The DOI matches its Crossref record; 14 of the 14 references it cites were found in a registry or an index.
Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis
Abstract
Dietary sodium intake has received considerable attention as a potential risk factor of cardiovascular disease. However, evidence on the dose-response association between dietary sodium intake and cardiovascular disease risk is unclear. Embase and PubMed were searched from their inception to 17 August 2020 and studies that examined the association between sodium intake and cardiovascular disease in adolescents were not included in this review. We conducted a meta-analysis to estimate the effect of high sodium intake using a random effects model. The Newcastle-Ottawa Scale assessment was performed. A random-effects dose-response model was used to estimate the linear and nonlinear dose-response relationships. Subgroup analyses and meta-regression were conducted to explain the observed heterogeneity. We identified 36 reports, which included a total of 616,905 participants, and 20 of these reports were also used for a dose-response meta-analysis. Compared with individuals with low sodium intake, individuals with high sodium intake had a higher adjusted risk of cardiovascular disease (Rate ratio: 1.19, 95% confidence intervals = 1.08–1.30). Our findings suggest that there is a significant linear relationship between dietary sodium intake and cardiovascular disease risk. The risk of cardiovascular disease increased up to 6% for every 1 g increase in dietary sodium intake. A low-sodium diet should be encouraged and education regarding reduced sodium intake should be provided.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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
“overconsumption of sodium among athletes does not confer performance benefits [60] and may pose health risks [61].”
From Dietary Intake of Canadian Middle‐Aged Endurance Athletes (2025) · cites this paper as [61]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Stang, A. (2010) · European Journal of Epidemiology · doi:10.1007/s10654-010-9491-z · Cited by 17,396
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010) · International Journal of Surgery · doi:10.1016/j.ijsu.2010.02.007 · Cited by 12,156
Methods for Trend Estimation from Summarized Dose-Response Data, with Applications to Meta-Analysis
Greenland, S., & Longnecker, M. P. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116237 · Cited by 2,353
Effect of lower sodium intake on health: systematic review and meta-analyses
Aburto, N. J., Ziolkovska, A., Hooper, L., Elliott, P., Cappuccio, F. P., & Meerpohl, J. J. (2013) · BMJ · doi:10.1136/bmj.f1326 · Cited by 1,242
Global Sodium Consumption and Death from Cardiovascular Causes
Mozaffarian, D., Fahimi, S., Singh, G. M., Micha, R., Khatibzadeh, S., Engell, R. E., Lim, S., Danaei, G., Ezzati, M., & Powles, J. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1304127 · Cited by 1,218 · cited 2×
“95 g, approximately twice as much as the recommended 2 g, which is a threshold for CVD risk [76].”
Cook, N. R., Cutler, J. A., Obarzanek, E., Buring, J. E., Rexrode, K. M., Kumanyika, S. K., Appel, L. J., & Whelton, P. K. (2007) · BMJ · doi:10.1136/bmj.39147.604896.55 · Cited by 1,179
Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events
O'Donnell, M., Mente, A., Rangarajan, S., McQueen, M. J., Wang, X., Liu, L., Yan, H., Lee, S. F., Mony, P., Devanath, A., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1311889 · Cited by 886
Stolarz-Skrzypek, K. (2011) · JAMA · doi:10.1001/jama.2011.574 · Cited by 569
Graudal, N., Jürgens, G., Baslund, B., & Alderman, M. H. (2014) · American Journal of Hypertension · doi:10.1093/ajh/hpu028 · Cited by 407 · cited 1×
“Participants with an intake of more than 215 mmol and less than 115 mmol had higher mortality compared to participants with a dietary sodium intake between 115–215 mmol [71].”
