Cited by 940Sodium Intake and HealthNutritional Studies and DietBlood Pressure and Hypertension Studies

Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide

Open access
Powles, John, Fahimi, Saman, Micha, Renata, Khatibzadeh, Shahab, Shi, Peilin, Ezzati, Majid, Engell, Rebecca E, Lim, Stephen S +3 more·2013·BMJ Open

Abstract

Objectives: To estimate global, regional (21 regions) and national (187 countries) sodium intakes in adults in 1990 and 2010. Design: Bayesian hierarchical modelling using all identifiable primary sources. Data sources and eligibility: We searched and obtained published and unpublished data from 142 surveys of 24 h urinary sodium and 103 of dietary sodium conducted between 1980 and 2010 across 66 countries. Dietary estimates were converted to urine equivalents based on 79 pairs of dual measurements. Modelling methods: Bayesian hierarchical modelling used survey data and their characteristics to estimate mean sodium intake, by sex, 5 years age group and associated uncertainty for persons aged 20+ in 187 countries in 1990 and 2010. Country-level covariates were national income/person and composition of food supplies. Main outcome measures: Mean sodium intake (g/day) as estimable by 24 h urine collections, without adjustment for non-urinary losses. Results: In 2010, global mean sodium intake was 3.95 g/day (95% uncertainty interval: 3.89 to 4.01). This was nearly twice the WHO recommended limit of 2 g/day and equivalent to 10.06 (9.88–10.21) g/day of salt. Intake in men was ∼10% higher than in women; differences by age were small. Intakes were highest in East Asia, Central Asia and Eastern Europe (mean >4.2 g/day) and in Central Europe and Middle East/North Africa (3.9–4.2 g/day). Regional mean intakes in North America, Western Europe and Australia/New Zealand ranged from 3.4 to 3.8 g/day. Intakes were lower (<3.3 g/day), but more uncertain, in sub-Saharan Africa and Latin America. Between 1990 and 2010, modest, but uncertain, increases in sodium intakes were identified. Conclusions: Sodium intakes exceed the recommended levels in almost all countries with small differences by age and sex. Virtually all populations would benefit from sodium reduction, supported by enhanced surveillance.

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  • Nearly every country in the world exceeds the recommended mean national intake of 2000 mg/d.

    “Nearly every country in the world exceeds the recommended mean national intake of 2000 mg/d.303”
  • The observed diversity of diets within and across individuals, generations, cultures, and populations further belies a particular biologic preference for food.

    “The observed diversity of diets within and across individuals, generations, cultures, and populations further belies a particular biologic preference for food.4, 346, 392-394”
  • The observed diversity of diets within and across individuals, generations, cultures, and populations further belies a particular biologic preference for food.

    “The observed diversity of diets within and across individuals, generations, cultures, and populations further belies a particular biologic preference for food.4, 346, 392-394”
  • These prior pooling projects pooled individual-level data across multiple prospective studies, together totaling 99 cohorts, 1.38 million participants, and 65,000 cardiovascular events, with consistent adjustment for confounders and accounting for regression dilution bias based on serial measures of blood pressure over time.

    “These studies pooled individual level data across multiple prospective studies, together totaling 99 cohorts, 1.38 million participants, and 65,000 cardiovascular events; with consistent adjustment for confounders and accounting for regression dilution bias based on serial measures of BP over time.”
  • The dose-response relationship between blood pressure and cardiovascular disease mortality has been established in prior pooling projects including the Prospective Studies Collaborative and the Asia Pacific Cohort Studies Collaborative.

    “The dose-response relationship between BP and CVD mortality has been established in prior pooling projects including the Prospective Studies Collaborative and the Asia Pacific Cohort Studies Collaborative.14,15”

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Research works printed but not linked: 3

  1. [21]Holbrook JT Patterson KY Bodner JE Sodium and potassium intake and balance in adults consuming self-selected diets. Am J Clin Nutr 1984; 40: 786– 93 6486085
  2. [27]World Health Organization WHO Guideline: sodium intake for adults and children. Geneva: World Health Organization, 2012 23658998
  3. [37]Sixty-sixth World Health Assembly Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases (Agenda Item 13, A66/A/CONF./1 Rev.1) Geneva: World Health Organisation, 2013

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Authors
Powles, J., Fahimi, S., Micha, R., Khatibzadeh, S., Shi, P., Ezzati, M., Engell, R. E., Lim, S. S., Danaei, G., Mozaffarian, D., & on behalf of the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE)
Affiliations
  • University of Cambridge (GB)
  • Agricultural University of Athens (GR)
  • Harvard University (US)
  • MRC Centre for Environment and Health (GB)
  • University of Washington (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Powles, John
Venue
BMJ Open
Publisher
BMJ
Published
2013-12
Volume
3
Issue
12
Pages
e003733
ISSN
2044-6055 (ISSN-L)
OpenAlex
W2155793865
Cited by
940
References
39
Citations by year
2026: 33 · 2025: 54 · 2024: 61 · 2023: 99 · 2022: 108 · 2021: 107 · 2020: 120 · 2019: 82 · 2018: 79 · 2017: 53 · 2016: 53 · 2015: 60 · 2014: 29 · 2013: 1 · 2012: 1
FWCI
43.65
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • OAR@UM (University of Malta) (submittedVersion, other-oa)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
Funders
  • United States Agency for International Development
  • Bill and Melinda Gates Foundation
  • Brown University
  • American University of Beirut
  • London School of Hygiene and Tropical Medicine
  • Rutgers, The State University of New Jersey
  • Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
  • King's College London
  • University of Aberdeen
  • Indian Council of Medical Research
  • University of Queensland
  • Ministerio de Salud de la Nación
  • Gazi Üniversitesi
  • Korea Health Industry Development Institute
  • Mahidol University
  • Universiteit Gent
  • Chinese Center for Disease Control and Prevention (R01-HD38700, R24 HD050924)
  • National and Kapodistrian University of Athens
  • Universidad de Antioquia
  • Hacettepe Üniversitesi
  • Universidade de São Paulo
  • Tallinna Tehnikaülikool
  • Shahid Beheshti University of Medical Sciences
  • Hôpitaux Universitaires de Genève
  • National Research University Higher School of Economics
  • National Nutrition and Food Technology Research Institute
  • Harokopio University
  • Kementerian Kesihatan Malaysia
  • Helsedirektoratet
  • Universitas Andalas
  • Terveyden ja hyvinvoinnin laitos
  • Hellenic Health Foundation
  • Robert Koch Institut
  • National Institutes of Health (2r24hd050924-06, R24 HD‐050924, #HD050924, 5 R24 HD050924)
  • Centers for Disease Control and Prevention
  • Gillings School of Public Health
  • University of North Carolina at Chapel Hill (R24 HD050924, R01-HD38700, 5 R24 HD050924)
  • Medical Research Council (MR/K005901/1)
  • Barts and The London School of Medicine and Dentistry
  • National Center for Chronic Disease Prevention and Health Promotion
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24 HD-050924, R01HD038700, R24HD041020)
  • Carolina Population Center, University of North Carolina at Chapel Hill (R24HD050924, HD050924, 5 R24 HD050924)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
sodium intake, dietary salt, 24-hour urinary sodium excretion, dietary surveys, sodium reduction

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