New AHA Advisory Reaffirms Dietary Sodium Intake Recommendations

On Nov. 2, the American Heart Association (AHA) issued a Presidential Advisory reaffirming the recommended dietary sodium intake of less than 1,500 mg/d for the entire U.S. population.

Published in Circulation, the advisory explains that studies published since the 2011 advisory on the same topic, confirm and reinforce, rather than contradict, the recommendation and add additional support to the link between excessive sodium consumption and cardiovascular disease (CVD).

The authors of the advisory reviewed a series of publications published in 2011 that address the relationship between sodium intake and CVD and stroke. They note that some of the studies support research that excessive sodium consumption is linked to heart disease and other illness, while other studies report "paradoxical inverse or J-shaped associations between sodium intake and CVD and stroke risk." These other studies, along with a meta-analysis, "have been widely misinterpreted as disproving the relationship between sodium and CVD and stroke risk, and have received considerable media attention … [and] stirred controversy and confusion in the popular press," wrote the advisory panel.

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Authors of the 2012 Presidential Advisory divided studies published since the 2011 Presidential Advisory into five categories: experimental and laboratory studies; survey data; risk association; clinical trials; and nutritional adequacy. In each category, the findings of the studies either support the association between excess sodium consumption and disease or are not persuasive enough to undermine existing evidence of the association:

  • Experimental and laboratory studies found that excess sodium consumption leads to high blood pressure, attenuation of the effects of antihypertensive medications and ventricular hypertrophy.
  • U.S.-based population surveys found sodium consumption well above nutritional recommendations.
  • Methodological and design problems with observational studies rendered the results unreliable.
  • Clinical trials confirmed that reductions in sodium consumption lead to lower blood pressure and other benefits.
  • Nutritional adequacy is achievable with current eating patterns in the U.S. even if lower sodium foods are introduced to diets.

The advisory concluded that "available data, including those from studies published since the 2011 AHA Presidential Advisory on sodium reduction, provide strong scientific support for the AHA guidelines to reduce sodium intake to <1,500 mg/d." In addition, "new animal and human studies continue to provide important evidence that excess sodium promotes structural and functional impairment of the heart, great vessels and kidneys. These pathophysiological changes progress over time to severe disease manifested by acute clinical events, costly hospitalizations for cardiac failure and end-stage renal disease, and death. Calls for abandoning the AHA dietary guidelines for sodium consumption are based on flawed analyses of data from observational studies that were not planned to study sodium relationships, with great potential to yield misleading results, and on misinterpretation of clinical trial results," they add.

"The AHA remains committed to improving the health of all Americans through the implementation of its national goals for health promotion and disease prevention, including the goal to reduce dietary sodium to <1,500 mg/d," they conclude.

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