UPDATED!! Time to end the war on Salt?

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Thu Mar 07, 2019 10:47 am

These guidelines of 2300 and 1500 mg/day are the same ones I use. The only difference is they have now changed them from an UL (Upper Limit) of 2300 and AI (Adequate Intake) of 1500 to Chronic Disease Risk Reduction Intakes (CDRRs).
HIGHLIGHTS


The National Acadmies of Sciences
Press Release
March 5, 2019
Sodium and Potassium Dietary Reference Intake Values Updated in New Report; Introduces New Category for Sodium Based on Chronic Disease Risk Reduction

http://www8.nationalacademies.org/onpin ... rdID=25353

WASHINGTON – A new report from the National Academies of Sciences, Engineering, and Medicine reviews current evidence and updates intake recommendations known as the Dietary Reference Intakes (DRIs) for sodium and potassium that were established in 2005. Dietary Reference Intakes for Sodium and Potassium revises the Adequate Intakes (AIs), which are the best estimate of intakes assumed to be adequate in apparently healthy individuals. The report reaffirms the sodium AI for individuals ages 14-50, decreases the sodium AIs for children age 1-13, increases the sodium AIs for adults ages 51 and older, and decreases the potassium AIs for individuals age 1 and older. The report also uses guidance from a 2017 National Academies report to introduce the first DRI specific to chronic disease risk reduction.

Sodium
The updated sodium AIs are 110 mg daily for infants 0-6 months; 370 mg daily for infants 7-12 months; 800 mg daily for children ages 1-3; 1,000 mg daily for ages 4-8; 1,200 mg daily for ages 9-13; and 1,500 mg daily for ages 14 and older. There remains limited evidence on sodium intakes below 1,500 mg per day for adults, which prevented the committee that conducted the study from considering further reductions in the sodium AI.

Report Highlights
https://www.nap.edu/resource/25353/0305 ... assium.pdf

Full Report
http://nationalacademies.org/hmd/report ... ssium.aspx
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Nov 06, 2019 5:45 pm

Salt increases monocyte CCR2 expression and inflammatory responses in humans
JCI Insight. 2019;4(21):e130508. https://doi.org/10.1172/jci.insight.130508.
First published November 1, 2019

https://insight.jci.org/articles/view/130508

Abstract
Inflammation may play a role in the link between high salt intake and its deleterious consequences. However, it is unknown whether salt can induce proinflammatory priming of monocytes and macrophages in humans. We investigated the effects of salt on monocytes and macrophages in vitro and in vivo by performing a randomized crossover trial in which 11 healthy human subjects adhered to a 2-week low-salt and high-salt diet. We demonstrate that salt increases monocyte expression of CCR2, a chemokine receptor that mediates monocyte infiltration in inflammatory diseases. In line with this, we show a salt-induced increase of plasma MCP-1, transendothelial migration of monocytes, and skin macrophage density after high-salt diet. Macrophages demonstrate signs of an increased proinflammatory phenotype after salt exposure, as represented by boosted LPS-induced cytokine secretion of IL-6, TNF, and IL-10 in vitro, and by increased HLA-DR expression and decreased CD206 expression on skin macrophages after high-salt diet. Taken together, our data open up the possibility for inflammatory monocyte and macrophage responses as potential contributors to the deleterious effects of high salt intake.



In conclusion, we demonstrate that HS promotes an inflammatory monocyte phenotype characterized by strongly enhanced expression of CCR2, together with increased plasma MCP-1, increased transendothelial migration of monocytes, and increased human tissue macrophage content. Macrophages demonstrate signs of increased proinflammatory priming after salt exposure. As such, this study might bring us one step closer to understanding the deleterious effects of high salt intake.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Fri Nov 22, 2019 11:19 am

Relationship of household salt intake level with long-term all-cause and cardiovascular disease mortality in Japan: NIPPON DATA80.
Hypertens Res. 2019 Nov 21. doi: 10.1038/s41440-019-0349-9. [Epub ahead of print]
PMID: 31748704

