · 2021: 87 · 2020: 94 · 2019: 81 · 2018: 78 · 2017: 90 · 2016: 98 · 2015: 109 · 2014: 95 · 2013: 92 · 2012: 61
FWCI: 46.14
Type: journal article
Language: en
Open access: closed
Locations: International Journal of Epidemiology (publishedVersion)
PubMed (publishedVersion)
Funders: World Health Organization
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, salt reduction, sodium excretion, INTERSALT, INTERMAP, sodium sources, processed foods, soy sauce, blood pressure, cardiovascular health, salt reduction policy, cross-national comparison
MeSH terms: Adolescent, Adult, Cardiovascular Diseases, Child, Child, Preschool, Cooking, Cross-Cultural Comparison, Diet, Feeding Behavior, Female, Health Promotion, Humans, Hypertension, Infant, Infant, Newborn, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Global Health, Sodium Chloride, Dietary, Young Adult

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Salt intakes around the world: implications for public health

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