e-Library of Evidence for Nutrition Actions (eLENA)


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Reducing sodium intake to reduce blood pressure and risk of cardiovascular diseases in adults

Intervention | Last updated: 19 May 2023

Cardiovascular diseases (CVDs) are the leading cause of death globally. An estimated 17.8 million people died from CVDs in 2017, representing approximately 32% of all deaths worldwide. High blood pressure (hypertension) is a major risk for CVDs, especially heart attack and stroke.

Evidence shows that reducing sodium intake significantly reduces blood pressure in adults. Sodium is found not only in table salt, but also naturally in a variety of foods, including milk, cream, eggs, meat and shellfish. It is also found in much high amounts in processed foods, such as breads, crackers, processed meats like bacon and snack foods such as pretzels, cheese puffs and popcorn, as well as in condiments such as soy sauce, fish sauce, and bouillon or stock cubes.

WHO Recommendations

WHO recommends a reduction in sodium intake to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults.

WHO recommends a reduction to <2 g/day sodium (5 g/day salt) in adults.

 

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These recommendations recognize that salt reduction and salt iodization are compatible. Monitoring of salt intake and salt iodization at country level is needed so that salt iodization can be adjusted over time as necessary, depending on observed salt intake in the population, to ensure that individuals consuming the recommended amount of sodium will continue to consume sufficient iodine.

These recommendations complement the WHO guideline on potassium consumption and should not be interpreted to replace or supersede that guideline. Public health interventions should aim to reduce sodium intake and simultaneously increase potassium intake through foods. Additional information can be found in the guidance summary, and in the guideline under 'WHO documents' below.



Evidence

Systematic reviews used to develop the guidelines

Effect of reduced sodium intake on blood pressures and potential adverse effects in children

Aburto NJ, Ziolkovska A. Geneva: World Health Organization; 2012.

Effect of lower sodium intake on health: systematic review and meta-analyses

Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. BMJ. 2013, 346:f1326.

Effect of reduced sodium intake on blood pressure, renal function, blood lipids and other potential adverse effects

Aburto NJ, Das S. Geneva: World Health Organization; 2012.

Related Cochrane reviews

Effect of longer-term modest salt reduction on blood pressure

He FJ, Li J, MacGregor GA. Cochrane Database of Systematic Reviews. 2013; Issue 4. Art. No.: CD004937.

Summary of this review Alternate Text

Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride

Graudal NA, Hubeck-Graudal T, Jurgens G.Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD004022.

Summary of this review Alternate Text

Reduced dietary salt for the prevention of cardiovascular disease

Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S. Cochrane Database of Systematic Reviews. 2014; Issue 12. Art. No.: CD009217.

Summary of this review Alternate Text

Other related systematic reviews

Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials

Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV et al. J Hypertens. 2006;24(2):215-33.

Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies

Strazzullo P, D'Elia L, Kandala NB, Cappuccio FP. BMJ. 2009;339:b4567.

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Cost-effectiveness analyses

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries

Mason H, Shoaibi A, Ghandour R, O'Flaherty M, Capewell S, Khatib R, et al. PLoS One. 2014; 9(1):e84445.

Cost-effectiveness of interventions to reduce dietary salt intake

Cobiac LJ, Vos T, Veerman JL. Heart. 2010; 96(23):1920-5.

Cost and cost-effectiveness of a school-based education program to reduce salt intake in children and their families in China

Li X, Jan S, Yan LL, Hayes A, Chu Y, Wang H, et al. PLoS One. 2017; 12(9):e0183033.

Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010-2020

Wilcox ML, Mason H, Fouad FM, Rastam S, al Ali R, Page TF, et al. Int J Public Health. 2015; 60 Suppl 1:S23-30.

Taxes and Subsidies for Improving Diet and Population Health in Australia: A Cost-Effectiveness Modelling Study

Cobiac LJ, Tam K, Veerman L, Blakely T. PLoS Med. 2017; 14(2):e1002232.

Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations

Webb M, Fahimi S, Singh GM, Khatibzadeh S, Micha R, Powles J, Mozaffarian D. BMJ. 2017; 356:i6699.

Health economic consequences of reducing salt intake and replacing saturated fat with polyunsaturated fat in the adult Finnish population: estimates based on the FINRISK and FINDIET studies

Martikainen JA, Soini EJ, Laaksonen DE, Niskanen L. Eur J Clin Nutr. 2011; 65(10):1148-55.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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