title: Effect of lower sodium intake on health: systematic review and meta-analyses.
abstract: OBJECTIVE
  To assess the effect of decreased sodium intake on blood pressure, related cardiovascular diseases, and potential adverse effects such as changes in blood lipids, catecholamine levels, and renal function.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, the Latin American and Caribbean health science literature database, and the reference lists of previous reviews.
  
  
  METHODS
  Randomised controlled trials and prospective cohort studies in non-acutely ill adults and children assessing the relations between sodium intake and blood pressure, renal function, blood lipids, and catecholamine levels, and in non-acutely ill adults all cause mortality, cardiovascular disease, stroke, and coronary heart disease.
  
  
  METHODS
  Potential studies were screened independently and in duplicate and study characteristics and outcomes extracted. When possible we conducted a meta-analysis to estimate the effect of lower sodium intake using the inverse variance method and a random effects model. We present results as mean differences or risk ratios, with 95% confidence intervals.
  
  
  RESULTS
  We included 14 cohort studies and five randomised controlled trials reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease; and 37 randomised controlled trials measuring blood pressure, renal function, blood lipids, and catecholamine levels in adults. Nine controlled trials and one cohort study in children reporting on blood pressure were also included. In adults a reduction in sodium intake significantly reduced resting systolic blood pressure by 3.39 mm Hg (95% confidence interval 2.46 to 4.31) and resting diastolic blood pressure by 1.54 mm Hg (0.98 to 2.11). When sodium intake was <2 g/day versus ≥ 2 g/day, systolic blood pressure was reduced by 3.47 mm Hg (0.76 to 6.18) and diastolic blood pressure by 1.81 mm Hg (0.54 to 3.08). Decreased sodium intake had no significant adverse effect on blood lipids, catecholamine levels, or renal function in adults (P>0.05). There were insufficient randomised controlled trials to assess the effects of reduced sodium intake on mortality and morbidity. The associations in cohort studies between sodium intake and all cause mortality, incident fatal and non-fatal cardiovascular disease, and coronary heart disease were non-significant (P>0.05). Increased sodium intake was associated with an increased risk of stroke (risk ratio 1.24, 95% confidence interval 1.08 to 1.43), stroke mortality (1.63, 1.27 to 2.10), and coronary heart disease mortality (1.32, 1.13 to 1.53). In children, a reduction in sodium intake significantly reduced systolic blood pressure by 0.84 mm Hg (0.25 to 1.43) and diastolic blood pressure by 0.87 mm Hg (0.14 to 1.60).
  
  
  CONCLUSIONS
  High quality evidence in non-acutely ill adults shows that reduced sodium intake reduces blood pressure and has no adverse effect on blood lipids, catecholamine levels, or renal function, and moderate quality evidence in children shows that a reduction in sodium intake reduces blood pressure. Lower sodium intake is also associated with a reduced risk of stroke and fatal coronary heart disease in adults. The totality of evidence suggests that most people will likely benefit from reducing sodium intake.
authors.affiliation: Nutrition Policy and Scientific Advice Unit, Department of Nutrition for Health and Development, World Health Organization, 1211 Geneva 27, Switzerland. nancy.aburto@wfp.org
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Aburto
authors.forename: Anna
authors.initials: A
authors.lastname: Ziolkovska
authors.forename: Lee
authors.initials: L
authors.lastname: Hooper
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
authors.forename: Francesco P
authors.initials: FP
authors.lastname: Cappuccio
authors.forename: Joerg J
authors.initials: JJ
authors.lastname: Meerpohl
mesh_terms: D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000378:metabolism / Q000517:prevention & control*; D002395:Catecholamines / Q000378:metabolism; D004039:Diet, Sodium-Restricted; D005260:Female; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000378:metabolism / Q000517:prevention & control*; D007668:Kidney / Q000378:metabolism*; D050356:Lipid Metabolism; D008297:Male; D011446:Prospective Studies; D011634:Public Health; D016032:Randomized Controlled Trials as Topic; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*
chemical_list: D002395:Catecholamines; D017673:Sodium Chloride, Dietary
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