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Dietary Sodium 'Controversy'—Issues and Potential Solutions

  • Public Health Nutrition (KE Charlton, Section Editor)
  • Published:
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Abstract

Purpose of Review

High dietary sodium is estimated to be the leading dietary risk for death attributed to 1.8 million deaths in 2019. There are uniform recommendations to reduce sodium consumption based on evidence that increased dietary sodium is responsible for approximately a third of the prevalence of hypertension, and meta-analyses of randomized controlled trials show that sodium reduction lowers blood pressure, cardiovascular disease, and total mortality. Nevertheless, there is a perception that the beneficial effect of reducing dietary sodium is controversial. We provide experiential evidence relating to some sources of the controversy and propose potential solutions.

Recent Findings

Inappropriate research methodology, lack of rigor in research, conflicts of interest and commercial bias, questions of professional conduct, and lack of policies to protect public interests are likely to contribute to the controversy about reducing dietary sodium.

Summary

There is a failure to protect policies to reduce dietary sodium from nonscientific threats. Significant efforts need to be made to ensure the integrity of nutritional research and maintain public trust.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Institute for Health Metrics and Evaluation, University of Washington. Global Burden of Disease Study. “Global burden of disease study. http://vizhub.healthdata.org/gbd-compare/. Accessed Feb 21 14, 2021. This website provides the most up-to-date estimates of risks and causes of death and disability at a global and national level.

  2. World Health Organization. The updated Appendix 3 of the WHO Global NCD Action Plan 2013-2020. Best Buys. Geneva: World Health Organization; 2017. https://apps.who.int/gb/ebwha/pdf_files/EB140/B140_27-en.pdf?ua=1

  3. World Health Organization. Saving lives, spending less: a strategic response to noncommunicable diseases. Geneva, Switzerland2018 (WHO/NMH/NVI/18.8). Licence: CC BY-NC-SA 3.0 IGO. Contract No.: WHO/NMH/NVI/18.8. https://apps.who.int/iris/handle/10665/272534

  4. Park H-K, Lee Y, Kang B-W, Kwon K-i, Kim J-W, Kwon O-S, et al. Progress on sodium reduction in South Korea. BMJ Glob Health. 2020;5(5):e002028. https://doi.org/10.1136/bmjgh-2019-002028https://gh.bmj.com/content/5/5/e002028.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Stallings VA, Harrison M, Oria M, Committee to Review the Dietary Reference Intakes for Sodium, Potassium. The National Academies Collection: Reports funded by National Institutes of Health. Dietary Reference Intakes for Sodium and Potassium. Washington (DC): National Academies Press (US) National Academy of Sciences.; 2019. https://www.ncbi.nlm.nih.gov/books/NBK538102/. This reference provides an exhaustive review and original research to support the American and Canadian dietary reference intakes for sodium.

  6. Filippini T, Malavolti M, Whelton PK, Naska A, Orsini N, Vinceti M. Blood pressure effects of sodium reduction: dose-response meta-analysis of experimental studies. Circulation. 2021;143. 10.1161/CIRCULATIONAHA.120.050371. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050371. This study provides causal evidence for a linear dose-response for increased blood pressure with increased dietary sodium.

  7. Huang L, Trieu K, Yoshimura S, Neal B, Woodward M, Campbell NR et al. Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials. BMJ. 2020;368:m315. https://www.bmj.com/content/368/bmj.m315. This study provides causal evidence for a linear dose-response for increased blood pressure with increased dietary sodium and for an incerased response with a study duration of over 2 weeks.

  8. Joffres M, Campbell NR, Manns B, Tu K. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Can J Cardiol. 2007;23(6):437–43 https://www.sciencedirect.com/science/article/abs/pii/S0828282X07707808.

    Article  Google Scholar 

  9. Committee on Public Health Priorities to Reduce and Control Hypertension, Institute of Medicine of the National Academy of Science. A population-based policy and systems change approach to prevent and control hypertension. Washington, DC, USA: National Academies Press 2010. Report No.: 0-309-14810-3. https://www.ncbi.nlm.nih.gov/books/NBK220087/

  10. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;346:f1326. https://www.bmj.com/content/346/bmj.f1326#:~:text=Conclusion,sodium%20intake%20reduced%20blood%20pressure.