Abstract
In Asian countries, a major source of salt intake is from seasoning or table salt added at home. However, little is known about the adverse effects of salt intake evaluated according to household unit. We investigated the relationship between household salt intake level and mortality from all-cause and cardiovascular diseases (CVDs). Participants included 8702 individuals (56% women) who were living with someone else and who were aged 30-79 years and enrolled in the National Nutritional Survey of Japan in 1980 with a 24-year follow-up. Household nutrient intake was evaluated using a 3-day weighing record method in which all foods and beverages consumed by any of the household members were recorded. The household salt intake level was defined as the amount of salt consumed (g) per 1000 kcal of total energy intake in each household, and its average was 6.25 (2.02) g/1000 kcal. During the follow-up, there were 2360 deaths (787 CVD, 168 coronary heart disease [CHD], and 361 stroke). Cox proportional hazard ratios (HRs) for an increment of 2 g/1000 kcal in household salt intake were calculated and adjusting for sex, age, body mass index, smoking status, alcohol consumption status, self-reported work exertion level, household potassium intake, household saturated fatty acid intake, and household long-chain n-3 polyunsaturated fatty acid intake. The HRs (95% confidence intervals) were 1.07 (1.02, 1.12) for all-cause mortality, 1.11 (1.03, 1.19) for CVD, 1.25 (1.08, 1.44) for CHD, and 1.12 (1.00, 1.25) for stroke. The household salt intake level was significantly associated with long-term risk of all-cause, CVD, CHD, and stroke mortality in a representative Japanese population.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Fri Jan 10, 2020 11:11 am

Food Products That May Cause an Increase in Blood Pressure.
Curr Hypertens Rep. 2020 Jan 8;22(1):2.
doi: 10.1007/s11906-019-1007-y. Review.
PMID: 31915940

Abstract

PURPOSE OF REVIEW:To review latest reports of the food products which might increase blood pressure and therefore might participate in the pathogenesis of hypertension.

RECENT FINDINGS:Results of clinical study suggest that consumption of high-sodium food leads to transient increase in plasma sodium concentration. This is accompanied by blood pressure increase. Results of both clinical and experimental studies suggest direct vasculotoxic effects of sodium. Increased plasma sodium concentration could mediate its effects on blood pressure by changes in endothelial cell stiffness and glycocalyx integrity. Energy drinks are non-alcoholic beverages with increasing popularity. Clinical, interventional, randomized, placebo controlled, and cross-sectional studies showed that energy drinks may increase arterial blood pressure. Blood pressure increase after exposure for the energy drinks is mainly related to the caffeine content in these drinks. Many case reports were published concerning the clinically significant increase in blood pressure caused by the consumption of liquorice root or food products containing liquorice, such as candies, tea, Pontefract cookies, and chewing gum. Liquorice contains a precursor of glycyrrhetic acid. Glycyrrhetic acid reduces the activity of the 11β-hydroxysteroid dehydrogenase type 2 (11ß-HSD2) isoenzyme, which leads to activation of the mineralocorticoid receptor by cortisol in the distal convoluted tubule resulting in hypertension, hypokalemia, and metabolic alkalosis. The relationship between chronic alcohol intake and blood pressure is well established on the basis of a diverse body of evidence including animal experiments, epidemiological studies, mendelian randomization studies, and interventional studies. Results of recent studies suggested that binge drinking (i.e., episodic consumption of a very high amount of alcohol beverages) has pronounced hypertensinogenic effects. Recently, it was documented that also low doses of alcohol may increase the risk of cardiovascular complications.Therefore, the amount of alcohol consumption that is safe is zero. High-salt food products, energy drinks, food products containing liquorice, and alcoholic beverages have hypertensinogenic properties. Patients with hypertension and other cardiovascular diseases should avoid even accidental consumption of these food products.

