Effect of lower sodium intake on health: systematic review and meta-analyses
Open accessAbstract
OBJECTIVE: To assess the effect of decreased sodium intake on blood pressure, related cardiovascular diseases, and potential adverse effects such as changes in blood lipids, catecholamine levels, and renal function. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, the Latin American and Caribbean health science literature database, and the reference lists of previous reviews. STUDY SELECTION: Randomised controlled trials and prospective cohort studies in non-acutely ill adults and children assessing the relations between sodium intake and blood pressure, renal function, blood lipids, and catecholamine levels, and in non-acutely ill adults all cause mortality, cardiovascular disease, stroke, and coronary heart disease. STUDY APPRAISAL AND SYNTHESIS: Potential studies were screened independently and in duplicate and study characteristics and outcomes extracted. When possible we conducted a meta-analysis to estimate the effect of lower sodium intake using the inverse variance method and a random effects model. We present results as mean differences or risk ratios, with 95% confidence intervals. RESULTS: We included 14 cohort studies and five randomised controlled trials reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease; and 37 randomised controlled trials measuring blood pressure, renal function, blood lipids, and catecholamine levels in adults. Nine controlled trials and one cohort study in children reporting on blood pressure were also included. In adults a reduction in sodium intake significantly reduced resting systolic blood pressure by 3.39 mm Hg (95% confidence interval 2.46 to 4.31) and resting diastolic blood pressure by 1.54 mm Hg (0.98 to 2.11). When sodium intake was <2 g/day versus ≥ 2 g/day, systolic blood pressure was reduced by 3.47 mm Hg (0.76 to 6.18) and diastolic blood pressure by 1.81 mm Hg (0.54 to 3.08). Decreased sodium intake had no significant adverse effect on blood lipids, catecholamine levels, or renal function in adults (P>0.05). There were insufficient randomised controlled trials to assess the effects of reduced sodium intake on mortality and morbidity. The associations in cohort studies between sodium intake and all cause mortality, incident fatal and non-fatal cardiovascular disease, and coronary heart disease were non-significant (P>0.05). Increased sodium intake was associated with an increased risk of stroke (risk ratio 1.24, 95% confidence interval 1.08 to 1.43), stroke mortality (1.63, 1.27 to 2.10), and coronary heart disease mortality (1.32, 1.13 to 1.53). In children, a reduction in sodium intake significantly reduced systolic blood pressure by 0.84 mm Hg (0.25 to 1.43) and diastolic blood pressure by 0.87 mm Hg (0.14 to 1.60). CONCLUSIONS: High quality evidence in non-acutely ill adults shows that reduced sodium intake reduces blood pressure and has no adverse effect on blood lipids, catecholamine levels, or renal function, and moderate quality evidence in children shows that a reduction in sodium intake reduces blood pressure. Lower sodium intake is also associated with a reduced risk of stroke and fatal coronary heart disease in adults. The totality of evidence suggests that most people will likely benefit from reducing sodium intake.
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Nearly all observational studies demonstrate a positive association between very high sodium intakes (e.g., 4000+ mg/d) and CVD events, in particular stroke.
“Nearly all observational studies demonstrate a positive association between very high sodium intakes (e.g., 4000+ mg/d) and CVD events, in particular stroke.305-307”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [305]
In meta-analyses of longitudinal studies, high sodium intakes associate with incident total stroke, stroke mortality, and CHD mortality.
“In meta-analyses of longitudinal studies, high sodium intakes associate with incident total stroke, stroke mortality, and CHD mortality (Figure 7).305-307”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [306]
In meta-analyses of prospective observational studies, the lowest mean intakes associated with lower risk of CVD events ranged from 1787 to 2391 mg/d.
“In meta-analyses of prospective observational studies, the lowest mean intakes associated with lower risk of CVD events ranged from 1787 to 2391 mg/d.305”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [305]
Nearly all observational studies demonstrate a positive association between very high sodium intakes (e.g., 4000+ mg/d) and CVD events, in particular stroke.
“Nearly all observational studies demonstrate a positive association between very high sodium intakes (e.g., 4000+ mg/d) and CVD events, in particular stroke.305-307”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [306]
In meta-analyses of longitudinal studies, high sodium intakes associate with incident total stroke, stroke mortality, and CHD mortality.
“In meta-analyses of longitudinal studies, high sodium intakes associate with incident total stroke, stroke mortality, and CHD mortality (Figure 7).305-307”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [305]
The included trials were underpowered to detect moderate risk reductions.
“Meta-analyses of CVD event trials did not report a significant reduction in CVD with lower sodium intake, but the included trials were underpowered to detect moderate risk reductions (258).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [258]
Meta-analyses of CVD event trials did not report a significant reduction in CVD with lower sodium intake.
“Meta-analyses of CVD event trials did not report a significant reduction in CVD with lower sodium intake, but the included trials were underpowered to detect moderate risk reductions (258).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [258]
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- Authors
- Aburto, N. J., Ziolkovska, A., Hooper, L., Elliott, P., Cappuccio, F. P., & Meerpohl, J. J.
- Affiliations
- World Health Organization (CH)
- University of East Anglia (GB)
- Imperial College London (GB)
- University of Warwick (GB)
- University Medical Center Freiburg (DE)
- Corresponding author
- Aburto, N. J.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2013-04-03
- Volume
- 346
- Issue
- apr03 3
- Pages
- f1326-f1326
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC4816261
- OpenAlex
- W2167945952
- Cited by
- 1,242
- References
- 163
- Citations by year
- 2026: 26 · 2025: 54 · 2024: 74 · 2023: 80 · 2022: 106 · 2021: 101 · 2020: 115 · 2019: 128 · 2018: 101 · 2017: 110 · 2016: 95 · 2015: 99 · 2014: 106 · 2013: 39 · 2012: 5
- FWCI
- 12.76
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion, cc-by-nc)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10136)
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007734)
- 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
- low sodium intake, dietary sodium reduction, blood pressure, cardiovascular disease, stroke, coronary artery disease, all-cause mortality, serum lipids, catecholamines, renal function, children, hypertension prevention, salt reduction interventions, sodium reduction
- MeSH terms
- Blood Pressure, Cardiovascular Diseases, Catecholamines, Diet, Sodium-Restricted, Female, Humans, Hypertension, Kidney, Male, Prospective Studies, Public Health, Randomized Controlled Trials as Topic, Sodium Chloride, Dietary, Lipid Metabolism
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