Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus

Dietary salt intake and diabetes complications in patients with diabetes: An overview

“…Dietary salt restriction has been noted as an essential constituent of diabetes care in many guidelines,4, 5, 6, 7 although supportive evidence is apt to depend on studies of participants without diabetes or small short‐term studies of patients with diabetes. On the other hand, some longitudinal studies were recently reported regarding the association between dietary salt intake and diabetes complications in patients with diabetes 8, 9, 10.…”

“…In guidelines for the treatment for diabetes in various countries, medical nutritional therapy is described with an individual chapter, explaining recommendations for macronutrient intake including carbohydrate, protein, and fat and micronutrient intake as typified by salt. Table 1 summarizes recommendations for dietary salt intake by the American Diabetes Association (ADA)5 and European Association for the Study of Diabetes (EASD),6 which lead in the treatment of diabetes in the United States and Europe, and that of the Japan Diabetes Society (JDS) 4. The current goals for daily intake of dietary salt in ADA guidelines are below 5.84 g/d5 and 6 g/d in EASD guidelines 6.…”

“…Table 1 summarizes recommendations for dietary salt intake by the American Diabetes Association (ADA)5 and European Association for the Study of Diabetes (EASD),6 which lead in the treatment of diabetes in the United States and Europe, and that of the Japan Diabetes Society (JDS) 4. The current goals for daily intake of dietary salt in ADA guidelines are below 5.84 g/d5 and 6 g/d in EASD guidelines 6. Further reductions in sodium intake are recommended by these associations for patients with both diabetes and high blood pressure.…”

“…The ADA recommended a dietary salt intake of 5.84 g/d based on a systematic review of short‐term randomized controlled trials (RCTs) that showed that decreases in sodium intake reduced blood pressure in patients with diabetes11 and an 8 week RCT of patients with type 2 diabetes that reported that the Dietary Approaches to Stop Hypertension (DASH) diet, in which salt intake is restricted to about 5.84 g/d and consumption of fruits, vegetables, and low‐fat dairy products is increased, improved blood pressure values 12. The statement of EASD6 also cited studies of the DASH diet in which participants were nondiabetic individuals13, 14 as well as an RCT focused on the association between moderate dietary sodium restriction and blood pressure in mildly hypertensive patients with type 2 diabetes 15…”

“…Particularly, consistent dietary salt restriction is emphasized for patients at high risk for arteriosclerosis such as those with diabetes, dyslipidemia, or renal disease 2, 3, 4. Guidelines for the treatment of diabetes throughout the world include recommendations for restriction of dietary salt intake4, 5, 6, 7 to prevent or at least slow the development of diabetes complications related to macroangiopathy such as CVD and microangiopathy such as nephropathy, retinopathy, and neuropathy.…”