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Sodium intake may promote weight gain: Results of the FANPE study in a representative sample of the adult Spanish population
Abstract
Introduction: Recent studies have indicated that diets rich in sodium may predispose to the development of obesity, either directly, or be associated with the consumption of foods that promote weight gain. Objetive: The aims of this study were to analyze the association between urinary sodium and the presence of excess of weight. Additionally, the study investigated the relationships between salt intake and dietary habits, as a high salt intake may be associated with inadequate eating habits and a high incidence of obesity. Methods: This study involved 418 adults (196 men and 222 women) aged 18 to 60 years old. Weight, height and waist circumference were measured, and we calculated, BMI and waist/height ratio. Dietary intake was estimated using a "24 h recalls", for two consecutive days, and sodium content was determined from 24 h urine sample. Results: The 34.4% of the population had overweight and 13.6% had obesity. A positive association was seen between BMI and urinary sodium concentration. Urine sodium values were also positively associated with others adiposity indicators such as waist circumference and waist/height ratio. Body weight, BMI, waist circumference, and waist/height ratio were higher in the group of individuals with a urinary sodium excretion ≥154 mmol/l (Percentile 50) (P50). Additionally, individuals placed in this group presented a higher caloric intake and total food intake, in particular, more meat, processed food and snacks. Adjusting by energy intake, a higher sodium intake was a risk factor of being overweight or obese (OR = 1.0041, IC 95% 1.0015-1.0067, p < 0.01). Conclusions: Salt intake was associated with obesity; since people with higher sodium intake consumed more energy and presented worse eating habits. Additionally, sodium intake itself appears to be related to obesity.
... Fifty-nine cross-sectional studies reported on the association between sodium intake and a measure of adiposity (Table S3) (9-12, 35, 51-104) , 33 of these were included in meta-analyses (9-11, 53, 59, 60, 62, 63, 65-67, 69-71, 73, 75, 76, 79, 80, 83, 85, 88, 91, 93, 95, 97-104) . Reasons for exclusion from metaanalyses included; findings were only presented as correlation coefficients (n=16) (35, 54-56, 61, 68, 77, 78, 81, 82, 84, 86, 87, 90, 92, 96) or as standardised regression coefficients (n=4) (57,64,89,94) , the exposure variable was presented as sodium density (n=2) (12,72) or 24-hr urinary sodium excretion was reported as sodium concentration (mmol/L) (74) or on a logarithmic scale (52,58) . Of the studies included in meta-analyses, 14 were from Asia (62,63,66,69,70,73,75,76,83,85,91,97,100,101) , eight from USA (10,11,59,60,71,88,102,103) , five from South and Central America (53,65,79,80,93) , four from Europe (9,67,95,99) , one from Samoa (98) and one included data collected across four countries (e.g. ...
... Across the 6 studies (52,57,58,74,89,94) which reported results as linear regression analysis, all but two of these studies (57,58) reported positive associations between sodium intake and BMI (Table S5). The final study which reported mean BMI across ntile of sodium density (i.e. ...
... A separate meta-analysis of three studies (9,11,104) Systematic review findings: risk of overweight/obesity Detailed findings from the remaining five studies that could not be included in metaanalyses are displayed in Table S5 (12,51,72,74,102) . All five studies reported a significant positive association between sodium intake and risk of overweight/obesity, however in one study (74) the reported effect size was negligible. ...
Higher intakes of sodium may contribute to weight gain. The primary aim of this systematic review and meta-analysis was to examine the relationship between dietary sodium intake and measures of adiposity in children and adults. Given the previous link between sodium intake and the consumption of sugar-sweetened beverages (SSBs), which are a known risk factor for obesity, a secondary aim examining the relationship between sodium intake and SSB consumption was assessed. A systematic literature search identified cross-sectional and longitudinal studies and randomised controlled trials (RCTs) which reduced dietary sodium (≥3 months). Meta-analysis was performed for outcomes with ≥3 studies. Cross-sectionally higher sodium intakes were associated with overweight/obesity in adults (5 studies; n=11,067; (OR) 1.74, 95%CI 1.43,2.13) and in children (3 studies; n=3625, OR=3.29,2.25, 4.80); and abdominal obesity (5 studies; n=19,744; OR=2.04, 1.72, 2.42) in adults. Overall, associations remained in sensitivity analyses which adjusted for energy. Findings from longitudinal studies were inconsistent. RCTs in adults indicated a trend for lower body weight on reduced sodium compared to control diets (15 studies; n=5274; -0.29 kg, -0.59,0.01; P=0.06), however it is unclear if energy intakes were also altered on reduced sodium diets. Among children higher sodium intakes were associated with higher intake of SSBs (4 studies, n=10,329, b=22, 16,26 g/d), no studies were retrieved for adults. Overall there was a lack of high quality studies retrieved. Whilst cross-sectional evidence indicates sodium intake was positively associated with adiposity, these findings have not been clearly confirmed by longitudinal studies or randomised controlled trials.
