title: Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide.
abstract: OBJECTIVE
  To estimate global, regional (21 regions) and national (187 countries) sodium intakes in adults in 1990 and 2010.
  
  
  METHODS
  Bayesian hierarchical modelling using all identifiable primary sources.
  
  
  METHODS
  We searched and obtained published and unpublished data from 142 surveys of 24 h urinary sodium and 103 of dietary sodium conducted between 1980 and 2010 across 66 countries. Dietary estimates were converted to urine equivalents based on 79 pairs of dual measurements.
  Bayesian hierarchical modelling used survey data and their characteristics to estimate mean sodium intake, by sex, 5 years age group and associated uncertainty for persons aged 20+ in 187 countries in 1990 and 2010. Country-level covariates were national income/person and composition of food supplies.
  
  
  METHODS
  Mean sodium intake (g/day) as estimable by 24 h urine collections, without adjustment for non-urinary losses.
  
  
  RESULTS
  In 2010, global mean sodium intake was 3.95 g/day (95% uncertainty interval: 3.89 to 4.01). This was nearly twice the WHO recommended limit of 2 g/day and equivalent to 10.06 (9.88-10.21) g/day of salt. Intake in men was ∼10% higher than in women; differences by age were small. Intakes were highest in East Asia, Central Asia and Eastern Europe (mean >4.2 g/day) and in Central Europe and Middle East/North Africa (3.9-4.2 g/day). Regional mean intakes in North America, Western Europe and Australia/New Zealand ranged from 3.4 to 3.8 g/day. Intakes were lower (<3.3 g/day), but more uncertain, in sub-Saharan Africa and Latin America. Between 1990 and 2010, modest, but uncertain, increases in sodium intakes were identified.
  
  
  CONCLUSIONS
  Sodium intakes exceed the recommended levels in almost all countries with small differences by age and sex. Virtually all populations would benefit from sodium reduction, supported by enhanced surveillance.
authors.affiliation: Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge, UK.
authors.forename: John
authors.initials: J
authors.lastname: Powles
authors.forename: Saman
authors.initials: S
authors.lastname: Fahimi
authors.forename: Renata
authors.initials: R
authors.lastname: Micha
authors.forename: Shahab
authors.initials: S
authors.lastname: Khatibzadeh
authors.forename: Peilin
authors.initials: P
authors.lastname: Shi
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Engell
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Lim
authors.forename: Goodarz
authors.initials: G
authors.lastname: Danaei
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
keywords: Epidemiology; Hypertension < Cardiology; Nutrition & Dietetics; Preventive Medicine