An Annotated Bibliography

Overview of Sodium Reduction

He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. Journal of Human Hypertension. 2009 Jun;23(6):363.

Salt consumption is likely the major factor for increasing population blood pressure. Multiple studies show that populations with successful reductions in salt consumption also reduced blood pressure as well as other adverse health outcomes, particularly cardiovascular disease. Despite this strong evidence, many countries have not yet developed a salt reduction plan. A few countries such as Finland, Japan, and the UK have successfully implemented large-scale salt reduction programs through strategies such as industry engagement for product reformulation and labeling or through public health education.

Frieden TR. Sodium reduction—saving lives by putting choice into consumers’ hands. JAMA. 2016 Aug 9;316(6):579-80.

In the United States, high blood pressure is the leading cause of cardiovascular disease deaths, and 90% of the population consumes too much sodium. Clear evidence from rigorous studies shows the benefit of sodium reduction on reducing blood pressure. Even small reductions in sodium intake can have great effects on hypertension prevalence, and likely on mortality from cardiovascular disease as well. “Over a decade, (a reduction of 1200 mg/d) could prevent up to an estimated 500000 deaths and may save an estimated $100 billion in health care costs.” Sodium reduction is unlikely to harm any segment of the population. This article advocates for the immediate implementation of the proposed US guidelines that would set voluntary sodium targets for industry.

Afshin A, Sur PJ, Fay KA, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2019 May 11;393(10184):1958-72.

The 2017 Global Burden of Disease study estimated that global consumption of sodium was 6g per day. High intake of sodium caused approximately 3 million deaths and 70 million disability-adjusted life-years (DALYs) in 2017. High intake of sodium was the leading dietary risk factor for mortality among men and was the leading risk for deaths and DALYs among older adults (≥70 years). It was also found to be the leading dietary risk factor for deaths and DALYs in east Asia and high-income Asia Pacific regions. Countries ranking high-middle and middle on the Socio-Demographic Index (SDI) were at the greatest risk of deaths and DALYs from high intake of sodium. For all countries except those at low SDI, sodium intake was one of the four leading dietary risks.

Overview of Sodium Reduction