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Can Sodium Intake Recommendations Be Too Low?

Pfeifer, Gail MA, RN, news director

AJN The American Journal of Nursing: August 2013 - Volume 113 - Issue 8 - p 18
doi: 10.1097/01.NAJ.0000432949.34774.dc
In the News

A new report says yes, but not all agree with the findings.

An expert committee at the Institute of Medicine (IOM) recently assessed the evidence regarding population-based sodium reduction strategies, paying particular attention to outcomes in high-risk subgroups, such as non-Hispanic blacks and other peoples with hypertension, prehypertension, diabetes, chronic kidney disease, and congestive heart failure, as well as in those who are 51 years old and older.

The report, Sodium Intake in Populations: Assessment of Evidence, has been met with skepticism, however, particularly by the American Heart Association. (Read the full report here:

The IOM report concluded that there is “insufficient and inconsistent” evidence linking sodium intakes below 2,300 mg daily with any benefit or risk regarding cardiovascular disease outcomes, including stroke and cardiovascular disease or all-cause mortality, in the United States. It also concluded that current recommendations to lower intake below that level aren't supported.

But the American Heart Association says that the IOM report is incomplete because it didn't specifically examine the evidence linking excess sodium consumption with hypertension. The American Heart Association maintains that consuming less than 1,500 mg of sodium daily “will significantly reduce the increase in blood pressure” that occurs with aging and will reduce health costs as well.

Reducing sodium intake to that level, adds the American Heart Association, would decrease hypertension by 26% and save more than $26 billion over one year.

And as we went to press, the Centers for Disease Control and Prevention—one of the agencies that commissioned the IOM report and which cites it on a Web page entitled Most Americans Should Consume Less Sodium(—has kept its recommended sodium intake at no more than 1,500 mg daily in those high-risk groups listed above.

The quibble seems to be related more to the amount of sodium reduction (to below 2,300 mg or 1,500 mg, say) than to the question of whether sodium intake should be reduced at all.

Overall, says the IOM report, the evidence does support efforts to lower excessive intake but does not support lowering it below 1,500 mg daily in the general population; nor does it support treating those high-risk subgroups differently. —Gail Pfeifer, MA, RN, news director

© 2013 Lippincott Williams & Wilkins. All rights reserved.