... Interdialytic weight gain is a crucial predictor of morbidity and mortality in HD patients due to a directly proportional increase in the risk of cardiovascular events, including hypertension, left ventricular hypertrophy, and congestive heart failure [18,19]. Previous studies have shown that intradialytic weight gain can be significantly reduced by a hypotonic diet [20,21]. Indeed, a systematic review reported that a hypotonic diet reduced interdialytic weight gain by 1.5 kg compared to a regular diet [22], and these data are supported by our results. ...
Introduction:
Adherence to a low sodium (Na) diet is crucial in patients under hemodialysis, as it improves cardiovascular outcomes and reduces thirst and interdialytic weight gain. Recommended salt intake is lower than 5 g/day. The new 6008 CareSystem monitors incorporate a Na module that offers the advantage of estimating patients' salt intake. The objective of this study was to evaluate the effect of dietary Na restriction for 1 week, monitored with the Na biosensor.
Methods:
A prospective study was conducted in 48 patients who maintained their usual dialysis parameters and were dialyzed with a 6008 CareSystem monitor with activation of the Na module. Total Na balance, pre/postdialysis weight, serum Na (sNa), changes in pre- to post-dialysis sNa (ΔsNa), diffusive balance, and systolic and diastolic blood pressure were compared twice, once after 1 week of patients' usual Na diet and again after another week with more restricted Na intake.
Results:
Restricted Na intake increased the percentage of patients on a low-sodium diet (<85 Na mmol/day) from 8% to 44%. Average daily Na intake decreased from 149 ± 54 to 95 ± 49 mmol and interdialytic weight gain was reduced by 460 ± 484 g per session. More restricted Na intake also decreased pre-dialysis sNa and increased both intradialytic diffusive balance and ΔsNa. In hypertensive patients, reducing daily sodium by more than 3 g Na/day lowered their systolic blood pressure.
Conclusions:
The new Na module allowed objective monitoring of Na intake, which in turn could permit more precise personalized dietary recommendations in patients under hemodialysis.
... This might be due to the differences in physical structure and calorie intake requirements between both sexes. This finding was also supported by another study that reported males consumed high sodium foods 10% more than females [24]. It may be possible that females are generally more concerned about their physical appearance and health, which compels them to make better and healthier food choices which tend to be less calorie-dense and low in sodium. ...
Background
High sodium intake was an established risk factor for stroke and cardiovascular diseases. The objective of this study was to investigate factors associated with high sodium intake based on 24-h urinary sodium excretion from the MyCoSS study.
Methods
The cross-sectional survey was conducted among adults aged 18 years and above in Malaysia. A multi-stage stratified sampling was used to represent nationally. Twenty-four-hour urine was collected from a total of 900 respondents. Indirect ion-selective electrode (ISE) method was used to measure sodium intake. Descriptive and logistic regression analysis was applied to determine factors associated with high sodium intake based on 24-h urinary sodium excretion.
Results
A total of 798 respondents (76% response rate) completed the 24-h urine collection process. Logistic regression revealed that high sodium intake associated with obese [aOR 2.611 (95% CI 1.519, 4.488)], male [aOR 2.436 (95% CI 1.473, 4.030)], having a waist circumference of > 90cm for adult males [aOR 2.260 ( 95% CI 1.020, 5.009) and >80cm for adult females [aOR 1.210 (95% CI 0.556, 2.631)], being a young adult [aOR 1.977 (95% CI 1.094, 3.574)], and living in urban areas [aOR 1.701 (95% CI 1.094, 2.645)].