  11. Strazzullo P, D'Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ. 2009;339:b4567 https://www.bmj.com/content/339/bmj.b4567.

    Article  Google Scholar 

  12. Poggio R, Gutierrez L, Matta MG, Elorriaga N, Irazola V, Rubinstein A. Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies. Public Health Nutr. 2015;18(4):695–704 https://www.cambridge.org/core/journals/public-health-nutrition/article/daily-sodium-consumption-and-cvd-mortality-in-the-general-population-systematic-review-and-metaanalysis-of-prospective-studies/215BA5FB0AACF84AD0EC1C4E6EFC16FC.

    Article  Google Scholar 

  13. Zhu Y, Zhang J, Li Z, Liu Y, Fan X, Zhang Y, et al. Association of sodium intake and major cardiovascular outcomes: a dose-response meta-analysis of prospective cohort studies. BMC Cardiovasc Disord. 2018;18(1):192. https://doi.org/10.1186/s12872-018-0927-9https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-018-0927-9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wang Y-J, Yeh T-L, Shih M-C, Tu Y-K, Chien K-L. Dietary sodium intake and risk of cardiovascular disease: a systematic review and dose-response meta-analysis. Nutrients. 2020;12(10):2934 https://www.mdpi.com/2072-6643/12/10/2934.

    Article  CAS  Google Scholar 

  15. EFSA Panel on Nutrition Novel Foods, and Food Allergens, Turck D, Castenmiller J, de Henauw S, Hirsch-Ernst K-I, Kearney J, et al. Dietary reference values for sodium. EFSA J. 2019;17(9):e05778. https://doi.org/10.2903/j.efsa.2019.5778https://efsa.onlinelibrary.wiley.com/doi/10.2903/j.efsa.2019.5778.

    Article  Google Scholar 

  16. O’Donnell M, Mente A, Alderman MH, Brady AJB, Diaz R, Gupta R et al. Salt and cardiovascular disease: insufficient evidence to recommend low sodium intake. Eur Heart J. 2020. doi:10.1093/eurheartj/ehaa586. https://academic.oup.com/eurheartj/article-abstract/41/35/3363/5917753?redirectedFrom=fulltext. This commentary illustrates the failure of peer review to ensure an accurate and complete provision and interpretation of evidence.

  17. Strazzullo P. Benefit assessment of dietary salt reduction: while the doctors study, should more people die? J Hypertens. 2011;29(5):829–31 https://journals.lww.com/jhypertension/pages/articleviewer.aspx?year=2011&issue=05000&article=00002&type=Fulltext.

    Article  CAS  Google Scholar 

  18. Campbell NR, Cappuccio FP, Tobe SW. Unnecessary controversy regarding dietary sodium: a lot about a little. Can J Cardiol. 2011;27(4):404–6 https://www.onlinecjc.ca/article/S0828-282X(11)00342-4/fulltext.

    Article  Google Scholar 

  19. Campbell NR, Lackland DT, Niebylski ML, Nilsson PM. Is reducing dietary sodium controversial? Is it the conduct of studies with flawed research methods that is controversial? A Perspective From the World Hypertension League Executive. J Clin Hypertens. 2015;17(2):85–6 https://onlinelibrary.wiley.com/doi/full/10.1111/jch.12437.

    Article  Google Scholar 

  20. Campbell NR, Lackland DT, MacGregor GA. Dietary sodium: a perspective on recent sodium evidence--its interpretation and controversies. J Clin Hypertens. 2013;15(11):765–8 https://onlinelibrary.wiley.com/doi/full/10.1111/jch.12187.

    Article  Google Scholar 

  21. Campbell NR, Appel LJ, Cappuccio FP, Correa-Rotter R, Hankey GJ, Lackland DT, et al. A call for Quality Research on Salt Intake and Health: From the World Hypertension League and Supporting Organizations. J Clin Hypertens. 2014;16(7):469–71 https://onlinelibrary.wiley.com/doi/full/10.1111/jch.12364.

