This fact sheet and global call to action is aimed at nutrition, hypertension, cardiovascular and other health care clinicians and scientists, and health advocates, as well as the organizations to which they belong. The ‘call’ is to align these audiences with the facts on:
the burden of disease and key evidence supporting reductions in dietary sodium,
the consistent recommendations for reducing dietary sodium from unbiased and comprehensive health and scientific reviews,
the current levels of sodium intake,
the cost savings expected from reducing high dietary sodium,
the sources of controversial opinions,
the current recommended approaches to reduce dietary sodium, and
how to stay up to date with evidence on how to reduce dietary sodium and the evolving research on the adverse health effects of a high sodium intake.
Health, nutrition, hypertension and cardiovascular organizations, and their members, need to become more engaged and advocate for reductions in dietary sodium, and for a greater priority to be given to high quality research on dietary sodium. The World Hypertension League, Resolve to Save Lives and International Society of Hypertension are committed to support reductions in dietary sodium as a high priority.
Diets high in sodium (salt, sodium chloride- see Table 1 for equivalents) are associated with a high burden of disease from increased blood pressure, cardiovascular disease (CVD), premature death and disability
Increased blood pressure (BP) is the leading preventable risk factor for heart disease (heart attack and heart failure), stroke, and kidney failure; and a major contributor to premature death, dementia, disability and health care costs [1,2,3,4].
Approximately 30% of hypertension prevalence can be attributed to high dietary sodium, which could result in hypertension in 400 to 500 million people, worldwide [5,6,7]. The evolving definition of hypertension includes all people with a usual systolic BP of ≥140 mmHg or diastolic ≥90 mmHg and those at high risk for CVD with a usual systolic BP of ≥130 mmHg . Reductions in dietary sodium can have a larger or smaller impact on hypertension prevalence, depending on the population distribution of sodium intake, BP distribution, extent of decrease in dietary sodium and prevalence of other causes of increased BP . The INTERSALT study and animal studies indicate high dietary sodium consumption may have a substantively larger life course impact on BP than is identified in the currently available relatively short-term sodium reduction trials and suggest that a component of the increased BP may be irreversible [9, 10]. Hence, the adverse effects may be greater than currently predicted and greater emphasis may be needed before permanent harm occurs in younger people.
The Global Burden of Disease Study estimated that in 2019 there were over 1.8 million deaths, and over 44 million disability-adjusted life years lost (including 40.5 million DALYs from CVD, including stroke), as a result of excess dietary sodium consumption .
A substantial proportion of BP-related disease occurs in people who have an average BP below the levels used to identify hypertension [5, 15]. Hence sodium reduction is relevant both for people with hypertension and those with a BP above the optimal level but not yet hypertensive.
Meta-analyses of randomized controlled trials demonstrate that reducing dietary sodium intake decreases BP in both those with and without hypertension, in children and in adults, and in all ethnic groups [16,17,18,19,20]. The association between BP and dietary sodium intake is approximately linear above 800 mg (2 gm salt) per day.
Individuals can be more or less prone to the adverse effects of sodium (‘salt sensitivity’) on a genetic, physiological or pathophysiological basis (e.g., primary hyperaldosteronism). There is a steeper sodium BP dose response slope in those who have hypertension, are older, or are of black African ancestry .
A meta-analysis of randomized controlled trials showed a linear decrease in CVD with reductions in sodium between 4100 mg (10.25 gm salt) and 2300 mg (5.75 gm salt) per day . Overall, this evidence has been characterized as moderate rather than strong because of an insufficient number of events. However, the one cohort study that the National Academies of Sciences, Engineering, and Medicine viewed as having low bias, found a linear association between sodium intake and mortality with less mortality at sodium intake below 2300 mg (5.75 gm salt) per day than above 3600 mg (9 gm, salt) per day [19, 21]. A more recent meta-analysis of cohort studies, that classified usual sodium intake with multiple 24 h. urine collections, found a direct linear association between sodium intake (1846 to 5230 mg (4.6 to 13.8 g salt) per day) and cardiovascular events . Each 1000 mg (2.5 gm salt) per day increase in sodium excretion was associated with an 18% increase in cardiovascular events .
Other diseases that have been associated with a high sodium intake include gastric cancer (probable procarcinogen) [23, 24], recurrent calcium-oxalate kidney stones , osteoporosis , obesity [27, 28], Meniere’s disease [29, 30], headache , and renal and cardiac damage . The quality of evidence for many of these disease associations is mixed and they are largely based on observational studies in which it is difficult to confirm causality. A variety of pathophysiologic mechanisms (e.g., increased inflammation and generation of reactive substances [32,33,34,35]) support the potential for high sodium intake causing a broad range of disease.