Conclusion
Adults who are obese, have a large waist circumference, of male gender, living in urban areas, and belonging to the young adult age group were found to have higher sodium intake than other demographic groups. Hence, reduction of salt consumption among these high-risk groups should be emphasised to reduce the risk of cardiovascular diseases.
... 30 Our study also found a similar result, possibly due to participants with high sodium intake consuming more energy and unhealthy food. 31 Meanwhile, the results of both our research and the SMASH 30 indicated that there was no significant association between urinary sodium excretion and elevated fasting glucose levels. Moreover, our results showed that the population with cardiovascular disease had a lower salt intake level. ...
Background and objectives:
Excessive salt intake is a major public health problem in several countries, especially in China. However, few people are aware of their salt intake. The purpose of this study is to carry out salt intake test in routine physical examination, and to explore the salt intake of different populations and their correlation with diet.
Methods and study design:
Spot urine sample was collected to test urinary sodium and creatinine excretions for each participant recruited from physical examinations at the Third Xiangya Hospital. The Tanaka formula was used to estimate 24-h urinary sodium excretion, which reflects salt intake. In addition to physical and laboratory examination, information including personal details, health-related habits, and selfreported disease histories was obtained from the National Physical Examination Questionnaire.
Results:
In total, 26,406 people completed the salt intake evaluation. After data cleansing, the average salt intake was 8.39±1.80 g/d. Male, middle-aged, overweight and obese, hypertensive, and dyslipidaemic populations, as well as those with non-cardiovascular diseases were more likely to have excessive salt intake. Dietary sources had an effect on salt intake. Salt intake was lower in those who consumed more milk and fruit (both p and p trend<0.01) but was higher in those who consumed more lean meat (both p and p trend<0.05), fatty meat (both p and p trend<0.01) and animal organs (both p and p trend<0.01).
Conclusions:
The salt intake in this population far surpasses the recommended amount. We strongly recommend salt intake assessment as routine test into physical examination center.
... No differences were found for other age or BMI group. Results of the FANPE study in a representative sample of the adult Spanish population (n = 418, 18-60 y) [55] found that sodium intake adjusted by energy was related to weight gain promotion. They showed a positive association between BMI and urinary sodium concentration, as well as with waist circumference and waist/height ratio, which we did not observe amongst the ANIBES study individuals. ...
Excessive sodium consumption is associated with adverse health effects. An elevated dietary intake of salt (sodium chloride) has been related to high blood pressure or hypertension, a major but modifiable risk factor for cardiovascular disease, as well as to other ill health conditions. In the present work, our aim was to describe the contribution of foods to sodium consumption within the Spanish population in a representative sample from the “anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain” (ANIBES) study (9–75 years), to identify high consumer groups, as well as the major food groups that contribute to sodium intake in the Spanish diet. Intakes were assessed by 3-day food records collected on a tablet device. Sodium intakes across the ANIBES study population exceeded recommendations, as total intakes reached 2025 ± 805 mg of sodium per day, that is approximately 5.06 g/day of salt (excluding discretionary salt, added at the table or during cooking). Sodium intakes were higher in males than in females and within the youngest groups. Main dietary sources of sodium were meat and meat products (27%), cereals and grains (26%), milk and dairy products (14%) and ready-to-eat meals (13%). Given the established health benefits of dietary salt reduction, it would be advisable to continue and even improve the current national initiatives of awareness and educational campaigns and particularly food reformulation to decrease overall salt intakes across the Spanish population.
... Sin embargo, en los últimos años el consumo se ha incrementado hasta alcanzar consumos medios muy parecidos a los del año 1870, año en el que se data su consumo máximo (14). En España, la ingesta media de sal es de aproximadamente unos 9,8 ± 4,6 g/día (15), casi el doble del máximo recomendado, que es de 5 g/día (2). No obstante, cabe resaltar que la cuantificación del consumo de sal y la ingesta estimada de sodio es uno de los aspectos más complicados en la valoración dietética. ...
