JS-WHL-ISH-RTSL-3: IS THE CURRENT RECOMMENDATION BY GUIDELINES FOR HYPERTENSION TO KEEP DAILY SODIUM INTAKE BELOW 5 G (SODIUM 2300 MG) REALISTIC?

Abstract

The human kidney has an exquisite ability to regulate sodium. Absent kidney disease or drugs that interfere with sodium transport, humans require little dietary sodium for physiological function. Most natural foods are low in sodium content. Generally, higher sodium intakes result from the consumption of processed foods or foods that contain excess sodium that has been added during food preparation. Policy recommendations for dietary sodium reduction are in place in almost 100 countries but the specifics of what is recommended and the approaches to implementation of the recommendations vary substantially. Daily sodium intake targets vary from about 1,200 to 2,400 mgs/day. A recent treatment trials dose-response meta-analysis identified a direct linear relationship between sodium intake and blood pressure (BP), suggesting that any reduction in dietary sodium intake is beneficial for BP lowering. Feeding studies have demonstrated a capacity to substantially reduce sodium intake. This approach can be applied in commercial programs but has only modest generalizability as a clinical or public health approach. Feeding studies do, however, underscore the value of policies aimed at reducing the addition of sodium during food processing and food preparation. Large behavior-change trials with relatively long periods of follow-up have documented 20–30% reductions in sodium intake. Sodium intake reductions of 10–20% have been achieved in national programs, with the degree of success depending on the level of rigor for implementation of sodium reduction strategies. Collectively, experience indicates that reducing sodium intake is challenging, especially over prolonged periods of follow-up. However, it can be achieved in both the clinical and public health setting, and even modest reductions in sodium intake result in important health benefits.