Scientific reviews of the evidence by governmental and nongovernmental health organizations
Several independent, comprehensive, and unbiased scientific reviews of the evidence conducted by governmental organizations provide recommendations for reduction in dietary sodium (Table 2) [19, 36,37,38,39].
Most non governmental health and scientific organizations provide recommendations to reduce dietary sodium (e.g., International Society of Hypertension , Chinese Hypertension League , British and Irish Hypertension Society , Turkish Hypertension Consensus Report , European Societies of Hypertension and of Cardiology , American College of Cardiology and American Heart Association , Japanese Society of Hypertension , Brazilian Hypertension Guideline  and a broad rage of Canadian Health and Scientific organizations (https://hypertension.ca/wp-content/uploads/2019/01/Sodium-Fact-Sheet-FINAL-Jan-23-2019.pdf). The American Heart Association and the American College of Cardiology - American Heart Association Hypertension Recommendations advise that adults with hypertension should optimally consume less than 1500 mg sodium (3.75 gm salt) per day but that any reduction is beneficial .
Globally, people consume too much sodium
The average global intake of sodium in adults is estimated to be about 4000 mg per day (salt 10 g per day), with higher intakes in Asia than other regions [48,49,50]. However, there is uncertainty regarding the exact levels of population sodium intake in many countries because few representative population studies have been based on 24 h. urine collections, the best way of estimating sodium intake [49, 50].
Only a small portion of dietary sodium intake results from consumption of unprocessed natural foods: <700 mg per day (salt < 1.75 g per day) in a typical mixed paleolithic non-vegetarian diet and <200 mg per day (salt < 0.5 g per day) in a paleolithic vegetarian diet .
In many high-income countries, most of the sodium consumed (70–80%) results from addition of sodium during food manufacturing and during food preparation in fast-food and sit-down restaurants. In many middle- and low-income countries, excessive sodium intake results from ‘discretionary’ addition of sodium, high-sodium sauces and condiments during home cooking and use of saltshakers at the table. However, globalization of the food industry (nutrition transition) is increasing the exposure of populations in middle- and low-income countries to sodium in processed foods  [52,53,54,55].
Table 3 provides standardized nomenclature for describing levels of sodium intake recommended by the World Hypertension League, and partner organizations, based on the level of sodium intake recommended by the World Health Organization .
Reduction in dietary sodium saves lives, health care resources and costs
Noncommunicable diseases threaten the global economy and economic development. In response, the World Health Assembly supports nine targets for prevention and control of noncommunicable diseases, including a key recommendation to reduce dietary sodium by 30% by 2025 .
Reducing dietary sodium is one of the most impactful and cost-effective mechanisms to improve population health and is one of the World Health Organization’s ‘best buys’ for prevention of chronic disease [57, 58] (https://resolvetosavelives.org/cardiovascular-health/lives-saved-calculator, accessed July 25, 2021).
A modest 15% reduction in dietary sodium is estimated to prevent 8.5 million deaths over 10 years in 23 developing countries where 80% of chronic disease deaths in developing nations occur . An analysis published in 2019 showed that a 30% reduction of sodium, could save 40 million lives globally within 25 years .
Controversies related to dietary sodium reduction are based largely on low quality research
There are no definitive randomized controlled trials to define the optimum level of sodium intake to reduce mortality and morbidity, which creates controversy for some . Very large, expensive trials of long duration in different populations would be required, and it is difficult for individuals, even in a clinical trial setting, to maintain a substantially reduced sodium diet in the current high sodium food environments . Nevertheless, there is evidence that sodium reduction prevents CVD events in randomized comparisons of those assigned to a dietary sodium reduction behavioral intervention compared with usual care during long-term follow up (trial and post-trial experience) even though optimal levels of sodium intake remain undefined [19, 21, 66].
Several prospective cohort studies in high profile journals have identified paradoxical J- and U-shaped relationships between sodium intake and CVD events, leading to a controversial conclusion that dietary sodium intake should only be reduced in adults with a very high daily sodium intake (>5000 mg (12.5 gm salt) per day) [64, 67, 68]. These studies have been criticized as having significant methodological limitations that could alter sodium intake disease associations (e.g., inaccurate measurement of baseline sodium intake, residual confounding, reverse causality, inadequate adjustment of confounding factors, inadequate sample sizes, and follow-up duration) . Many of the controversial studies that have identified a paradoxical relationship between sodium intake and CVD have employed spot (single untimed spontaneously voided) urine samples to estimate usual sodium intake. The Kawasaki, and other formulae, used to estimate 24 h sodium intake based on spot urine measurements have been shown to result in biased estimates of sodium intake compared with estimates based on 24 h. urinary collections [50, 70, 71], to result in a spurious J-shaped association between sodium intake and mortality, and to provide an inaccurate representation of the association between dietary sodium and BP [72,73,74].