Introduction:
Objectives: the culture and the eating habits of a territory give shape its gastronomy and determine the nutritional and health status of its population. We set the goal of reviewing food, culture, gastronomy and the nutritional and health status of the Catalan population. Methods: bibliographic and documentation search. Results: the origin of Catalan gastronomy dates back to the classical era. From Greek and Roman times, when olive oil and wine were incorporated into our cuisine, until today, multiple civilizations have influenced it, being the Arab contribution and the discovery of America fundamental events in the increase of Spanish wealth and its gastronomic variety. At Catalan level, the geographical, cultural and social characteristics of Catalonia, with a marked Mediterranean influence, were incorporated and creating Catalan cuisine and gastronomy, which currently have international recognition and prestige. The food consumption of the Catalan population has been studied since 1983. Nowadays, it shows a food consumption and an energy and nutrients intake similar to the national average, similarly to the prevalence of morbidity and lifestyles. Conclusion: in order to that the union of gastronomy and food consumption favors also the health of population, we must encourage the recovery of the healthiest and easiest to prepare dishes from their gastronomy and boost modifications that improve technically the more complex and/or less healthy dishes.
... Sin embargo, en los últimos años el consumo se ha incrementado hasta alcanzar consumos medios muy parecidos a los del año 1870, año en el que se data su consumo máximo (14). En España, la ingesta media de sal es de aproximadamente unos 9,8 ± 4,6 g/día (15), casi el doble del máximo recomendado, que es de 5 g/día (2). No obstante, cabe resaltar que la cuantificación del consumo de sal y la ingesta estimada de sodio es uno de los aspectos más complicados en la valoración dietética. ...
Introduction:
Introduction: at present, it is precisely the Mediterranean countries whose characteristic lifestyle was recognized as a health paradigm and promoted to the rest of the world, those who are at mostly at risk, in which it becomes necessary the immediate development of strategies based on education that may contribute to the adoption of a healthier diet and lifestyle. Objectives: to review the current dietary patterns in Spain, as well as its evolution in the last years. Methods: review of the studies that have been published in relation to the subject. Results: changes in the diet and lifestyle that have been introduced in recent years in Spain have led to a gradual decreased in the consumption of cereals and derivatives, potatoes and legumes, whereas an increase in the intake of meats and meat derivatives and non-alcoholic drinks has occurred. From the nutritional point of view, these trends resulted in an increase of the proportion of total fats (mainly saturated) and proteins (highly in those of animal origin) in the diet while complex carbohydrates have experienced a decrease (accompanied by a higher consumption of total sugars, including added ones). At the same time, the Spanish society should be considered as with a sedentary behavior. These facts have as one of the main negative consequences that Spain show one of the highest prevalence rates of childhood obesity in Europe, but also in adults. Conclusions: in this context, there is a need to promote the recovery of our culture (Mediterranean diet), and to return to feed and live according to patterns that have kept us protected during generations of many diseases. In fact, it should be important to try to answer the following question: If not so many years ago we had a food model that fulfilled all the recommendations of a healthy diet, which are the main barriers at present from returning to it?
... In a representative sample of the adult Spanish population, urinary sodium excretion was found to be associated with obesity. Specifically, participants with high sodium intake had overall greater energy intake and unhealthy lifestyles which were associated with the increased risk for being overweight and central obesity [37]. ...
Background:
Previous studies have reported an association between dietary sodium intake and overweight/central obesity. However, dietary survey methods were prone to underestimate sodium intake. Therefore, this study investigated the associations of calculated 24-h urinary sodium excretion, an index of dietary sodium intake, with various obesity parameters including body mass index (BMI) and waist circumference (WC) in a population with a relatively high sodium intake.
Methods:
A total of 16,250 adults (aged ≥19 years) and 1476 adolescents (aged 10-18 years), with available information on spot urine sodium levels and anthropometric measurements from the Korea National Health and Nutrition Examination Survey (KNHANES) were included in this study. We calculated 24-h urine sodium excretion levels from spot urine sodium levels using the Tanaka formula.
Results:
In adults, those with high sodium excretion levels (≥ 3200 mg) showed increased odds of overweight and central obesity compared to those with low urinary sodium excretion level (< 2200 mg) (odds ratio [OR] = 2.17, 95% confidence interval [CI] = 1.90-2.49 for overweight; OR = 2.50, 95% CI = 2.13-2.94 for central obesity). These associations were also observed in adolescents (OR = 5.80, 95% CI = 3.17-10.60 for overweight; OR = 4.19, 95% CI = 1.78-9.89 for central obesity).
