Sodium and health—concordance and controversy

Cook, Nancy R.; He, Feng J; MacGregor, Graham A.; Graudal, Niels

doi:10.1136/bmj.m2440

Cited by 66 publications

(60 citation statements)

References 55 publications

(65 reference statements)

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“…Reverse causation occurs when the likelihood of exposure is causally affected by the research outcome 50 . Persons with hypertension or other pre-existing illnesses (cardiovascular disease, kidney disease) may be advised to reduce sodium intake, and persons treated with diuretics or drugs that block RAAS provoking hyponatremia may have a lower apparent sodium intake 51 .…”

Section: Discussionmentioning

confidence: 99%

Association between 24-h urinary sodium and potassium excretion and blood pressure among Chinese adults aged 18–69 years

Fang

et al. 2021

Sci Rep

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The direction and magnitude of the association between sodium and potassium excretion and blood pressure (BP) may differ depending on the characteristics of the study participant or the intake assessment method. Our objective was to assess the relationship between BP, hypertension and 24-h urinary sodium and potassium excretion among Chinese adults. A total of 1424 provincially representative Chinese residents aged 18 to 69 years participated in a cross-sectional survey in 2017 that included demographic data, physical measurements and 24-h urine collection. In this study, the average 24-h urinary sodium and potassium excretion and sodium-to-potassium ratio were 3811.4 mg/day, 1449.3 mg/day, and 4.9, respectively. After multivariable adjustment, each 1000 mg difference in 24-h urinary sodium excretion was significantly associated with systolic BP (0.64 mm Hg; 95% confidence interval [CI] 0.05–1.24) and diastolic BP (0.45 mm Hg; 95% CI 0.08–0.81), and each 1000 mg difference in 24-h urinary potassium excretion was inversely associated with systolic BP (− 3.07 mm Hg; 95% CI − 4.57 to − 1.57) and diastolic BP (− 0.94 mm Hg; 95% CI − 1.87 to − 0.02). The sodium-to-potassium ratio was significantly associated with systolic BP (0.78 mm Hg; 95% CI 0.42–1.13) and diastolic BP (0.31 mm Hg; 95% CI 0.10–0.53) per 1-unit increase. These associations were mainly driven by the hypertensive group. Those with a sodium intake above about 4900 mg/24 h or with a potassium intake below about 1000 mg/24 h had a higher risk of hypertension. At higher but not lower levels of 24-h urinary sodium excretion, potassium can better blunt the sodium-BP relationship. The adjusted odds ratios (ORs) of hypertension in the highest quartile compared with the lowest quartile of excretion were 0.54 (95% CI 0.35–0.84) for potassium and 1.71 (95% CI 1.16–2.51) for the sodium-to-potassium ratio, while the corresponding OR for sodium was not significant (OR, 1.28; 95% CI 0.83–1.98). Our results showed that the sodium intake was significantly associated with BP among hypertensive patients and the inverse association between potassium intake and BP was stronger and involved a larger fraction of the population, especially those with a potassium intake below 1000 mg/24 h should probably increase their potassium intake.

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Section: Discussionmentioning

confidence: 99%

Association between 24-h urinary sodium and potassium excretion and blood pressure among Chinese adults aged 18–69 years

Fang

et al. 2021

Sci Rep

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“…Accumulating evidence has indicated that modifiable lifestyle factors, such as nutrition and physical activity (PA), are closely linked to mental health ( Biddle et al, 2019 , Cook et al, 2020 ). In fact, several experts have expressed concerns about nutrition and PA when it comes to psychological burden during the COVID-19 pandemic ( Shen et al, 2020 ).…”

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confidence: 99%

Mental health problems among Chinese adolescents during the COVID-19: The importance of nutrition and physical activity

