Study finds that too much sodium is a worldwide killer

Salt accounts for more than 1.6 million cardiovascular-related deaths each year. Credit: Juliette Borda

Americans are not alone in their taste for salty foods. Whether the salt comes from French fries or miso soup, people all over the world are getting more than the current recommendations. And according to an analysis of global sodium intake published in the New England Journal of Medicine, that overabundance of salt accounts for more than 1.6 million cardiovascular-related deaths each year.

13 april 2015--The researchers looked at existing data on sodium intake in 187 countries representing nearly three-quarters of the world's adult population. Separately, they determined the effects of sodium on blood pressure and of blood pressure on cardiovascular diseases—including heart disease and stroke—by analyzing more than 100 previous clinical trials.

These findings were combined with current rates of cardiovascular disease around the world to estimate the number of cardiovascular deaths attributable to taking in more than 2,000 mg of sodium per day, the World Health Organization's recommended amount.

In 2010, the average global sodium consumption was nearly double that recommendation—3,950 mg—the researchers found. In fact, all regions of the world were above recommended levels, with averages ranging from 2,180 mg per day in sub-Saharan Africa to 5,510 mg per day in Central Asia.

"These 1.65 million deaths represent nearly one in 10 of all deaths from cardiovascular causes worldwide. No world region and few countries were spared," says Dariush Mozaffarian, dean of the Friedman School, who led the research while at the Harvard School of Public Health and is first author on the paper. Some of the highest rates were in East Asia and Southeast Asia, where excess salt consumption accounted for more than 20 percent of cardiovascular deaths in people under age 70, the study found.

In the United States, the researchers found that nearly 58,000 cardiovascular deaths each year could be attributed to daily sodium consumption greater than 2,000 mg. Average U.S. sodium intake was 3,600 mg per day, 80 percent higher than the WHO's recommendation and 57 percent higher than the 2,300 mg recommended by the Dietary Guidelines for Americans.

"These new findings inform the need for strong policies to reduce dietary sodium in the United States and across the world," says Mozaffarian, who chairs the Global Burden of Diseases, Nutrition and Chronic Disease Expert Group, an international team of more than 100 scientists studying the effects of nutrition on health that contributed to the research.

Provided by Tufts University

Population-wide reduction in salt consumption recommended

The American Heart Association today issued a call to action for the public, health professionals, the food industry and the government to intensify efforts to reduce the amount of sodium (salt) Americans consume daily.

14 jan 2011--In an advisory, published in Circulation: Journal of the American Heart Association, the association sets out the science behind the American Heart Association's recommendation for the general population, which is to consume no more than 1500 milligrams (mg) of sodium a day because of the harmful effects of sodium – elevated blood pressure and increased risk of stroke, heart attacks and kidney disease. Elevated blood pressure (hypertension) is a major public health problem – approximately 90 percent of all Americans will develop hypertension over their lifetime.

Sodium consumption is currently more than two times higher than the recommended upper limit of 1,500 mg daily, with 77 percent of that consumption coming from packaged, processed and restaurant foods. "Even a modest decline in intake – say 400 mg per day –would produce benefits that are substantial and warrant implementation," say the advisory authors. The 2005 United States Dietary Guidelines for Americans recommended a sodium intake limit of 2,300 mg per day, which many health experts say is too much for most Americans. Earlier this year, the Dietary Guidelines Advisory Committee recommended to the secretaries of the United States Departments of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) that the goal should be modified to 1,500 mg per day for the general population. The advisory committee consists of leading scientists who reviewed the most recent scientific studies and created a set of recommendations that are being reviewed by the secretaries.

Recently, the American Heart Association lowered their recommendation to no more than 1500 mg of sodium daily for the general public, after a report from the Centers for Disease Control found that a majority of the American population either have high blood pressure or are at high risk for developing it.

According to the advisory:

• As sodium intake rises, so does blood pressure and the risk of negative health outcomes.
  
• Independent of its effects on blood pressure, excess sodium intake adversely affects the heart, kidneys, and blood vessels.
  
• The potential public health benefits of sodium reduction are enormous and extend to all Americans.
  
• Scientific evidence on the adverse effects of excess sodium is strong and compelling
  
• The American Heart Association's 2020 impact goals – to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent – include a population-wide reduction of sodium consumption to less than 1,500 mg daily as one of the ways the association will measure the nation's cardiovascular health. Furthermore, a normal range blood pressure is another key factor the association will use to measure the nation's cardiovascular health status.
  
• The American Heart Association is part of the National Salt Reduction Initiative, which is working with the food industry to reduce sodium content in packaged and restaurant food.

Inherent to the negative health effects are rising healthcare costs, the authors add. They point to one recent study that suggests a national effort that reduces sodium intake by 1,200 mg per day should reduce the health burdens related to heart disease in addition to reducing costs by up to $24 billion per year.

"Americans deserve the opportunity to choose how much sodium is in the food they eat. By supporting measures that will reduce sodium in the overall food supply, we are giving consumers freedom to select foods that could allow them to meet sodium recommendations and improve their ideal cardiovascular health," said Ralph Sacco, M.D., president of the American Heart Association.