Conclusions:
The present study suggests that reducing salt intake might be important for preventing overweight and central obesity, especially in adolescents. However, because the present study was conducted with cross-sectional study design, further longitudinal studies are warranted to confirm the causal relationship between urinary sodium excretion and overweight/central obesity.
Sodium is a physiologically essential nutrient, but excessive intake is linked to the increased risk of various chronic diseases, particularly cardiovascular. It is, therefore, necessary to accomplish an evidence-based approach and establish the Korean Dietary Reference Intakes (KDRIs) index, to identify both the nutritional adequacy and health effects of sodium. This review presents the rationale for and the process of revising the KDRIs for sodium and, more importantly, establishing the sodium Chronic Disease Risk Reduction Intake (CDRR) level, which is a new specific set of values for chronic disease risk reduction. To establish the 2020 KDRIs for dietary sodium, the committee conducted a systematic literature review of the intake-response relationships between the selected indicators for sodium levels and human chronic diseases. In this review, 43 studies published from January 2014 to December 2018, using databases of PubMed and Web of Science, were finally included for evaluating the risk of bias and strength of evidence (SoE). We determined that SoE of the relationship between dietary sodium and cardiovascular diseases, cerebrovascular disease, and hypertension, was moderate to strong. However, due to insufficient scientific evidence, we were unable to establish the estimated average requirement and the recommended nutrient intake for dietary sodium. Therefore, the adequate intake of sodium for adults was established to be 1,500 mg/day, whereas the CDRR for dietary sodium was established at 2,300 mg/day for adults. Intake goal for dietary sodium established in the 2015 KDRIs instead of the tolerable upper intake level was not presented in the 2020 KDRIs. For the next revision of the KDRIs, there is a requirement to pursue further studies on nutritional adequacy and toxicity of dietary sodium, and their associations with chronic disease endpoint in the Korean population.
The present study reports the Na intake of a representative sample of Spanish young and middle-aged adults aged 18-60 years (n 418, 53·1 % women, selected from the capitals of fifteen provinces and the surrounding semi-urban/rural area), measured with a 24 h urinary Na excretion method. To validate the paper collection of 24 h urine, the correlation between fat-free mass determined by electrical bioimpedance (50·8 (sd 11·3) kg) and that determined via urinary creatinine excretion (51·5 (sd 18·8) kg) was calculated (r 0·633, P < 0·001). Urinary Na excretion correlated with systolic and dyastolic blood pressure data (r 0·243 and 0·153, respectively). Assuming that all urinary Na (168·0 (sd 78·6) mmol/d) comes from the diet, Na excretion would correspond with a dietary salt intake of 9·8 (sd 4·6) g/d, and it would mean that 88·2 % of the subjects had salt intakes above the recommended 5 g/d. Logistic regression analysis, adjusted for sex, age and BMI, showed male sex (OR 3·678, 95 % CI 2·336, 5·791) and increasing BMI (OR 1·069, 95 % CI 1·009, 1·132) (P < 0·001) to be associated with excreting >200 mmol/d urinary Na--a consequence of the higher salt intake in men and in participants with higher BMI. The present results help us to know the baseline salt intake in the Spanish young and middle-aged adult population, and can be used as the baseline to design policies to reduce salt consumption.
To assess dietary habitual sodium intake and the association between daily sodium intake and anthropometric indices, food habits and hypertension in the sample of adult male population participating in the Olivetti Heart Study.
The study population was composed of 940 men participating in the 2002-2004 follow-up examination of the Olivetti Heart Study. Blood pressure, anthropometric indices, biochemical parameters and sodium excretion in a 24-h urine collection were measured. The frequency of consumption of selected foods was estimated by a food frequency questionnaire (FFQ) capturing the previous year data. In a subgroup of the study population (n=138), the fractional excretion of sodium was estimated by endogenous lithium clearance.
Dietary sodium intake estimated by 24 h urinary excretion was 203+/-70 mmol/day. Sodium excretion was significantly lower in treated hypertensive patients and higher in overweight/obese participants when compared with normotensive and normal-weight individuals, respectively. In addition, the inverse correlation detected in normal-weight individuals (r=-0.321; P<0.05) between fractional proximal tubular sodium reabsorption and dietary sodium intake was disrupted in overweight/obese individuals (r=0.058; P=NS). The independent determinants of 24 h urinary sodium excretion were body mass index (BMI), the occurrence of antihypertensive treatment, and frequency of consumption of pasta and cold cuts.
