Association Between Sodium Excretion and Cardiovascular Disease and Mortality in the Elderly: A Cohort Study

Abstract

Reduced sodium excretion is associated with increased mortality in a sample of community-dwelling older people, especially among the frail participants. High levels of sodium excretion are not associated with adverse outcomes in this population; therefore, sodium restriction might not be beneficial in older people.

Science of Salt: A regularly updated systematic review of salt and health outcomes studies (April to October 2018)

“…This systematic review identified only three out of nineteen studies that met the pre‐specified criteria for quality in a 6‐month period. Of these, a cohort study identified an association between lower sodium intake (<6.25 g/d) and increased mortality in Italian adults, most of whom consumed well above recommended sodium intakes assessed by single 24‐hour urine collections at baseline . Two randomized controlled trials confirmed the previously identified positive association between sodium intake and elevated blood pressure.…”

“…The weekly search identified 4141 citations over the period from April 3 to October 30, 2018, of which 19 studies including dietary sodium and health outcomes met the criteria for full review (Table ). These included systematic review and meta‐analyses (n = 2), randomized controlled trials (n = 3, including one post hoc analysis of a randomized controlled trial), a non‐randomized controlled trial (n = 1), prospective cohort studies (n = 4), a retrospective cohort study using population data (n = 1), and cross‐sectional studies (n = 8) . Two studies assessed mortality outcomes, four studies assessed morbidity outcomes, and one study assessed symptoms/quality of life/functional status outcomes .…”

“…Eight studies assessed clinical surrogate outcomes, one study assessed physiologic surrogate outcomes, and three studies assessed other outcomes according to our pre‐specified categories. Of these, three studies met the minimum methodological criteria for detailed critical appraisal …”

“…The prospective cohort study included participants from the InCHIANTI study (median age 74.5) conducted in two Italian cities and showed all‐cause mortality was higher in those who consumed <6250 mg/d of sodium (equivalent to 15.63 g salt) at baseline over a mean follow‐up period of 9 years. There was no association between sodium intake and incident CVD in adjusted models . An RCT investigating a 6‐month intervention of low sodium salt use in a free‐living population in China reported that low sodium salt use was associated with decreased sodium intake, as measured by 24‐hour urinary sodium excretion, and reduced systolic blood pressure (SBP) in those diagnosed with isolated systolic hypertension, but not in those with non‐isolated systolic hypertension .…”

“…These included systematic review and meta-analyses (n = 2), 22,23 randomized controlled trials (n = 3, including one post hoc analysis of a randomized controlled trial), [24][25][26] a non-randomized controlled trial (n = 1), 27 prospective cohort studies (n = 4), [28][29][30][31] a retrospective cohort study using population data (n = 1), 32 and cross-sectional studies (n = 8). [33][34][35][36][37][38][39][40] Two studies assessed mortality outcomes, 28,29 four studies assessed morbidity outcomes, [30][31][32][33] and one study assessed symptoms/quality of life/functional status outcomes. 22 Eight studies assessed clinical surrogate outcomes, [23][24][25][26][27][34][35][36] one study assessed physiologic surrogate outcomes, 37 and three studies assessed other outcomes [38][39][40] according to our pre-specified categories.…”