    Article  Google Scholar 

  22. Campbell NR, Lackland DT, Niebylski ML, Orias M, Redburn KA, Nilsson PM, et al. 2016 Dietary Salt Fact Sheet and Call to Action: The World Hypertension League, International Society of Hypertension, and the International Council of Cardiovascular Prevention and Rehabilitation. J Clin Hypertens. 2016;18:1082–4 https://onlinelibrary.wiley.com/doi/full/10.1111/jch.12894.

    Article  Google Scholar 

  23. Campbell NR. Dissidents and dietary sodium: concerns about the commentary by O'Donnell et al. Int J Epidemiol. 2016. doi:https://doi.org/10.1093/ije/dyw292. https://academic.oup.com/ije/article/46/1/362/2760167

  24. Cappuccio FP, Sever PS. The importance of a valid assessment of salt intake in individuals and populations. A scientific statement of the British and Irish Hypertension Society. J Hum Hypertens. 2019;33:345–8. https://doi.org/10.1038/s41371-019-0203-1. https://www.nature.com/articles/s41371-019-0203-1.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cappuccio FP, Beer M, Strazzullo P, on behalf of the European Salt Action Network. Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network. Nutr Metab Cardiovasc Dis. 2019;29:107–14. https://doi.org/10.1016/j.numecd.2018.11.010. https://www.nmcd-journal.com/article/S0939-4753(18)30352-1/fulltext.

    Article  Google Scholar 

  26. Cappuccio FP, Capewell S, He FJ, MacGregor GA. Salt: the dying echoes of the food industry. Am J Hypertens. 2014;27(2):279–81 https://academic.oup.com/ajh/article/27/2/279/161804.

    Article  Google Scholar 

  27. Cappuccio FP, Capewell S. Facts, issues, and controversies in salt reduction for the prevention of cardiovascular disease. Functional Food Reviews. 2015;7(1):41–61.

    Google Scholar 

  28. Webster J, Waqanivalu T, Arcand J, Trieu K, Cappuccio FP, Appel LJ, et al. Understanding the science that supports population-wide salt reduction programs. J Clin Hypertens. 2017;19(6):569–76. https://doi.org/10.1111/jch.12994https://onlinelibrary.wiley.com/doi/full/10.1111/jch.12994.

    Article  Google Scholar 

  29. Cappuccio FP. Pro: Reducing salt intake at population level: is it really a public health priority? Nephrol Dial Transplant. 2016;31(9):1392–6. https://doi.org/10.1093/ndt/gfw279https://academic.oup.com/ndt/article/31/9/1392/1752250.

    Article  PubMed  Google Scholar 

  30. He FJ, Appel LJ, Cappuccio FP, de Wardener HE, MacGregor GA. Does reducing salt intake increase cardiovascular mortality? Kidney Int. 2011;80(7):696–8. https://doi.org/10.1038/ki.2011.246https://www.kidney-international.org/article/S0085-2538(15)55129-6/fulltext.

    Article  PubMed  Google Scholar 

  31. Cappuccio FP, Campbell NR. Population dietary salt reduction and the risk of cardiovascular disease: a commentary on recent evidence. J Clin Hypertens. 2017;19(1):4–5. https://doi.org/10.1111/jch.12917https://onlinelibrary.wiley.com/doi/full/10.1111/jch.12917.

    Article  Google Scholar 

  32. Cook NR, He FJ, MacGregor GA, Graudal N. Sodium and health—concordance and controversy. BMJ. 2020;369:m2440. https://doi.org/10.1136/bmj.m2440https://www.bmj.com/content/369/bmj.m2440.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Brownell KD, Warner KE. The perils of ignoring history: Big Tobacco played dirty and millions died. How similar is Big Food? Milbank Q. 2009;87(1):259–94 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879177/.

