Adding to that confusion the NUTRICODE study of global sodium consumption attributed 1.65 million annual death from cardiovascular disease to sodium intake above a reference value of 2.0g of sodium per day....Of note this was a modelling exercise based on what is known on sodium intake, blood pressure and CV mortality...Modelling exercises are subject to many confounders not the least the assumptions made in the model...including the 2.0g/day reference cut off that may be based on the PURE data discussed above inappropriate!
I feel that the third article on the same topic in the NEJM is still more confusing...I have much difficulties to only read and understand it!!!
Also, I have a provocative question:
How many of your patients follow the recommendations of NaClcommendation...Maybe you more disciplined patients...
How many of your patients follow the recommendations of NaClcommendation...Maybe you more disciplined patients...
Getting patients to restrict salt is very difficult but some do manage it...
Aren't the data presented relatively consistent... High salt intake is associated with adverse CV outcomes
Low salt intake is not harmful but may simply reflect comorbidity
Aren't the data presented relatively consistent... High salt intake is associated with adverse CV outcomes
Low salt intake is not harmful but may simply reflect comorbidity
I remember a hard lesson given to me by one of my professors when i was in Lyon , i was trying to convince a patient to reduce her salt consumption to control her bl.p and i ordered a 24 hrs urinary Na for her..and he said to me :this is nonsense just give her a diuretic , convincing people to reduce salt in food is just unrealistic !!
Only a minority of patients could stick to 5-6 gm salt per day.
Only a minority of patients could stick to 5-6 gm salt per day.
Agree with you Arif;
Salt restriction in practice is easier in rural population still who have little "invisible" salt in their routine diet.
Remember a case of nephrotic edema who has dropped his urine Na to undetectable after being counselled about salt free diet.
Salt restriction in practice is easier in rural population still who have little "invisible" salt in their routine diet.
Remember a case of nephrotic edema who has dropped his urine Na to undetectable after being counselled about salt free diet.
Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality: A Meta-Analysis
Am J Hypertens (2014) 27 (9): 1129-1137.
ajh.oxfordjournals.org/content/27/9/1129
Abstract
BACKGROUND The effect of sodium intake on population health remains controversial. The objective was to investigate the incidence of all-cause mortality (ACM) and cardiovascular disease events (CVDEs) in populations exposed to dietary intakes of low sodium (<115 mmol), usual sodium (low usual sodium: 115–165 mmol; high usual sodium: 166–215 mmol), and high sodium (>215 mmol).
METHODS The relationship between individual measures of dietary sodium intake vs. outcome in cohort studies and randomized controlled trials (RCTs) measured as hazard ratios (HRs) were integrated in meta-analyses.
RESULTS No RCTs in healthy population samples were identified. Data from 23 cohort studies and 2 follow-up studies of RCTs (n = 274,683) showed that the risks of ACM and CVDEs were decreased in usual sodium vs. low sodium intake (ACM: HR = 0.91, 95% confidence interval (CI) = 0.82–0.99; CVDEs: HR = 0.90, 95% CI = 0.82–0.99) and increased in high sodium vs. usual sodium intake (ACM: HR = 1.16, 95% CI = 1.03–1.30; CVDEs: HR = 1.12, 95% CI = 1.02–1.24). In population representative samples adjusted for multiple confounders, the HR for ACM was consistently decreased in usual sodium vs. low sodium intake (HR = 0.86; 95% CI = 0.81–0.92), but not increased in high sodium vs. usual sodium intake (HR = 1.04; 95% CI = 0.91–1.18). Within the usual sodium intake range, the number of events was stable (high usual sodium vs. low usual sodium: HR = 0.98; 95% CI = 0.92–1.03).
CONCLUSIONS Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes.
Am J Hypertens (2014) 27 (9): 1129-1137.
ajh.oxfordjournals.org/content/27/9/1129
Abstract
BACKGROUND The effect of sodium intake on population health remains controversial. The objective was to investigate the incidence of all-cause mortality (ACM) and cardiovascular disease events (CVDEs) in populations exposed to dietary intakes of low sodium (<115 mmol), usual sodium (low usual sodium: 115–165 mmol; high usual sodium: 166–215 mmol), and high sodium (>215 mmol).
METHODS The relationship between individual measures of dietary sodium intake vs. outcome in cohort studies and randomized controlled trials (RCTs) measured as hazard ratios (HRs) were integrated in meta-analyses.
RESULTS No RCTs in healthy population samples were identified. Data from 23 cohort studies and 2 follow-up studies of RCTs (n = 274,683) showed that the risks of ACM and CVDEs were decreased in usual sodium vs. low sodium intake (ACM: HR = 0.91, 95% confidence interval (CI) = 0.82–0.99; CVDEs: HR = 0.90, 95% CI = 0.82–0.99) and increased in high sodium vs. usual sodium intake (ACM: HR = 1.16, 95% CI = 1.03–1.30; CVDEs: HR = 1.12, 95% CI = 1.02–1.24). In population representative samples adjusted for multiple confounders, the HR for ACM was consistently decreased in usual sodium vs. low sodium intake (HR = 0.86; 95% CI = 0.81–0.92), but not increased in high sodium vs. usual sodium intake (HR = 1.04; 95% CI = 0.91–1.18). Within the usual sodium intake range, the number of events was stable (high usual sodium vs. low usual sodium: HR = 0.98; 95% CI = 0.92–1.03).
CONCLUSIONS Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes.