Conclusions
1. The results of animal experiments and clinical trials have shown that sodium has direct vasculotoxic effects.
2. High-salt food products, energy drinks, food products containing liquorice, and alcoholic beverages have hypertensinogenic properties.
3. Patients with hypertension and other cardiovascular dis- eases should avoid even accidental consumption of these food products.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Thu Mar 05, 2020 7:02 am

Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials. BMJ 2020;368:m315

https://www.bmj.com/content/368/bmj.m315

Abstract
Objective To examine the dose-response relation between reduction in dietary sodium and blood pressure change and to explore the impact of intervention duration.

Design Systematic review and meta-analysis following PRISMA guidelines.

Data sources Ovid MEDLINE(R), EMBASE, and Cochrane Central Register of Controlled Trials (Wiley) and reference lists of relevant articles up to 21 January 2019.

Inclusion criteria Randomised trials comparing different levels of sodium intake undertaken among adult populations with estimates of intake made using 24 hour urinary sodium excretion.

Data extraction and analysis Two of three reviewers screened the records independently for eligibility. One reviewer extracted all data and the other two reviewed the data for accuracy. Reviewers performed random effects meta-analyses, subgroup analyses, and meta-regression.

Results 133 studies with 12 197 participants were included. The mean reductions (reduced sodium v usual sodium) of 24 hour urinary sodium, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 130 mmol (95% confidence interval 115 to 145, P<0.001), 4.26 mm Hg (3.62 to 4.89, P<0.001), and 2.07 mm Hg (1.67 to 2.48, P<0.001), respectively. Each 50 mmol reduction in 24 hour sodium excretion was associated with a 1.10 mm Hg (0.66 to 1.54; P<0.001) reduction in SBP and a 0.33 mm Hg (0.04 to 0.63; P=0.03) reduction in DBP. Reductions in blood pressure were observed in diverse population subsets examined, including hypertensive and non-hypertensive individuals. For the same reduction in 24 hour urinary sodium there was greater SBP reduction in older people, non-white populations, and those with higher baseline SBP levels. In trials of less than 15 days’ duration, each 50 mmol reduction in 24 hour urinary sodium excretion was associated with a 1.05 mm Hg (0.40 to 1.70; P=0.002) SBP fall, less than half the effect observed in studies of longer duration (2.13 mm Hg; 0.85 to 3.40; P=0.002). Otherwise, there was no association between trial duration and SBP reduction.

Conclusions The magnitude of blood pressure lowering achieved with sodium reduction showed a dose-response relation and was greater for older populations, non-white populations, and those with higher blood pressure. Short term studies underestimate the effect of sodium reduction on blood pressure.

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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Fri Jul 17, 2020 11:13 am

Link Between Dietary Sodium Intake, Cognitive Function, and Dementia Risk in Middle-Aged and Older Adults: A Systematic Review.
J Alzheimers Dis. 2020 Jul 13.
doi: 10.3233/JAD-191339. Online ahead of print.
PMID: 32675410

Abstract

Background:
A key focus for dementia risk-reduction is the prevention of socio-demographic, lifestyle, and nutritional risk factors. High sodium intake is associated with hypertension and cardiovascular disease (both are linked to dementia), generating numerous recommendations for salt reduction to improve cardiovascular health.

Objective:
This systematic review aimed to assess, in middle- and older-aged people, the relationship between dietary sodium intake and cognitive outcomes including cognitive function, risk of cognitive decline, or dementia.Methods: Six databases (PubMed, EMBASE, CINAHL, Psych info, Web of Science, and Cochrane Library) were searched from inception to 1 March 2020. Data extraction included information on study design, population characteristics, sodium reduction strategy (trials) or assessment of dietary sodium intake (observational studies), measurement of cognitive function or dementia, and summary of main results. Risk-of-bias assessments were performed using the National Heart, Lung, and Blood Institute (NHLBI) assessment tool.

Results:
Fifteen studies met the inclusion criteria including one clinical trial, six cohorts, and eight cross-sectional studies. Studies reported mixed associations between sodium levels and cognition. Results from the only clinical trial showed that a lower sodium intake was associated with improved cognition over six months. In analysis restricted to only high-quality studies, three out of four studies found that higher sodium intake was associated with impaired cognitive function.