    Article  Google Scholar 

  34. He FJ, Campbell NRC, Ma Y, MacGregor GA, Cogswell ME, Cook NR. Errors in estimating usual sodium intake by the Kawasaki formula alter its relationship with mortality: implications for public health. Int J Epidemiol. 2018;47:1784–95. https://doi.org/10.1093/ije/dyy114This study demonstrates that a spurious J-curve relationship between dietary sodium and total mortality is created when a common but inappropriate method is used.

    Article  PubMed  PubMed Central  Google Scholar 

  35. He FJ, Ma Y, Campbell NRC, MacGregor GA, Cogswell ME, Cook NR. Formulas to estimate dietary sodium intake from spot urine alter sodium-mortality relationship. Hypertension. 2019;74(3):572–80. https://doi.org/10.1161/HYPERTENSIONAHA.119.13117https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.13117.

    Article  CAS  PubMed  Google Scholar 

  36. McLean RM, Farmer VL, Nettleton A, Cameron CM, Cook NR, Woodward M, et al. Twenty-Four-Hour Diet recall and Diet records compared with 24-hour urinary excretion to predict an individual's sodium consumption: a systematic review. J Clin Hypertens. 2018;20(10):1360–76. https://doi.org/10.1111/jch.13391https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13391.

    Article  Google Scholar 

  37. McLean RM, Farmer VL, Nettleton A, Cameron CM, Cook NR, Campbell NRC. Assessment of dietary sodium intake using a food frequency questionnaire and 24-hour urinary sodium excretion: a systematic literature review. J Clin Hypertens. 2017;19(12):1214–30. https://doi.org/10.1111/jch.13148https://onlinelibrary.wiley.com/doi/10.1111/jch.13148.

    Article  Google Scholar 

  38. Ji C, Sykes L, Paul C, Dary O, Legetic B, Campbell NRC, et al. Systematic review of studies comparing 24-hour and spot urine collections for estimating population salt intake. Rev Panam Salud Publica. 2012;32(4):307–15 https://scielosp.org/article/rpsp/2012.v32n4/307-315/en/.

    Article  Google Scholar 

  39. Ji C, Miller MA, Venezia A, Strazzullo P, Cappuccio FP. Comparisons of spot vs 24-h urine samples for estimating population salt intake: validation study in two independent samples of adults in Britain and Italy. Nutr Metab Cardiovasc Dis. 2014;24(2):140–7 https://www.sciencedirect.com/science/article/abs/pii/S0939475313001609.

    Article  CAS  Google Scholar 

  40. Olde Engberink RHG, Hoek TC, Noordenne ND, Born BH, Peters-Sengers H, Vogt L. 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. 2017;136. doi:https://doi.org/10.1161/CIRCULATIONAHA.117.029028. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029028

  41. Cobb LK, Anderson CA, Elliott P, Hu FB, Liu K, Neaton JD. Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes: a science advisory from the American Heart Association. Circulation. 2014;129:1173–86. https://doi.org/10.1161/CIR.0000000000000015https://www.ahajournals.org/doi/full/10.1161/cir.0000000000000015.

    Article  CAS  PubMed  Google Scholar 

  42. Johnson C, Raj TS, Trieu K, Arcand J, Wong MM, McLean R, et al. The science of salt: a systematic review of quality clinical salt outcome studies June 2014 to May 2015. J Clin Hypertens. 2016;18(9):832–9 https://onlinelibrary.wiley.com/doi/full/10.1111/jch.12877.

    Article  CAS  Google Scholar 

  43. Lucko A, Doktorchik CTA, Campbell NRC. Impact of quality of research on patient outcomes in the Institute of Medicine 2013 report on dietary sodium. J Clin Hypertens. 2018;20:345–50 https://onlinelibrary.wiley.com/doi/pdf/10.1111/jch.13168.

    Article  Google Scholar 

  44. Tan M, He FJ, MacGregor GA. Salt and cardiovascular disease in PURE: a large sample size cannot make up for erroneous estimations. J Ren-Angio-Aldo Syst. 2018;19(4):1470320318810015. https://doi.org/10.1177/1470320318810015https://journals.sagepub.com/doi/10.1177/1470320318810015.