Thomas, M. C., Moran, J., Forsblom, C., Harjutsalo, V., Thorn, L., Ahola, A., Wadén, J., Tolonen, N., Saraheimo, M., Gordin, D., et al. (2011) · Diabetes Care · doi:10.2337/dc10-1722 · Cited by 349
Research works printed but not linked: 71
- Powles, 2013, Global, regional and national sodium intakes in 1990 and 2010: A systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide, BMJ Open, 3, e003733, 10.1136/bmjopen-2013-003733 · DOI · Paper page
- Stamler, 1997, The INTERSALT Study: Background, methods, findings, and implications, Am. J. Clin. Nutr., 65, 626s, 10.1093/ajcn/65.2.626S · DOI · Paper page
- DeSalvo, 2016, Dietary Guidelines for Americans, JAMA, 315, 457, 10.1001/jama.2015.18396 · DOI · Paper page
- Ayala, 2009, Application of lower sodium intake recommendations to adults—United States, 1999–2006, MMWR Morb. Mortal. Wkly. Rep., 58, 281
- He, F.J., Li, J., and MacGregor, G.A. (2013). Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst. Rev. · DOI · Paper page
- Graudal, 2019, Dose-response relation between dietary sodium and blood pressure: A meta-regression analysis of 133 randomized controlled trials, Am. J. Clin. Nutr., 109, 1273, 10.1093/ajcn/nqy384 · DOI
- Huang, 2020, Effect of dose and duration of reduction in dietary sodium on blood pressure levels: Systematic review and meta-analysis of randomised trials, BMJ, 368, m315, 10.1136/bmj.m315 · DOI · Paper page
- Elliott, 1991, Observational studies of salt and blood pressure, Hypertension, 17, I3, 10.1161/01.HYP.17.1_Suppl.I3 · DOI
- Campbell, 2019, The international consortium for quality research on dietary sodium/salt (TRUE) position statement on the use of 24-hour, spot, and short duration (<24 h) timed urine collections to assess dietary sodium intake, J. Clin. Hypertens., 21, 700, 10.1111/jch.13551 · DOI
- Taylor, R.S., Ashton, K.E., Moxham, T., Hooper, L., and Ebrahim, S. (2011). Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database Syst. Rev. · DOI
- Strazzullo, 2009, Salt intake, stroke, and cardiovascular disease: Meta-analysis of prospective studies, BMJ, 339, b4567, 10.1136/bmj.b4567 · DOI · Paper page
- Zhu, Y., Zhang, J., Li, Z., Liu, Y., Fan, X., Zhang, Y., and Zhang, Y. (2018). Association of sodium intake and major cardiovascular outcomes: A dose-response meta-analysis of prospective cohort studies. BMC Cardiovasc. Disord., 18. · DOI
- DerSimonian, 1986, Meta-analysis in clinical trials, Control. Clin. Trials, 7, 177, 10.1016/0197-2456(86)90046-2 · DOI · Paper page
- Peters, 2005, Choice of exposure scores for categorical regression in meta-analysis: A case study of a common problem, Cancer Causes Control, 16, 383, 10.1007/s10552-004-5025-x · DOI
- Orsini, 2011, Meta-analysis for linear and nonlinear dose-response relations: Examples, an evaluation of approximations, and software, Am. J. Epidemiol., 175, 66, 10.1093/aje/kwr265 · DOI · Paper page
- Harrell, 2017, Regression modeling strategies, BIOS, 330, 2018
- White, 2009, Multivariate random-effects meta-analysis, Stata J., 9, 40, 10.1177/1536867X0900900103 · DOI · Paper page
- Orsini, 2006, Generalized least squares for trend estimation of summarized dose–response data, Stata J., 6, 40, 10.1177/1536867X0600600103 · DOI · Paper page
- Desquilbet, 2010, Dose-response analyses using restricted cubic spline functions in public health research, Stat. Med., 29, 1037, 10.1002/sim.3841 · DOI · Paper page
- Hamling, 2008, Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category, Stat. Med., 27, 954, 10.1002/sim.3013 · DOI · Paper page
- Higgins, 2003, Measuring inconsistency in meta-analyses, BMJ, 327, 557, 10.1136/bmj.327.7414.557 · DOI · Paper page
