Cited by 1,242Sodium Intake and HealthBlood Pressure and Hypertension StudiesNutritional Studies and Diet

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Effect of lower sodium intake on health: systematic review and meta-analyses

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Aburto, N. J., Ziolkovska, A., Hooper, L., Elliott, P., Cappuccio, F. P., Meerpohl, J. J.·2013·BMJ

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Abstract

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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Fig 1 Flow of records in adults and childrenCC BY-NC · PubMed Central

Fig 2 Effect of reduced sodium intake on resting systolic blood pressure in adultsCC BY-NC · PubMed Central

Fig 3 Direct comparisons of effect of sodium consumption of <2 g/day v >2g/day, <1.2 g/day v >1.2 g/day, and a reduction by one third or more versus less than one third relative to control on systolic blood pressure in adultsCC BY-NC · PubMed Central

Fig 4 Effect of reduced sodium intake on resting systolic blood pressure in childrenCC BY-NC · PubMed Central

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Reduced dietary salt for the prevention of cardiovascular disease
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Reduced dietary salt for the prevention of cardiovascular disease
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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.
ORCID: Hooper, L.
Elliott, P.
Cappuccio, F. P.
Meerpohl, J. J.
Venue: BMJ
Publisher: BMJ
Published: 2013-04-03
Volume: 346
Issue: apr03 3
Pages: f1326-f1326
ISSN: 1756-1833 (ISSN-L)
DOI: 10.1136/bmj.f1326
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
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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