Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study

Tuomilehto, Jaakko; Jousilahti, Pekka; Rastenytė, Daiva; Moltchanov, Vladislav; Tanskanen, Antti; Pietinen, Pirjo; Nissinen, Aulikki

doi:10.1016/s0140-6736(00)04199-4

Cited by 497 publications

(412 citation statements)

References 23 publications

Supporting

Mentioning

372

Contrasting

Unclassified

Order By: Relevance

“…Thus, it is very optimistic to expect rapid changes at the population level. Our calculations based on both the selection of low-salt products and the imaginary situation where all foods would be prepared with 50% less salt show that both of these measures are effective and needed in order to reach the aim of about 6 g day 21 . This means that besides labelling and regulating the salt content of processed foods, all cooked foods, whether prepared in the food service sector or at home, need to have a lower salt content.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland

Pietinen

Valsta

Hirvonen

et al. 2008

Public Health Nutr.

Self Cite

112

View full text Add to dashboard Cite

Objective: To estimate the impact of choosing food products labelled either as low or high in salt on salt intake in the Finnish adult population. Setting and subjects: The National FINDIET 2002 survey with 48-hour recalls from 2007 subjects aged 25-64 years. Sodium intake was calculated based on the Fineli s food composition database including the sodium content of natural and processed foods as well as the salt content of recipes. The distribution of salt intake was calculated in different ways: the present situation; assuming that all breads, cheeses, processed meat and fish, breakfast cereals and fat spreads consumed would be either 'lightly salted' or 'heavily salted' based on the current labelling practice; and, in addition, assuming that all foods would be prepared with 50% less or more salt. Results: Excluding underreporters, the mean salt intake would be reduced by 1.8 g in men and by 1.0 g in women if the entire population were to choose lightly salted products and further by 2.5 and 1.8 g, respectively, if also salt used in cooking were halved. Choosing heavily salted products would increase salt intake by 2.1 g in men and by 1.4 g in women. In the worst scenarios, salt intake would be further increased by 2.3 g in men and by 1.6 g in women.Conclusions: These calculations show that the potential impact of labelling and giving consumers the possibility to choose products with less salt is of public health importance. In addition, strategies to reduce the salt content of all food groups are needed.

show abstract

Section: Discussionmentioning

confidence: 98%

“…All effective strategies are welcome since there is no easy way to reach the upper recommended salt intake level, which is less than 5 g day 21 according to the World Health Organization 5 , and according to the Finnish National Nutrition Council 7 g for men and 6 g for women. The latter recommendations are based on the Nordic Nutrition Recommendations 6 .…”

mentioning

confidence: 99%

Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland

Pietinen

Valsta

Hirvonen

et al. 2008

Public Health Nutr.

Self Cite

112

View full text Add to dashboard Cite

show abstract

“…53 A recent study from Finland using a random sample of the Finnish adult population showed that salt intake was directly related to increased cardiovascular mortality and total mortality. 54 For a 6 g …”

Section: Mortality Studiesmentioning

confidence: 99%

“…Precision is the reciprocal of the standard error of the net change in systolic or diastolic blood pressure. Figure 5 Hazard ratios for coronary heart disease (CHD), cardiovascular disease (CVD), and all-cause mortality associated with a 6 g/day increase in salt intake as judged by 24-h urinary sodium excretion (Adapted from Tuomilehto et al 54 ).…”