- Egger, 1997, Bias in meta-analysis detected by a simple, graphical test, BMJ, 315, 629, 10.1136/bmj.315.7109.629 · DOI · Paper page
- Kagan, 1985, Dietary and other risk factors for stroke in Hawaiian Japanese men, Stroke, 16, 390, 10.1161/01.STR.16.3.390 · DOI
- Hu, 1992, Incidence of stroke in Taiwan, Stroke, 23, 1237, 10.1161/01.STR.23.9.1237 · DOI
- Alderman, 1998, Dietary sodium intake and mortality: The National Health and Nutrition Examination Survey (NHANES I), Lancet, 351, 781, 10.1016/S0140-6736(97)09092-2 · DOI · Paper page
- He, 1999, Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults, J. Am. Med Assoc., 282, 2027, 10.1001/jama.282.21.2027 · DOI · Paper page
- Tuomilehto, 2001, Urinary sodium excretion and cardiovascular mortality in Finland: A prospective study, Lancet, 357, 848, 10.1016/S0140-6736(00)04199-4 · DOI · Paper page
- He, 2002, Dietary sodium intake and incidence of congestive heart failure in overweight US men and women: First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, Arch. Intern. Med., 162, 1619, 10.1001/archinte.162.14.1619 · DOI
- Nagata, 2004, Sodium intake and risk of death from stroke in Japanese men and women, Stroke, 35, 1543, 10.1161/01.STR.0000130425.50441.b0 · DOI · Paper page
- Cohen, 2006, Sodium intake and mortality in the NHANES II follow-up study, Am. J. Med., 119, 275.e7, 10.1016/j.amjmed.2005.10.042 · DOI
- Geleijnse, 2007, Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: The Rotterdam Study, Eur. J. Epidemiol., 22, 763, 10.1007/s10654-007-9186-2 · DOI
- Cohen, 2008, Sodium intake and mortality follow-up in the Third National Health and Nutrition Examination Survey (NHANES III), J. Gen. Intern. Med., 23, 1297, 10.1007/s11606-008-0645-6 · DOI
- Larsson, 2008, Magnesium, calcium, potassium, and sodium intakes and risk of stroke in male smokers, Arch. Intern. Med., 168, 459, 10.1001/archinte.168.5.459 · DOI
- Umesawa, 2008, Relations between dietary sodium and potassium intakes and mortality from cardiovascular disease: The Japan Collaborative Cohort study for evaluation of cancer risks, Am. J. Clin. Nutr., 88, 195, 10.1093/ajcn/88.1.195 · DOI
- Dong, 2010, Low dietary sodium intake increases the death risk in peritoneal dialysis, Clin. J. Am. Soc. Nephrol., 5, 240, 10.2215/CJN.05410709 · DOI
- Takachi, 2010, Consumption of sodium and salted foods in relation to cancer and cardiovascular disease: The Japan public health center-based prospective study, Am. J. Clin. Nutr., 91, 456, 10.3945/ajcn.2009.28587 · DOI
- Yang, 2011, Sodium and potassium intake and mortality among US adults: Prospective data from the Third National Health and Nutrition Examination Survey, Arch. Intern. Med., 171, 1183, 10.1001/archinternmed.2011.257 · DOI · Paper page
- Ikehara, 2012, Salt preference and mortality from stroke and coronary heart disease for Japanese men and women: The JACC study, Prev. Med., 54, 32, 10.1016/j.ypmed.2011.10.013 · DOI
- Cook, 2014, Lower levels of sodium intake and reduced cardiovascular risk, Circulation, 129, 981, 10.1161/CIRCULATIONAHA.113.006032 · DOI · Paper page
- Horikawa, 2014, Dietary sodium intake and incidence of diabetes complications in Japanese patients with type 2 diabetes: Analysis of the Japan diabetes complications study (JDCS), J. Clin. Endocrinol. Metab., 99, 3635, 10.1210/jc.2013-4315 · DOI
- Joosten, 2014, Sodium excretion and risk of developing coronary heart disease, Circulation, 129, 1121, 10.1161/CIRCULATIONAHA.113.004290 · DOI
- Pfister, 2014, Estimated urinary sodium excretion and risk of heart failure in men and women in the EPIC-Norfolk study, Eur. J. Heart Fail., 16, 394, 10.1002/ejhf.56 · DOI · Paper page