Habitual salt intake in this sample of male adult population in southern Italy was well above the recommended amounts. A higher salt intake and an altered renal sodium handling were observed in overweight and obese participants. Sodium intake was only slightly reduced in hypertensive participants on pharmacological therapy.
Few studies have examined recent shifts in meat consumption (MC), differences among US population groups, and the influence of psychosocial-behavioural factors.
Nationally representative data collected for US adults aged >or=18 years in the 1988-1994 and 1999-2004 National Health and Nutrition Examination Survey (NHANES) and the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS) were used.
We found a U-shaped trend in MC, a decrease between 1988-1994 and 1994-1996, and an increase from 1994-1996 to 1999-2004. NHANES 1988-1994 and 1999-2004 indicate that MC did not change significantly, particularly for all meat, red meat, poultry and seafood. Between 1994-1996 and 1999-2004, average MC, including red meat, poultry, seafood and other meat products, increased in men. Women's total MC decreased, mainly due to decreased red meat and other meat products, except for increased seafood. Noticeable differences existed in the changes across population groups. Black men had the largest increase in consumption of total meat, poultry and seafood; Mexican American men had the smallest increase in poultry, seafood and other meat products. In 1999-2004, ethnic differences in MC became greater in women than among women in 1994-1996. Associations between MC and energy intake changed over time. Perceived benefit of dietary quality and food label use were associated with reduced red MC.
Noticeable differences exist in the shifts in MC across population groups and surveys. MC increased in men but decreased in women in recent years.
There has been a growing concern about obesity worldwide. We performed a review on the prevalence and trends of obesity among adults and children. We reviewed the data on the prevalence of adult obesity and being overweight from the Global Database on Body Mass Index on the World Health Organisation (WHO) Website and prevalence of children being overweight from the International Obesity Task Force website. Various databases were also searched for relevant reviews and these include PubMed, EMBASE, NHS CRD databases and Cochrane. The prevalence of obesity is high in many parts of the world. Generally, there is an increasing trend of prevalence of adult obesity with age. The peak prevalence is reached at around 50 to 60 years old in most developed countries and earlier at around 40 to 50 years old in many developing countries. Obesity is a major health concern. Appropriate strategies need to be adopted to tackle obesity which itself brings about significant disability and premature deaths. Further observation may be needed to see if the trend of prevalence abates or increases in the near future.
One plausible explanation for the controversy that surrounds the causes and clinical management of obesity is the notion that overeating and obesity may only be a couple of "symptoms" associated with a yet to be discovered medical disorder.
To introduce the Salted Food Addition Hypothesis. This theory proposes that salted food acts in the brain like an opiate agonist, producing a hedonic reward which has been perceived as being only peripherally "flavorful", "tasty" or "delicious". The Salted Food Addition Hypothesis also proposes that opiate receptor withdrawal has been perceived as "preference," "urges," "craving" or "hunger" for salted food.
The Salted Food Addiction Hypothesis is made manifest by individually presenting a basic review of its primary coexisting components; the Neurological Component and the Psychosocial Component. We also designed a prospective study in order to test our hypothesis that opiate dependent subjects increase their consumption of salted food during opiate withdrawal.
The neuropsychiatric evidence integrated here suggests that salted food acts like an, albeit mild, opiate agonist which drives overeating and weight gain. The opiate dependent group studied (N=27) developed a 6.6% increase in weight during opiate withdrawal.
Salted Food may be an addictive substance that stimulates opiate and dopamine receptors in the brain's reward and pleasure center more than it is "tasty", while salted food preference, urge, craving and hunger may be manifestations of opiate withdrawal. Salted food and opiate withdrawal stimulate appetite, increases calorie consumption, augments the incidence of overeating, overweight, obesity and related illnesses. Obesity and related illnesses may be symptoms of Salted Food Addiction.
High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption.
Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985-87) and INTERMAP (1996-99) studies, and recent dietary and urinary sodium data from observational or interventional studies--identified by a comprehensive search of peer-reviewed and 'grey' literature--presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data.
Sodium intakes around the world are well in excess of physiological need (i.e. 10-20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods ( approximately 75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources.
Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide. If policies for salt reduction at the population level are to be effective, policy development and implementation needs to target the main source of dietary sodium in the various populations.