Section: Q1mentioning

confidence: 99%

Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health

2002

View full text Add to dashboard Cite

Two recent meta-analyses of randomised salt reduction trials have concluded that there is little purpose in reducing salt intake in the general population. However, the authors, as with other previous meta-analyses, included trials of very short duration (eg 1 week or less) and trials of acute salt loading followed by abrupt reductions to very low salt intake (eg from 20 to less than 1 g of salt/day). These acute salt loading and salt depletion experiments are known to increase sympathetic tone, and with salt depletion cause a rise in renin release and, thereby, plasma angiotensin II. These trials are not appropriate, therefore, for helping to inform public health policy, which is for a more modest reduction in salt intake, ie, from a usual intake of E10 to E5 g of salt per day over a more prolonged period of time. We carried out a meta-analysis to assess the effect of a modest salt reduction on blood pressure. Our data sources were MEDLINE, EMBASE, Cochrane library, CINAHL, and the reference lists of original and review articles. We included randomised trials with a modest reduction in salt intake and a duration of 4 or more weeks. Meta-analysis, meta-regression, and funnel plots were performed. A total of 17 trials in hypertensives (n ¼ 734) and 11 trials in normotensives (n ¼ 2220) were included in our study. The median reduction in 24-h urinary sodium excretion was 78 mmol (equivalent to 4.6 g of salt/day) in hypertensives and 74 mmol in normotensives. The pooled estimates of blood pressure fall were 4.96/2.73 7 0.40/0.24 mmHg in hypertensives (Po0.001 for both systolic and diastolic) and 2.03/ 0.97 7 0.27/0.21 mmHg in normotensives (Po0.001 for both systolic and diastolic). Weighted linear regression analyses showed a dose response between the change in urinary sodium and blood pressure. A reduction of 100 mmol/day (6 g of salt) in salt intake predicted a fall in blood pressure of 7.11/3.88 mmHg (Po0.001 for both systolic and diastolic) in hypertensives and 3.57/ 1.66 mmHg in normotensive individuals (systolic: Po0.001; diastolic: Po0.05). Our results demonstrate that a modest reduction in salt intake for a duration of 4 or more weeks does have a significant and, from a population viewpoint, important effect on blood pressure in both hypertensive and normotensive individuals. This meta-analysis strongly supports other evidence for a modest and long-term reduction in population salt intake, and would be predicted to reduce stroke deaths immediately by E14% and coronary deaths by E9% in hypertensives, and reduce stroke and coronary deaths by E6 and E4%, in normotensives, respectively.

show abstract

“…High sodium 9 and alcohol 10,11 intakes, obesity, 12 smoking, 13,14 low heart rate variability 15,16 and in some studies high plasma renin activity (PRA) 17 are associated with increased risk of cardiovascular events. Obesity, 18 smoking, 19,20 and intakes of alcohol 20,21 and salt 22 may also modulate heart rate variability.…”

Section: Introductionmentioning

confidence: 99%

Reduced heart rate variability in hypertension: associations with lifestyle factors and plasma renin activity

et al. 2003

View full text Add to dashboard Cite

Limited information exists on the relations between heart rate variability, hypertension, lifestyle factors and renin-angiotensin-aldosterone system. A total of 191 newly diagnosed yet untreated hypertensive men and women, 35-54 years of age, were compared with an ageand gender-stratified random population sample of 105 normotensive men and women to find out independent determinants of heart rate variability. Heart rate variability was computed from 5-min ECG time series using the standard deviation of normal-to-normal RR intervals (SDNN), the square root of the mean of squared differences between adjacent normal RR intervals (RMSSD) and the fast Fourier transform spectral analysis. All absolute measures of heart rate variability were reduced in hypertension (Po0.001 for each, ANOVA). In multivariate regression analyses, reduced heart rate variability was independently associated with higher heart rate (Po0.001 for all absolute measures of heart rate variability), higher age (P=0.001 for SDNN, total and LF powers; Po0.001 for RMSSD and HF power) and higher mean arterial pressure (Po0.05 for total power, Po0.01 for the other absolute measures) but not with sodium and alcohol intakes, body mass index and smoking. Increased plasma renin activity (PRA) was an independent attributor of reduced HF power (Po0.05) and reduced RMSSD (Po0.01). Increased blood pressure and heart rate are associated with decreased heart rate variability without any direct effects on heart rate variability of lifestyle factors. High PRA is an independent determinant of diminished modulation of vagal activity.

show abstract

Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study

Cited by 497 publications

References 23 publications

Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland

Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland

Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health

Reduced heart rate variability in hypertension: associations with lifestyle factors and plasma renin activity

Contact Info

Product

Resources

About