Conclusion:
There is some evidence that high salt intake is associated with poor cognition. However, findings are mixed, likely due to poor methodological quality, and heterogeneous dietary, analytical, and cognitive assessment methods and design of the studies. Reduced sodium intake may be a potential target for intervention. High quality prospective studies and clinical trials are needed.Keywords: Cognitive dysfunction; dementia; salt; sodium; systematic review.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Fri Mar 05, 2021 11:19 am

JeffN wrote:High Sodium Intake Is Associated With Self-Reported Rheumatoid Arthritis: A Cross Sectional and Case Control Analysis Within the SUN Cohort.
Medicine (Baltimore). 2015 Sep;94(37):e0924. doi: 10.1097/MD.0000000000000924.
Salgado E1, Bes-Rastrollo M, de Irala J, Carmona L, Gómez-Reino JJ.


Abstract
Sodium intake is a potential environmental factor for immune-mediated inflammatory diseases. The aim of this study is to investigate the association of sodium intake with rheumatoid arthritis.We performed a cross-sectional study nested in a highly educated cohort investigating dietary habits as determinants of disease. Daily sodium intake in grams per day was estimated from a validated food frequency questionnaire. We identified prevalent self-reported cases of rheumatoid arthritis. Logistic regression models were used to estimate the odds ratio for rheumatoid arthritis by sodium intake adjusting for confounders. Linear trend tests and interactions between variables were explored. Sensitivity analyses included age- and sex-matched case-control study, logistic multivariate model adjusted by residuals, and analysis excluding individuals with prevalent diabetes or cardiovascular disease.The effective sample size was 18,555 individuals (mean age 38-years old, 60% women) including 392 self-reported rheumatoid arthritis. Median daily sodium intake (estimated from foods plus added salt) was 3.47 (P25-75: 2.63-4.55) grams. Total sodium intake in the fourth quartile showed a significant association with rheumatoid arthritis (fully adjusted odds ratio 1.5; 95% CI 1.1-2.1, P for trend = 0.02). Never smokers with high sodium intake had higher association than ever smokers with high sodium intake (P for interaction = 0.007). Dose-dependent association was replicated in the case-control study.High sodium intake may be associated with a diagnosis of rheumatoid arthritis. This confirms previous clinical and experimental research.
PMID: 26376372


Another one...

eCollection 2017.

Sodium excretion is higher in patients with rheumatoid arthritis than in matched
controls. PLoS One. 2017 Oct 13;12(10):e0186157. doi: 10.1371/journal.pone.0186157.

OBJECTIVE: It was shown that sodium can promote auto-immunity through the
activation of the Th17 pathway. We aimed to compare sodium intake in patients
with rheumatoid arthritis (RA) vs. matched controls.

METHODS: This case-control study included 24 patients with RA at diagnosis and
24 controls matched by age, gender and body mass index. Sodium intake was
evaluated by 24-hr urinary sodium excretion.

RESULTS: Sodium excretion was greater for patients with early RA (2,849±1,350
vs. 2,182±751.7mg/day, p = 0.039) than controls. This difference remained
significant after adjustment for smoking and the use of anti-hypertensive and
nonsteroidal anti-inflammatory drugs (p = 0.043). Patients with radiographic
erosion at the time of diagnosis had a higher sodium excretion than those
without (p = 0.028).

CONCLUSION: Patients with early RA showed increased sodium excretion which may
have contributed to autoimmunity.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue May 25, 2021 8:20 am

While the DASH diet may not be the healthiest, it is one of the healthier patterns recommended by many of the leading Nutrition/Health organizations. Keeping the DASH diet constant and then manipulating the amount of sodium shows that while a healthy diet is important to lowering BP (and its CVD related concerns), eating healthy and lowering sodium has a bigger impact.


