Sundquist, J., Palmér, K., Memon, A. A., Wang, X., Johansson, L. M., & Sundquist, K. | (2018)| Long‐term improvements after mindfulness‐based group therapy of depression, anxiety and stress and adjustment disorders: A randomized controlled trial| Early intervention in psychiatry| Doi: https://doi.org/10.1016/S0140-6736(18)31376-X
A new international study published in the journal The Lancet investigated the associations between community-level mean sodium and potassium intake, cardiovascular disease, and mortality. The authors highlight that the WHO target- consumption of less than 2g a day- is not only not practicable, it might also be pointless; as no country has managed to reach this level of salt intake.
WHO recommends that populations consume less than 2 g/day sodium as a preventive measure against cardiovascular disease, but this target has not been achieved in any country. This recommendation is primarily based on individual-level data from short-term trials of blood pressure (BP) without data relating low sodium intake to reduced cardiovascular events from randomised trials or observational studies. We investigated the associations between community-level mean sodium and potassium intake, cardiovascular disease, and mortality.
The Prospective Urban Rural Epidemiology study is ongoing in 21 countries. Here we report an analysis done in 18 countries with data on clinical outcomes. Eligible participants were adults aged 35–70 years without cardiovascular disease, sampled from the general population. We used morning fasting urine to estimate 24 h sodium and potassium excretion as a surrogate for intake. We assessed community-level associations between sodium and potassium intake and BP in 369 communities (all more than 50 participants) and cardiovascular disease and mortality in 255 communities (all more than 100 participants), and used individual-level data to adjust for known confounders.
95 767 participants in 369 communities were assessed for BP and 82 544 in 255 communities for cardiovascular outcomes with follow-up for a median of 8·1 years. 82 (80%) of 103 communities in China had a mean sodium intake greater than 5 g/day, whereas in other countries 224 (84%) of 266 communities had a mean intake of 3–5 g/day. Overall, mean systolic BP increased by 2·86 mm Hg per 1 g increase in mean sodium intake, but positive associations were only seen among the communities in the highest tertile of sodium intake (p less than 0·0001 for heterogeneity). The association between mean sodium intake and major cardiovascular events showed significant deviations from linearity (p=0·043) due to a significant inverse association in the lowest tertile of sodium intake, no association in the middle tertile, and a positive but non-significant association in the highest tertile. A strong association was seen with stroke in China compared with in other countries. All major cardiovascular outcomes decreased with increasing potassium intake in all countries.
Sodium intake was associated with cardiovascular disease and strokes only in communities where mean intake was greater than 5 g/day. A strategy of sodium reduction in these communities and countries but not in others might be appropriate.
The full article can be read by staff via Athens
You can read the article in full at The Lancet
In the media:
The Guardian Salt not as damaging to health as previously thought, says study