    Article  Google Scholar 

  45. Oparil S. Low sodium intake — Cardiovascular health benefit or risk? NEJM. 2014;371(7):677–9. https://doi.org/10.1056/NEJMe1407695https://www.nejm.org/doi/full/10.1056/nejme1407695.

    Article  CAS  PubMed  Google Scholar 

  46. Campbell NRC. More on dissidents and dietary sodium. Int J Epidemiol. 2018;48:670–3. https://doi.org/10.1093/ije/dyy003https://academic.oup.com/ije/article/47/2/670/4903005.

    Article  Google Scholar 

  47. Chinthapalli K. Dethroning the king of condiments: what is the link between salt, hypertension, and mortality? BMJ. 2013;347:f7192 https://www.bmj.com/content/347/bmj.f7192.

    Article  Google Scholar 

  48. Logan AG. Dietary sodium intake and its relation to human health: a summary of the evidence. J Am Coll Nutr. 2006;25(3):4F–169F https://www.tandfonline.com/doi/abs/10.1080/07315724.2006.10719528.

    Article  Google Scholar 

  49. Alderman MH. Evidence relating dietary sodium to cardiovascular disease. J Am Coll Nutr. 2006;25(3 Suppl):256S–61S https://www.tandfonline.com/doi/abs/10.1080/07315724.2006.10719575?journalCode=uacn20.

    Article  CAS  Google Scholar 

  50. Franco V, Oparil S. Salt sensitivity, a determinant of blood pressure, cardiovascular disease and survival. J Am Coll Nutr. 2006;25(3 Suppl):247S–55S https://www.tandfonline.com/doi/abs/10.1080/07315724.2006.10719574.

    Article  CAS  Google Scholar 

  51. Conflict of Interest Disclosures Associated with JACN Volume 25, Number 3(S), June 2006. J Am Coll Nutr. 2006;25(6):550-. doi:10.1080/07315724.2006.10719571. https://www.tandfonline.com/doi/abs/10.1080/07315724.2006.10719571

  52. Nestle M. Food politics: how the food industry infuences nutrition and health. Berkeley, CA: University of California Press; 2007. https://www.foodpolitics.com/food-politics-how-the-food-industry-influences-nutrition-and-health/

    Book  Google Scholar 

  53. Bes-Rastrollo M, Schulze MB, Ruiz-Canela M, Martinez-Gonzalez MA. Financial conflicts of interest and reporting bias regarding the association between sugar-sweetened beverages and weight gain: a systematic review of systematic reviews. PLoSMed. 2013;10(12):e1001578 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876974/.

    Google Scholar 

  54. O'Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011;306(20):2229–38 https://jamanetwork.com/journals/jama/fullarticle/1105553.

    Article  CAS  Google Scholar 

  55. Mente A, O'Donnell M, Rangarajan S, Dagenais G, Lear S, McQueen M, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. Lancet. 2016;388(10043):465–75 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30467-6/fulltext.

    Article  CAS  Google Scholar 

  56. Alderman M, Sealey J, Cohen H, Madhavan S, Laragh J. Urinary sodium excretion and myocardial infarction in hypertensive patients: a prospective cohort study. Am J Clin Nutr. 1997;65(2 Suppl):682S–6S https://academic.oup.com/ajcn/article/65/2/682S/4655398.

    Article  CAS  Google Scholar 

  57. Marschner IC, Simes RJ, Keech A. Biases in the identification of risk factor thresholds and J-curves. Am J Epidemiol. 2007;166(7):824–31. https://doi.org/10.1093/aje/kwm145https://academic.oup.com/aje/article/166/7/824/94722.

    Article  PubMed  Google Scholar 

  58. Cohen HW, Hailpern SM, Alderman MH. Sodium intake and mortality follow-up in the Third National Health and Nutrition Examination Survey (NHANES III). J Gen Intern Med. 2008;23(9):1297–302 https://link.springer.com/article/10.1007/s11606-008-0645-6.

    Article  Google Scholar 

  59. He J, Ogden LG, Vupputuri S, Bazzano LA, Loria C, Whelton PK. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA. 1999;282(21):2027–34 https://jamanetwork.com/journals/jama/fullarticle/192154.