The American Heart Association advocates for more robust sodium criteria within school nutrition standards, foods advertised and marketed to children and foods purchased by employers or government feeding programs, and for the Secretaries of HHS and USDA to adopt the Dietary Guidelines Advisory Committee recommendations.

The association also supports improved food labeling that helps consumers understand how much sodium is in their diet and consumer education in restaurants to help consumers choose lower-sodium options.

Provided by American Heart Association

FDA Hears Calls to Revoke Salt's GRAS Status and Give it Blood Pressure Warning

COLLEGE PARK, Md., Nov. 30 -- The FDA should limit salt content in food and include a hypertension warning on salt's labeling, demanded sodium foes at a daylong public hearing.
Action Points
Explain to interested patients that the American Heart Association advises adults to limit daily sodium intake to less than 2,300 milligrams, or about one teaspoon, but the average American consumes about 3,300 milligrams per day.
Explain to interested patients that most of the salt in the American diet comes from processed and restaurant foods, not the salt shaker.
Explain to interested patients that consuming too much salt has been purportedly associated with high blood pressure, stroke, heart attacks, kidney failure, and early death, although no direct population-wide causal links have been established.
Explain to interested patients that many public health advocates want the FDA to regulate and restrict the salt in processed foods.Salt is currently on the FDA's so-called GRAS list -- generally regarded as safe.
But the Center for Science in the Public Interest and the American Medical Association both pressed the FDA to revoke the GRAS status, and the hearing was stacked with speakers pointing out the purported health hazards associated with salty diets.
The FDA was silent on its plans for salt, but Laura Tarantino, Ph.D., director of the FDA's food safety office, said that it was "really a good time to be having this meeting" because of increased research interest in salt and regulatory changes in other countries.
Yet the Salt Institute noted that there are no solid population-wide data showing how the health of the nation would benefit from a sharp reduction in sodium consumption.
"Trimming the salt content in processed and restaurant foods by half would save a minimum of 150,000 lives a year," countered Stephen Havas, M.D., M.P.H., vice president for science, quality, and public health at the AMA. Adults are consuming more than 4,000 mg of sodium a day, he said, almost double the AHA recommended amount of 2,300 mg, equal to one teaspoon of salt.
"The deaths attributed to excess salt consumption represent a huge toll -- the equivalent of a jumbo jet with more than 400 passengers crashing every day of the year, year after year," Dr. Havas said.
Dr. Havas, who testified at the hearing, said in an interview, "I'd like to see the FDA set strict limits on the amount of salt that is allowed in food and develop a better system of warning labels that would be placed on the front of food packaging so people will know what is in their foods."
Specifically, Dr. Havas proposed a red light, yellow light, green light system similar to the one used in Britain. "A green light on a package would indicate that the product is low salt, while red would mean it is high in salt," he explained. "This is very easy for people to understand."
This system would also encourage food manufacturers to reduce the salt in their products, because they won't want a red light on the front of the package, Dr. Havas said.
An AMA scientific statement supports a minimum 50% reduction in sodium in processed foods, fast food products, and restaurant meals to be achieved over the next decade.
The dangers of salt consumption are well recognized, asserted Michael F. Jacobson, of the Center for Science in the Public Interest. He said excess salt increases the risk of hypertension, stroke, kidney failure, heart attacks, and premature death.
He said the FDA could no longer back away from challenging food makers on sodium content because "it is increasingly hard for FDA officials to ignore the calls to action made in recent years by the medical community."
Jacobson cited the American Heart Association recommendation that adults limit daily sodium intake to less than 2,300 mg.
But the Salt Institute, an industry trade group, argued that labeling should not be changed without solid scientific evidence of the dangers of salt. Richard L. Hanneman, speaking for the group, said it would support a controlled trial to determine whether reducing salt consumption across a broad population would reduce the rate of hypertension, renal failure, and stroke.
"Let's do the study and find out the truth," he said. "This is an investment well worth making."
In testimony, Hanneman stated that correcting current deficiencies in potassium, calcium and magnesium by encouraging greater consumption of fruits, vegetables, whole grains, and dairy products would be more beneficial to public health.
That's all well and good, contended Dr. Havas, but specifically reducing salt can have a quick and powerful effect on health.
"Getting consumers to eat more fruit and vegetables is occurring at a glacial pace, but by [restricting] sodium we can do something very quickly," he said.
"The simplest thing to change and the one killing the most people is salt," Dr. Havas said. "Once we start reducing blood pressure, we can see an effect on stroke rate, heart disease rate and mortality within a year," he said.
Brian Kennedy, a spokesperson for the Grocery Manufacturers Association, based in the District of Columbia, said there was no need for a label change for salt "because it is an important ingredient in food and it's been in use for literally thousands of years and has important taste and functional properties."
Instead, the group pointed out that consumers have a broad range of foods containing no sodium or low sodium from which to choose.
Moreover, Kennedy said food companies have been very successful at making incremental reductions in salt levels in food products and processing and packaging technologies also allow for less salt or sodium.
The FDA gave no indication on when it would reach a decision.