- Singer, 2015, Assessing the associations of sodium intake with long-term all-cause and cardiovascular mortality in a hypertensive cohort, Am. J. Hypertens., 28, 335, 10.1093/ajh/hpu141 · DOI
- Lamelas, 2016, Association of urinary sodium excretion with blood pressure and cardiovascular clinical events in 17,033 Latin Americans, Am. J. Hypertens., 29, 796, 10.1093/ajh/hpv195 · DOI
- Polonia, 2016, High salt intake is associated with a higher risk of cardiovascular events: A 7.2-year evaluation of a cohort of hypertensive patients, Blood Press. Monit., 21, 301, 10.1097/MBP.0000000000000205 · DOI
- Vogt, 2017, Use of a single baseline versus multiyear 24-hour urine collection for estimation of long-term sodium intake and associated cardiovascular and renal risk, Circulation, 136, 917, 10.1161/CIRCULATIONAHA.117.029028 · DOI
- Prentice, 2017, Associations of Biomarker-Calibrated Sodium and Potassium Intakes with Cardiovascular Disease Risk among Postmenopausal Women, Am. J. Epidemiol., 186, 1035, 10.1093/aje/kwx238 · DOI
- Kieneker, 2018, Association of Low Urinary Sodium Excretion with Increased Risk of Stroke, Mayo Clin. Proc., 93, 1803, 10.1016/j.mayocp.2018.05.028 · DOI
- Lelli, 2018, Association between sodium excretion and cardiovascular disease and mortality in the elderly: A cohort study, J. Am. Med Dir. Assoc., 19, 229, 10.1016/j.jamda.2017.09.004 · DOI
- Liu, 2018, Urinary sodium excretion and risk of cardiovascular disease in the Chinese population: A prospective study, Hypertens. Res., 41, 849, 10.1038/s41440-018-0091-8 · DOI
- Mente, 2018, Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: A community-level prospective epidemiological cohort study, Lancet, 392, 496, 10.1016/S0140-6736(18)31376-X · DOI · Paper page
- Kondo, 2019, Cardiovascular risk assessment chart by dietary factors in Japan—NIPPON DATA80, Circ. J., 83, 1254, 10.1253/circj.CJ-18-1002 · DOI
- Mente, 2019, Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: Prospective cohort study, BMJ, 364, l772
- Milajerdi, 2019, Dose–response association of dietary sodium intake with all-cause and cardiovascular mortality: A systematic review and meta-analysis of prospective studies, Public Health Nutr., 22, 295, 10.1017/S1368980018002112 · DOI
- Graudal, 2014, The data show a u-shaped association of sodium intake with cardiovascular disease and mortality, Am. J. Hypertens., 28, 424, 10.1093/ajh/hpu236 · DOI
- Cobb, 2014, Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes: A science advisory from the American Heart Association, Circulation, 129, 1173, 10.1161/CIR.0000000000000015 · DOI · Paper page
- Jayedi, 2019, Dietary sodium, sodium-to-potassium ratio, and risk of stroke: A systematic review and nonlinear dose-response meta-analysis, Clin. Nutr., 38, 1092, 10.1016/j.clnu.2018.05.017 · DOI
- Peach, 1977, Renin-angiotensin system: Biochemistry and mechanisms of action, Physiol. Rev., 57, 313, 10.1152/physrev.1977.57.2.313 · DOI · Paper page
- Walker, 1979, Relation between blood pressure and renin, renin substrate, angiotensin II, aldosterone and urinary sodium and potassium in 574 ambulatory subjects, Hypertension, 1, 287, 10.1161/01.HYP.1.3.287 · DOI · Paper page
- Haddy, 1980, Mechanism, prevention and therapy of sodium-dependent hypertension, Am. J. Med., 69, 746, 10.1016/0002-9343(80)90445-3 · DOI
- Weinberger, 1996, Salt sensitivity of blood pressure in humans, Hypertension, 27, 481, 10.1161/01.HYP.27.3.481 · DOI · Paper page
- Dunn, M., and Tannen, R. (1977). Low Renin Essential Hypertension. Hypertension, McGraw-Hill.