    Article  CAS  Google Scholar 

  60. Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, et al. Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2011;171(13):1183–91 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1106080.

    Article  Google Scholar 

  61. Dinicolantonio JJ, Pasquale PD, Taylor RS, Hackam DG. Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis. Heart. 2013 Mar 12. https://doi.org/10.1136/heartjnl-2012-302337https://pubmed.ncbi.nlm.nih.gov/22914535/.

  62. Cook NR, Appel LJ, Whelton PK. Lower levels of sodium intake and reduced cardiovascular risk. Circulation. 2014;129:981–9. https://doi.org/10.1161/CIRCULATIONAHA.113.006032https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006032.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Mente A, O’Donnell M, Yusuf S. Sodium and health: another challenge to the current dogma. Eur Heart J. 2021. doi:10.1093/eurheartj/ehaa1093. https://pubmed.ncbi.nlm.nih.gov/33484121/. This commentary demonstrates a failure of peer review to ensure an accurate provision and interpretation of evidence

  64. Santos JA, Tekle D, Rosewarne E, Flexner N, Cobb L, Al-Jawaldeh A et al. A systematic review of salt reduction initiatives around the world: a midterm evaluation of progress towards the 2025 global non-communicable diseases salt reduction target. Advances in Nutrition. 2021. doi:https://doi.org/10.1093/advances/nmab008. https://academic.oup.com/advances/advance-article/doi/10.1093/advances/nmab008/6159028

  65. He FJ, Tan M, Ma Y, MacGregor GA. Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(6):6632–47. https://doi.org/10.1016/j.jacc.2019.11.055https://www.sciencedirect.com/science/article/pii/S0735109719386929?via%3Dihub.

    Article  CAS  Google Scholar 

  66. He FJ, Brinsden HC, MacGregor GA. Salt reduction in the United Kingdom: a successful experiment in public health. J Hum Hypertens. 2014;28(6):345-52. https://www.nature.com/articles/jhh2013105. An updated review of the dietary sodium and health issues.

  67. Mancia G, Oparil S, Whelton PK, McKee M, Dominiczak A, Luft FC, et al. The technical report on sodium intake and cardiovascular disease in low- and middle-income countries by the joint working group of the World Heart Federation, the European Society of Hypertension and the European Public Health Association. Eur Heart J. 2017:ehw549. https://doi.org/10.1093/eurheartj/ehw549. https://academic.oup.com/eurheartj/article/38/10/712/2932130.

  68. McIntrye L. Post-Truth. London, United Kingdom: The MIT Press; 2018. https://mitpress.mit.edu/books/post-truth

    Book  Google Scholar 

  69. Alderman MH, Madhavan S, Ooi WL, Cohen H, Sealey JE, Laragh JH. Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension. NEJM. 1991;324(16):1098–104 https://www.nejm.org/doi/full/10.1056/NEJM199104183241605.

    Article  CAS  Google Scholar 

  70. Graudal N, Hubeck-Graudal T, Jurgens G, Taylor RS. Dose-response relation between dietary sodium and blood pressure: a meta-regression analysis of 133 randomized controlled trials. Am J Clin Nutr. 2019;109:1273–8 https://academic.oup.com/ajcn/article/109/5/1273/5480600.

    Article  Google Scholar 

  71. Graudal NA, Galloe AM, Garred P. Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA. 1998;279(17):1383–91 https://jamanetwork.com/journals/jama/article-abstract/187486.

    Article  CAS  Google Scholar 

  72. Tsirimiagkou C, Karatzi K, Argyris A, Chalkidou F, Tzelefa V, Sfikakis PP, Yannakoulia M, Protogerou AD Levels of dietary sodium intake: diverging associations with arterial stiffness and atheromatosis. Hellenic J Cardiol. 2021. doi:https://doi.org/10.1016/j.hjc.2021.02.005.