Chi

Liang

Chen

et al. 2021

International Journal of Clinical and Health Psychology

165

132

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Background/Objective Mental health problems are common among adolescents and greatly influenced by stressful events. This study sought to assess the prevalence and correlates of insomnia, depressive and anxiety symptoms among Chinese adolescents during the COVID-19. Method Cross-sectional study ( N = 1794 adolescents, mean age = 15.26) was conducted in May 2020. An online survey was used to collect socio-demographic data, COVID-related fear (COVID-fear), nutrition, physical activity (PA) level and the symptoms of insomnia, depression and anxiety. Results The prevalence of insomnia, depressive and anxiety symptoms was 37.80%, 48.20% and 36.70%, respectively, among Chinese adolescents during the pandemic. Generalized linear models revealed that female, left behind children, and students with greater COVID-fear tended to report symptoms of insomnia, depression and anxiety concurrently. After adjusting for socio-demographic factors and COVID-fear, better nutritional status and moderately active PA were both associated with lower levels of depressive and anxiety symptoms, while highly active PA was associated with lower levels of insomnia, depressive and anxiety symptoms. Conclusions These findings suggest that more attention should be paid to psychological health among adolescents while combating COVID-19. To promote adolescents’ mental health, educators should help adolescents develop a healthy lifestyle with balanced diet and regular exercise.

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“…Our analysis does not represent a direct assessment of the sodium–CVD risk relationship, a major issue of cardiovascular health and more generally human health. 135 – 137 However, the effect of sodium intake on BP is inherently of major interest, given the importance of BP to CVD morbidity and mortality, and the use of BP as a surrogate end point for CVD. 19 Therefore, the findings in this review and dose–response meta-analysis, confirming and strengthening previous reports and providing additional complementary information by summarizing the entire body of the evidence generated by human experimental studies, may provide sound evidence to strengthen recommendations to reduce dietary sodium intake in most populations and individuals.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Effects of Sodium Reduction

et al. 2021

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Background: The relationship between dietary sodium intake and blood pressure (BP) has been tested in clinical trials and nonexperimental human studies, indicating a direct association. The exact shape of the dose–response relationship has been difficult to assess in clinical trials because of the lack of random-effects dose–response statistical models that can include 2-arm comparisons. Methods: After performing a comprehensive literature search for experimental studies that investigated the BP effects of changes in dietary sodium intake, we conducted a dose–response meta-analysis using the new 1-stage cubic spline mixed-effects model. We included trials with at least 4 weeks of follow-up; 24-hour urinary sodium excretion measurements; sodium manipulation through dietary change or supplementation, or both; and measurements of systolic and diastolic BP at the beginning and end of treatment. Results: We identified 85 eligible trials with sodium intake ranging from 0.4 to 7.6 g/d and follow-up from 4 weeks to 36 months. The trials were conducted in participants with hypertension (n=65), without hypertension (n=11), or a combination (n=9). Overall, the pooled data were compatible with an approximately linear relationship between achieved sodium intake and mean systolic as well as diastolic BP, with no indication of a flattening of the curve at either the lowest or highest levels of sodium exposure. Results were similar for participants with or without hypertension, but the former group showed a steeper decrease in BP after sodium reduction. Intervention duration (≥12 weeks versus 4 to 11 weeks), type of study design (parallel or crossover), use of antihypertensive medication, and participants’ sex had little influence on the BP effects of sodium reduction. Additional analyses based on the BP effect of difference in sodium exposure between study arms at the end of the trial confirmed the results on the basis of achieved sodium intake. Conclusions: In this dose–response analysis of sodium reduction in clinical trials, we identified an approximately linear relationship between sodium intake and reduction in both systolic and diastolic BP across the entire range of dietary sodium exposure. Although this occurred independently of baseline BP, the effect of sodium reduction on level of BP was more pronounced in participants with a higher BP level.

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Sodium and health—concordance and controversy

Abstract: Nancy Cook and colleagues describe the sources of agreement and disagreement about the health effects of sodium and how they might be resolved

Cited by 66 publications

References 55 publications

Association between 24-h urinary sodium and potassium excretion and blood pressure among Chinese adults aged 18–69 years

Association between 24-h urinary sodium and potassium excretion and blood pressure among Chinese adults aged 18–69 years

Mental health problems among Chinese adolescents during the COVID-19: The importance of nutrition and physical activity

Blood Pressure Effects of Sodium Reduction

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