Effects of Diet and Sodium Reduction on Cardiac Injury, Strain, and Inflammation: The DASH-Sodium Trial
J Am Coll Cardiol. 2021 Jun, 77 (21) 2625–2634

Abstract

Background
The DASH (Dietary Approaches to Stop Hypertension) diet has been determined to have beneficial effects on cardiac biomarkers. The effects of sodium reduction on cardiac biomarkers, alone or combined with the DASH diet, are unknown.

Objectives
The purpose of this study was to determine the effects of sodium reduction and the DASH diet, alone or combined, on biomarkers of cardiac injury, strain, and inflammation.

Methods
DASH-Sodium was a controlled feeding study in adults with systolic blood pressure (BP) 120 to 159 mm Hg and diastolic BP 80 to 95 mm Hg, randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4 weeks. Body weight was kept constant. At the 2,100 kcal level, the 3 sodium levels were low (50 mmol/day), medium (100 mmol/day), and high (150 mmol/day). Outcomes were 3 cardiac biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) (measure of cardiac injury), N-terminal pro–B-type natriuretic peptide (NT-proBNP) (measure of strain), and high-sensitivity C-reactive protein (hs-CRP) (measure of inflammation), collected at baseline and at the end of each feeding period.

Results
Of the original 412 participants, the mean age was 48 years; 56% were women, and 56% were Black. Mean baseline systolic/diastolic BP was 135/86 mm Hg. DASH (vs. control) reduced hs-cTnI by 18% (95% confidence interval [CI]: −27% to −7%) and hs-CRP by 13% (95% CI: −24% to −1%), but not NT-proBNP. In contrast, lowering sodium from high to low levels reduced NT-proBNP independently of diet (19%; 95% CI: −24% to −14%), but did not alter hs-cTnI and mildly increased hs-CRP (9%; 95% CI: 0.4% to 18%). Combining DASH with sodium reduction lowered hs-cTnI by 20% (95% CI: −31% to −7%) and NT-proBNP by 23% (95% CI: −32% to −12%), whereas hs-CRP was not significantly changed (−7%; 95% CI: −22% to 9%) compared with the high sodium-control diet.

Conclusions
Combining a DASH dietary pattern with sodium reduction can lower 2 distinct mechanisms of subclinical cardiac damage: injury and strain, whereas DASH alone reduced inflammation. (Dietary Patterns, Sodium Intake and Blood Pressure [DASH – Sodium]; NCT00000608)
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Nov 17, 2021 12:10 pm

Salt: It is much more then just blood pressure.

The Influence of Dietary Salt Beyond Blood Pressure
Curr Hypertens Rep. 2019 Apr 25; 21(6): 42.
Published online 2019 Apr 25. doi: 10.1007/s11906-019-0948-5

Full text
https://www.ncbi.nlm.nih.gov/labs/pmc/a ... MC7309298/

Abstract

Excess sodium from dietary salt (NaCl) is linked to elevations in blood pressure (BP). However, salt sensitivity of BP varies widely between individuals and there are data suggesting that salt adversely affects target organs, irrespective of BP. For example, high dietary salt has been shown to adversely affect the vasculature, heart, kidneys, skin, brain, and bone. Common mediators of the target organ dysfunction include heightened inflammation and oxidative stress. These physiological alterations may contribute to disease development over time. Despite the adverse effects of salt on BP and several organ systems, there is controversy surrounding lower salt intakes and cardiovascular outcomes. Our goal here is to review the physiology contributing to BP-independent effects of salt and address the controversy around lower salt intakes and cardiovascular outcomes. We will also address the importance of background diet in modulating the effects of dietary salt.