A 2019 report from the U.S. National Academies of Sciences, Engineering, and Medicine confirmed an Agency for Healthcare Research and Quality report that many of the controversial studies had a high risk of bias and stated “the paradoxical J- and U-shaped relationships of sodium intake and CVD and mortality are likely observed because of methodological limitations of the individual observational studies” .
Similarly, international scientific organizations and scientific reviews concluded that low quality research methods and designs were a source of controversy regarding the benefits of reducing the intake of dietary sodium [42, 75,76,77,78].
A major issue is that estimation of dietary sodium intake is challenging because intake varies substantially from day to day, depending on food choice and portion size, as well as random variation [79, 80]. The best feasible estimate of dietary sodium intake for individuals in clinical research is based on multiple, carefully collected, 24 h urines on nonconsecutive days, but few studies have used this methodology [77, 81]. Instead, most studies use methods that are very inaccurate with both systematic and random error in assessing usual sodium intake [19, 69, 77, 81,82,83,84].
Other studies with controversial findings have used dietary recall or food frequency questionnaire methods for estimation of 24 h dietary sodium intake. These are not recommended for this purpose because they are known to underestimate dietary sodium intake and to be unreliable for assessing an individual’s sodium intake [83, 84].
One study found that a single 24 h. estimate of usual sodium intake had a spurious J curve association with cardiorenal outcomes that became linear when multiple 24 h urine assessments defined usual sodium intake .
Resources for keeping up to date on the evolving evidence on dietary sodium and how to reduce dietary sodium
The World Hypertension League, along with other national and international partners and the Journal of Human Hypertension, have developed multiple mechanisms to ensure that the evidence on dietary sodium intake is maintained up to date.
The ‘science of salt’, a regularly updated critical appraisal of research evidence related to dietary sodium measurement and consumption, clinical consequences, and effectiveness of programs to reduce dietary sodium intake has been published in the Journal of Clinical Hypertension from 2013 until 2020 and more recently in the Journal of Human Hypertension [49, 86,87,88,89,90,91,92] (https://www.georgeinstitute.org/projects/science-of-salt-weekly, accessed June 19, 2021).
Resolve To Save Lives maintains a website that includes best practices in dietary sodium reduction and an updated annotated bibliography which summarizes important evidence on sodium intake, reduction strategies, and measurement (https://resolvetosavelives.org/cardiovascular-health/sodium, and https://linkscommunity.org/toolkit/salt-reduction; accessed July 18, 2021).
The Nourishing Framework provides regular updates to governmental policies to promote healthier nutrition including reducing dietary sodium (https://www.iccp-portal.org/system/files/resources/PPA_Nourishing_A5%2520leaflet_web%2520FINAL.pdf, accessed June 18, 2021).
The Centre for Disease Control and Prevention (USA) has a CDC salt bites newsletter that provides updates on sodium reduction research and activities (https://www.cdc.gov/salt/index.htm).
The WHO Collaborating Centre on Population Salt Reduction at the George Institute for Global Health also regularly reviews national salt reduction activities around the world  and features a regular newsletter updating sodium reduction activities and science (https://www.whoccsaltreduction.org/).
The Centre for Science in the Public Interest hosts a sodium listserv communications group (subscribe by contacting email@example.com).
World Action on Salt, Sugar and Health (WASSH) provides regular updates on publications and worldwide salt reduction activities (http://www.worldactiononsalt.com/news/salt-in-the-news/2021/).
The World Health Organization and the Pan American Health Organization provide updated national policy actions on dietary sodium reduction (https://extranet.who.int/nutrition/gina/es/scorecard/sodium and https://www.paho.org/en/noncommunicable-diseases-and-mental-health/noncommunicable-diseases-and-mental-health-data-29, respectively, accessed August 16, 2021).
Multicomponent comprehensive policies can be effective in reducing dietary sodium intake and have been associated with reductions in BP and CVD [94, 95]
The World Health Organization technical package for dietary sodium reduction ‘SHAKE’ is based on
Surveillance: to measure and monitor the amount of sodium consumed, the main dietary sources of sodium and the amount of sodium in specific foods.
Harnessing (through policies that include regulations) the food industry to reduce the amount of sodium added in food processing including the setting of targets and timelines for sodium content of foods [96, 97].
Adopting front of package food labels and implementing strategies to reduce misleading marketing of high sodium foods.
Knowledge enhancement to empower individuals to eat less sodium.
Environmental changes through healthy food procurement policies.
