Trending Topics pieces (Article Analyses, Evidence Clips and Other Topics) are published in timely response to recent media and journal articles, position statements, clinical guidelines, etc. Since they are based on the most recent evidence/publications, they may not be consistent with PEN evidence in other PEN content areas. As soon as possible, when this occurs, the PEN content will be reviewed and updated as needed.
DRI Updates for Sodium and Potassium
A press release from the National Academies of Sciences, Engineering, and Medicine outlines a new report titled, Dietary Reference Intakes for Sodium and Potassium. A National Academies committee conducted the study to assess current relevant data and update, as appropriate, the DRIs for sodium and potassium that were developed in 2005. Posted: 2019-03-11
The report “reaffirms the sodium AI for individuals ages 14-50, decreases the sodium AIs for children age 1-13, increases the sodium AIs for adults ages 51 and older, and decreases the potassium AIs for individuals age 1 and older” (1). In addition, the committee applied recommendations from the 2017 Guiding Principles Report and established a new category of DRIs based on chronic disease, the Chronic Disease Risk Reduction Intake (CDRR) for sodium, based on the benefits of reducing sodium intake on blood pressure and cardiovascular disease risk.
The review was sponsored by Health Canada, the U.S. National Institutes of Health, the Public Health Agency of Canada, the U.S. Centers for Disease Control and Prevention, the U.S. Department of Agriculture, and the U.S. Food and Drug Administration.
Also available is a Consensus Study Report providing report highlights.
National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for sodium and potassium. Washington D.C.: The National Academies Press; 2019. Available from: https://www.nap.edu/read/25353/chapter/1#ii
Salt Intake and CVD: The Ongoing Debate
A Canadian and European Government- and NGO-funded study investigating the associations between community-level mean sodium and potassium intake, cardiovascular disease and mortality was recently published in The Lancet (1). The study reports on clinical outcomes based on an analysis of 94,378 participants from 18 countries. Participants were aged 35 to 70 years and did not have cardiovascular disease at baseline. As a surrogate for sodium intake, morning fasting urine was used to estimate 24-hour sodium and potassium excretion. The authors’ main interpretation was that sodium intake was associated with cardiovascular disease and stroke but only in communities where estimated mean sodium intake was greater than 5 g/day.
The validity of the results has been questioned by others (2,3) for two main reasons. First, this is an observational study based on community averages and not on individual data (ecologic study design). Second, 24-hour sodium excretion was estimated from urine collected after overnight fasting, which is not a reliable measurement of daily salt intake as is a repeated 24-hour urine sample. For more on the salt and hypertension debate, see Salt and Heart Disease: A Second Round of "Bad Science" and Expert Reaction to Study Looking at Salt Consumption and Health Risks.
See Additional PEN content: Does diet have a role in preventing hypertension?
- Mente A, O'Donnell M, Rangarajan S, Yeates K, Teo K, Yusuf S, et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study. The Lancet. 2018 Aug;392(10146):496-506. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31376-X/fulltext
- Messerli FH, Hofstetter L, Bangalore S. Salt and heart disease: a second round of “bad science”? The Lancet. 2018 Aug;392:10146:456-8. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31724-0/fulltext?rss=yes
- Science Media Centre. Expert reaction to study looking at salt consumption and health risks. 2018 August 9. Available from: http://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-salt-consumption-and-health-risks/
Pink Himalayan Sea Salt
Wondering about the hype around pink Himalayan sea salt? See the review by Harriet Hall, MD from Science-Based Medicine.
Article Analysis and Commentary on Low-salt Diets Research