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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Nov 17, 2021 6:14 pm

Conclusion: "Higher sodium and lower potassium intakes, as measured in multiple 24-hour urine samples, were associated in a dose–response manner with a higher cardiovascular risk. These findings may support reducing sodium intake and increasing potassium intake from current levels." Y. Ma, et. al.

https://www.nejm.org/doi/full/10.1056/N ... =707482450
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Feb 16, 2022 11:18 am

Sodium and Health: Old Myths and a Controversy Based on Denial
Current Nutrition Reports https://doi.org/10.1007/s13668-021-00383-z
Accepted: 20 October 2021 © The Author(s) 2021

https://link.springer.com/content/pdf/1 ... 0383-z.pdf

Abstract

Purpose of Review
The scientific consensus on which global health organizations base public health policies is that high sodium intake increases blood pressure (BP) in a linear fashion contributing to cardiovascular disease (CVD). A moderate reduction in sodium intake to 2000 mg per day helps ensure that BP remains at a healthy level to reduce the burden of CVD.

Recent Findings
Yet, since as long ago as 1988, and more recently in eight articles published in the European Heart Journal in 2020 and 2021, some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry’s vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst. Nevertheless, some researchers, often with funding from the food industry, continue to publish such claims without addressing the numerous objections. This article analyzes the eight articles as a case study, summarizes misleading claims, their objections, and it offers possible reasons for such claims.

Summary
Our study calls upon journal editors to ensure that unfounded claims about sodium intake be rigorously chal- lenged by independent reviewers before publication; to avoid editorial writers who have been co-authors with the subject paper’s authors; to require statements of conflict of interest; and to ensure that their pages are used only by those who seek to advance knowledge by engaging in the scientific method and its collegial pursuit. The public interest in the prevention and treatment of disease requires no less.

Conclusion

The articles recently published in the European Heart Jour- nal are based on flawed, biased, incomplete, and inaccu- rate science. In addition, the level of misrepresentation and denial of the enormous body of evidence supporting rec- ommendations to reduce dietary sodium intake raises seri- ous concerns. A false sense of equipoise now obfuscates the facts and creates an aura of controversy that adds cred- ibility to dissenting scientists who publish in high-impact journals. Their science is affected by poor rigour in research methodology, consistent bias and misrepresentation of the entire body of evidence available. The overrepresentation of dissenting paradoxical viewpoints in scientific journals, conferences, media, blogs, and other information outlets has “...succeeded in creating a false equivalence, even when there is only one credible side”, as an observer said [162].

The resurgence of advocacy against reducing dietary sodium intake might have occurred for complex reasons: conflict of interest and commercial bias have been a long- standing issue, with some individuals known to be consult- ants to the salt, food and pharmaceutical industries. Effort that creates a “debate” in the scientific literature when there is no authentic debate can generate research funding. Many reasons have hampered the ability to refute the false and misleading claims. They often include lack of public access to the data allegedly supporting research claims, unscientific conduct, and unclear rules as to which institution is respon- sible for policing ethics obligations when many institutions are involved (granting bodies, research ethics committees, journals, health and scientific organizations, and govern- ments) [38••]. Finally, controversial scientific papers might be accepted for publication because they are more “inter- esting” and journals might apply lower standards regarding their methodological rigour and reproducibility [163].

For the case study presented, there has been a lapse in implementing the European Heart Journal “Conflict of Interest Policy”, which raises questions about the scientific publishing enterprise. Editorial writers [74] have been co- authors [76] with authors of a paper they commented on, as with a recent paper [78]. This could be “perceived” as a conflict of interest, especially when glaring omissions are detected in the editorial. Furthermore, the article by O’Donnell et al. [76], rather than presented as a View Point or Debate, was portrayed by the journal as a Clinical Review (listed in the Instructions for Authors as State-of-the-Art Review), thus misrepresenting the field. Conflicts of inter- est were not declared, thus undermining public trust in the scientific process and the credibility of the published articles [38••]. In nutrition science, there has been a long-standing lack of ethical guidance and relaxed implementation from all stakeholders [164]. Journals and editors are responsible for the scientific integrity of what they publish [165]. The studies we have reviewed on salt and CVD indicate the need to revamp the current medical publishing system [166, 167]. The present case study has identified issues of significant societal consequence that are critical to address to main- tain public trust in the scientific process. We have identified numerous challenges to scientific integrity that plague sci- ence (like those seen in the past regarding tobacco and cur- rently regarding climate change). The case study highlights the need to develop, implement and enforce higher research quality and publishing standards to safeguard public policy in areas of nutrition where millions of lives are at risk.