  73. Mente A, O'Donnell MJ, Dagenais G, Wielgosz A, Lear SA, McQueen MJ, et al. Validation and comparison of three formulae to estimate sodium and potassium excretion from a single morning fasting urine compared to 24-h measures in 11 countries. J Hypertens. 2014;32(5):1005–14 https://journals.lww.com/jhypertension/pages/articleviewer.aspx?year=2014&issue=09000&article=00034&type=Fulltext.

    Article  CAS  Google Scholar 

  74. McCarron DA, Geerling JC, Kazaks AG, Stern JS. Can dietary sodium intake be modified by public policy? Clin J Am Soc Nephrol. 2009;4(11):1878–82 https://cjasn.asnjournals.org/content/4/11/1878.

    Article  Google Scholar 

  75. Alderman MH. Presidential Address: 21st Scientific Meeting of the International Society of Hypertension: dietary sodium and cardiovascular disease: the ‘J’-shaped relation. J Hypertens. 2007;25(5):903–7 https://warwick.ac.uk/fac/sci/med/staff/cappuccio/who/whl_video/presidential_address__21st_scientific_meeting_of.11.pdf.

    Article  CAS  Google Scholar 

  76. Garduno-Diaz SD, Aksnes B, Alvim Leite M. The normalization of conflicts of interest in the USA and their potential impact on public health nutrition. In: Nutrition W, editor.2017. p. 123-7. https://worldnutritionjournal.org/index.php/wn/article/view/24

  77. Mozaffarian D. Conflict of interest and the role of the food industry in nutrition research. JAMA. 2017;317(17):1755–6. https://doi.org/10.1001/jama.2017.3456https://jamanetwork.com/journals/jama/article-abstract/2623631.

    Article  PubMed  Google Scholar 

  78. Stuckler D, Nestle M. Big food, food systems, and global health. PLoSMed. 2012;9(6):e1001242 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001242.

    Google Scholar 

  79. Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoSMed. 2012;9(6):e1001235 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001235.

    Google Scholar 

  80. Liu X, Bai Y, Li S, O’Donnell M, Mente A, Yin L, et al. Associations of estimated 24-h urinary sodium excretion with mortality and cardiovascular events in Chinese adults: a prospective cohort study. J Hypertens. 2021;39:484–93. https://doi.org/10.1097/hjh.0000000000002647https://journals.lww.com/jhypertension/Fulltext/2021/03000/Associations_of_estimated_24_h_urinary_sodium.15.aspx.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada

    N. R. C. Campbell

  2. Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK

    F. J. He & G. A. MacGregor

  3. University of Warwick, WHO Collaborating Centre for Nutrition, Coventry, UK

    F. P. Cappuccio

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  1. N. R. C. Campbell
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  2. F. J. He
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  3. F. P. Cappuccio
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  4. G. A. MacGregor
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Correspondence to N. R. C. Campbell.

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Conflict of Interest

NRCC reports personal fees from Resolve to Save Lives and the World Bank (RTSL), outside the submitted work; and is an unpaid member of World Action on Salt, Sugar and Health and an unpaid consultant on dietary sodium and hypertension control to numerous governmental and non-governmental organizations. NRCC chairs the International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) which is an unpaid voluntary position. FJH is an unpaid member of Action on Salt, and World Action on Salt, Sugar and Health (WASSH). FH is partially funded by the National Institute for Health Research (NIHR) and the Medical Research Council (MRC). FPC has the following unpaid activities; immediate-Past President and Trustee of the British and Irish Hypertension Society (2017-19), member of Action on Salt, Sugar and Health, member of the TRUE Consortium, and Advisor to the World Health Organization. FPC reports speaker fees from Omron Healthcare and book royalties from Oxford University Press, both unrelated to the present topic. GAM is the unpaid Chair of Action on Salt, Sugar and Health, World Action on Salt, Sugar and Health (WASSH) and Blood Pressure UK. GAM is partially funded by the National Institute for Health Research (NIHR) and the Medical Research Council (MRC).

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Campbell, N.R.C., He, F.J., Cappuccio, F.P. et al. Dietary Sodium 'Controversy'—Issues and Potential Solutions. Curr Nutr Rep 10, 188–199 (2021). https://doi.org/10.1007/s13668-021-00357-1

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