- Chen, 2009, Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: A dietary intervention study, Lancet, 373, 829, 10.1016/S0140-6736(09)60144-6 · DOI
- Koomans, 1982, Salt sensitivity of blood pressure in chronic renal failure. Evidence for renal control of body fluid distribution in man, Hypertension, 4, 190, 10.1161/01.HYP.4.2.190 · DOI
- Weinberger, 1986, Definitions and characteristics of sodium sensitivity and blood pressure resistance, Hypertension, 8, II127, 10.1161/01.HYP.8.6_Pt_2.II127 · DOI · Paper page
- Rodriguez, 1994, Rise of blood pressure with age. New evidence of population differences, Hypertension, 24, 779, 10.1161/01.HYP.24.6.779 · DOI
- Weinberger, 1987, Association of haptoglobin with sodium sensitivity and resistance of blood pressure, Hypertension, 10, 443, 10.1161/01.HYP.10.4.443 · DOI
- Land, 2014, The association of knowledge, attitudes and behaviours related to salt with 24-hour urinary sodium excretion, Int. J. Behav. Nutr. Phys. Act., 11, 47, 10.1186/1479-5868-11-47 · DOI
- Yuan, 2017, Validity of a dietary questionnaire assessed by comparison with multiple weighed dietary records or 24-hour recalls, Am. J. Epidemiol., 185, 570, 10.1093/aje/kww104 · DOI · Paper page
- Micheli, 2003, Estimation of sodium intake by urinary excretion and dietary records in children and adolescents from Porto Alegre, Brazil: A comparision of two methods, Nutr. Res., 23, 1477, 10.1016/S0271-5317(03)00157-X · DOI
- McLean, 2019, Comparison of 24-hour urine and 24-hour diet recall for estimating dietary sodium intake in populations: A systematic review and meta-analysis, J. Clin. Hypertens., 21, 1753, 10.1111/jch.13729 · DOI
Cited by
Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001123 · Cited by 8,300
Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001052 · Cited by 5,987
Martin, S. S., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Barone Gibbs, B., Beaton, A. Z., Boehme, A. K., et al. (2024) · Circulation · doi:10.1161/cir.0000000000001209 · Cited by 2,800
Dietary Intake of Canadian Middle‐Aged Endurance Athletes
Ghomeshi, B., McPhee, L., Morello, O., Ismail, M., Kebbe, M., & Totosy de Zepetnek, J. O. (2025) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.70182
Metadata
- Authors
- Wang, Y.-J., Yeh, T.-L., Shih, M.-C., Tu, Y.-K., & Chien, K.-L.
- Affiliations
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2020-09-25
- Volume
- 12
- Issue
- 10
- Pages
- 2934
- ISSN
- 2072-6643
- Cited by
- 217
- References
- 14
- Language
- en
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
How to cite
Cite CoChat for the checks on this page, and the paper for its own findings.
- This page
- CoChat. (2026). Citation check: Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis. https://app.cochat.ai/papers/10.3390/nu12102934
- The paper
- Wang, Y.-J., Yeh, T.-L., Shih, M.-C., Tu, Y.-K., & Chien, K.-L. (2020). Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis. Nutrients. https://doi.org/10.3390/nu12102934
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.