Evidence supporting population-wide reduction in sodium intake is consistent, robust, and endorsed by such major health authorities as the WHO [16] and NASEM [8••]. A comprehensive public health approach to reduce sodium in the food supply is underway to prevent millions of unnecessary deaths and billions in health-care costs. This important work aims literally to save lives. It should not
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue Dec 13, 2022 8:26 am

Blood Pressure Effects of Sodium Reduction
Dose–Response Meta-Analysis of Experimental Studies
Circulation. 2021;143:1542–1567. DOI: 10.1161/CIRCULATIONAHA.120.050371

https://www.ncbi.nlm.nih.gov/pmc/articl ... 3-1542.pdf

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.



Clinical Perspective
What Is New?
• A comprehensive dose–response meta-analysis of trials detailing the effects of changes in dietary sodium on blood pressure (BP), using the most up- to-date statistical dose–response modeling, shows that the relationship is positive, and almost but not entirely linear.

• The sodium change–BP relationship was present in analyses of long-term trials, although slightly atten- uated compared with the corresponding finding in short-term studies, and was noted in both analy- ses based on differences in sodium intake between study arms and achieved sodium intake.

• Higher background sodium consumption and BP increase strength and steepness of the effects on BP by changes in sodium intake.

What Are the Clinical Implications?
• The clinical implications of a substantially linear positive relationship between sodium intake and BP even in the long-term trials are that a progres- sively large reduction in BP can be expected with decreases in sodium consumption down to lev- els as low as 1 to 1.5 g/d, with no evidence for a threshold in benefit.

• Advice to reduce dietary sodium intake applies not only to adults with hypertension, who can be expected to derive a substantial reduction in BP, but also to those without hypertension, in whom the expected reduction in BP is smaller but still important.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue Nov 14, 2023 9:30 am

Effect of Dietary Sodium on Blood Pressure
A Crossover Trial
JAMA. Published online November 11, 2023. doi:10.1001/jama.2023.23651

https://jamanetwork.com/journals/jama/f ... le/2811931

Key Points
Question What is the impact of dietary sodium intake on blood pressure in middle-aged to elderly individuals?

Findings In this prospectively allocated diet order crossover study of 213 individuals, 1 week of a low-sodium diet resulted in an average 8–mm Hg reduction in systolic blood pressure vs a high-sodium diet, with few adverse events. The low-sodium diet lowered systolic blood pressure in nearly 75% of individuals compared with the high-sodium diet.

Meaning In this trial, the blood pressure–lowering effect of dietary sodium reduction was comparable with a commonly used first-line antihypertensive medication.


Abstract
Importance Dietary sodium recommendations are debated partly due to variable blood pressure (BP) response to sodium intake. Furthermore, the BP effect of dietary sodium among individuals taking antihypertensive medications is understudied.

Objectives To examine the distribution of within-individual BP response to dietary sodium, the difference in BP between individuals allocated to consume a high- or low-sodium diet first, and whether these varied according to baseline BP and antihypertensive medication use.

Design, Setting, and Participants Prospectively allocated diet order with crossover in community-based participants enrolled between April 2021 and February 2023 in 2 US cities. A total of 213 individuals aged 50 to 75 years, including those with normotension (25%), controlled hypertension (20%), uncontrolled hypertension (31%), and untreated hypertension (25%), attended a baseline visit while consuming their usual diet, then completed 1-week high- and low-sodium diets.

Intervention High-sodium (approximately 2200 mg sodium added daily to usual diet) and low-sodium (approximately 500 mg daily total) diets.

Main Outcomes and Measures Average 24-hour ambulatory systolic and diastolic BP, mean arterial pressure, and pulse pressure.

Results Among the 213 participants who completed both high- and low-sodium diet visits, the median age was 61 years, 65% were female and 64% were Black. While consuming usual, high-sodium, and low-sodium diets, participants’ median systolic BP measures were 125, 126, and 119 mm Hg, respectively. The median within-individual change in mean arterial pressure between high- and low-sodium diets was 4 mm Hg (IQR, 0-8 mm Hg; P < .001), which did not significantly differ by hypertension status. Compared with the high-sodium diet, the low-sodium diet induced a decline in mean arterial pressure in 73.4% of individuals. The commonly used threshold of a 5 mm Hg or greater decline in mean arterial pressure between a high-sodium and a low-sodium diet classified 46% of individuals as “salt sensitive.” At the end of the first dietary intervention week, the mean systolic BP difference between individuals allocated to a high-sodium vs a low-sodium diet was 8 mm Hg (95% CI, 4-11 mm Hg; P < .001), which was mostly similar across subgroups of age, sex, race, hypertension, baseline BP, diabetes, and body mass index. Adverse events were mild, reported by 9.9% and 8.0% of individuals while consuming the high- and low-sodium diets, respectively.

Conclusions and Relevance Dietary sodium reduction significantly lowered BP in the majority of middle-aged to elderly adults. The decline in BP from a high- to low-sodium diet was independent of hypertension status and antihypertensive medication use, was generally consistent across subgroups, and did not result in excess adverse events.


Conclusions
In conclusion, sodium reduction significantly lowered BP in the majority of middle-aged to elderly adults in this study. The decline in BP from a high-sodium diet to a low-sodium diet was independent of hypertension status and antihypertensive medication use, generally consistent across subgroups, and did not result in excess adverse events.


Lowering salt (one teaspoon) in the diet among middle-aged and older adults was as good an effect for reducing BP as a first-line anti-hypertensive drug, independent of severity of HTN or meds, in ~75% of people, from a randomized trial
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JeffN
 
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Mon Mar 11, 2024 7:24 am

Lets add another concern with excess salt to the list....

Dietary Sodium Intake and Risk of Incident Type 2 Diabetes
ORIGINAL ARTICLE| VOLUME 98, ISSUE 11, P1641-1652, NOVEMBER 2023Download Full Issue
Open AccessDOI:https://doi.org/10.1016/j.mayocp.2023.02.029

https://www.mayoclinicproceedings.org/article/S0025-6196(23)00118-0/fulltext

Abstract

Objective

To fill the knowledge gap of the relation between long-term dietary sodium intake and type 2 diabetes (T2D), we evaluate the association between the frequency of adding salt to foods, a surrogate marker for evaluating the long-term sodium intake, and incident T2D risk.
Methods

A total of 402,982 participants from UK Biobank (March 13, 2006 – October 10, 2010) who were free of diabetes, chronic kidney disease, cancer, or cardiovascular disease at baseline, and had completed information on adding salt were analyzed in this study.
Results

During a median of 11.9 years of follow-up, 13,120 incident cases of T2D were documented. Compared with participants who “never/rarely” added salt to foods, the adjusted HRs were 1.11 (95% CI, 1.06 to 1.15), 1.18 (95% CI, 1.12 to 1.24), and 1.28 (95% CI, 1.20 to 1.37) across the groups of “sometimes,” “usually,” and “always,” respectively (P-trend<.001). We did not find significant interactions between the frequency of adding salt to foods and baseline hypertension status and other covariates on the risk of incident T2D. The observed positive association was partly mediated by body mass index, waist to hip ratio, and C-reactive protein, with a significant mediation effect of 33.8%, 39.9%, and 8.6%, respectively. The significant mediation effect of body mass index was largely driven by the body fat mass rather than the body fat-free mass.
Conclusion

Our findings for the first time indicate that higher frequency of adding salt to foods, a surrogate marker for a person’s long-term salt taste preference and intake, is associated with a higher T2D risk.
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JeffN
 
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