The World Health Organization has developed global benchmarks for the sodium content of packaged foods (https://www.who.int/publications/i/item/9789240025097, accessed Aug 16, 2021), as has the Food and Drug Administration (FDA United States, https://www.fda.gov/media/98264/download, accessed Oct 19, 2021) and the Pan American Health Organization has updated its regional benchmarks for sodium content of packaged foods [98, 99].
The Pan American Health Organization  and the World Health Organization Regional Office for Europe (https://www.euro.who.int/__data/assets/pdf_file/0006/457611/Accelerating-salt-reduction-in-Europe.pdf), accessed August 2, 2021) also have useful technical resources for reducing dietary sodium .
Resolve to Save Lives has a comprehensive framework for dietary sodium reduction programs that includes resources, implementation tools and examples of successful interventions (https://linkscommunity.org/toolkit/sodium-framework, accessed Nov 25, 2021).
As of 2020, 96 countries had national strategies to reduce dietary sodium intake . A recent systematic review of sodium reduction found that 4 population-based interventions had reduced average sodium intake levels by 800 or more mg (>2 gm salt)/day (Argentina, China, South Korea, Turkey) and 9 countries had reduced between 400 and 800 mg (1–2 gm salt)/day . Gradual (over a few months) but substantial reductions in sodium of processed foods can be made without altering the perceived taste of food .
Clinical trials longer than 5 weeks indicate reducing dietary sodium to 2300 mg (5.75 g salt) /day in older adults is feasible and could reduce mortality from stroke by 39% and ischemic heart disease by 30% . A good practical example of the successful implementation of a salt intake reduction program on a national level is Japan, where such an intervention was associated with a dramatic reduction in stroke mortality .
Governments in more countries should take action to develop and implement multi-sectoral national strategies based on the WHO SHAKE technical package to reduce sodium consumption using implementation research methodology [95, 109, 110].
Broad policies to reduce dietary sodium and consumption of ultra processed foods to improve nutrition (e.g., mandatory sodium targets, front of pack warning labels, marketing restrictions especially to children, healthy public food procurement, and fiscal measures (i.e., taxes)) are believed to be important to reduce population sodium intake [95, 109].
Industry-based voluntary approaches to reduce the addition of sodium during food processing have a long history of being ineffective unless they are coupled with strong government oversight and close monitoring . Government-led regulated approaches may be more effective .
Public education (particularly through mass media campaigns) and behavior change interventions (e.g., using a COMBI framework) are likely important as part of a broader strategy, especially where discretionary sodium is the major dietary source [113,114,115,116]. The use of social marketing strategies and ‘whole of society’ approaches may be beneficial to change social norms and behaviours related to the use of discretionary sodium [113, 117].
In a recent randomized controlled trial, replacing regular salt with a reduced-sodium salt (where 25% of the sodium was replaced with potassium) in adults with stroke or at high risk for stroke reduced the risk of stroke (14%), cardiovascular events (13%) and premature death (12%) without any evidence of an increased risk of hyperkalemia . Reduced sodium salt can be considered as part of a population sodium reduction strategy and is likely to be most effective in countries where discretionary salt constitutes a significant source of dietary sodium (annotated bibliography https://linkscommunity.org/toolkit/sodium-reduction-an-annotated-bibliography#_Toc14352403, accessed July 25, 2021) [119,120,121,122,123,124]. Reduced sodium salts and condiments may also help to reduce sodium intake from packaged foods, restaurant foods and discretionary use . Regulatory changes, such as making labeling of potassium additives in processed food products more consumer friendly, may help (e.g., labeling potassium additives as potassium or potassium salt versus potassium chloride).
Close monitoring of sodium intake, sources of sodium in the diet, sodium levels in foods, as well as knowledge, attitudes and behaviours of the public are essential components of sodium reduction programs [100, 109].
National hypertension, CVD, nutrition, and health organizations
Hypertension, CVD, nutrition, and health organizations have important roles in research, interpretation of research, education, and advocacy. We call on these organizations to:
Provide organizational support for this Call to Action by contacting the World Hypertension League at firstname.lastname@example.org. An updated list of supporting organizations will be maintained until 2025.
Promote research, presentations and publications on high quality research related to dietary sodium emphasizing the importance of high-quality research methodology, data that are in the public domain and where interpretation is free of commercial interest.
Educate members on the health risks of high dietary sodium and how to reduce sodium intake.
Broadly disseminate relevant information on dietary sodium integrated with other healthy nutrition and physical activity advice to the public and patients.
Educate policy and decision makers on the health benefits of lowering BP among normotensive and hypertensive people, regardless of age.
Advocate for policies and regulations that will contribute to population-wide reductions in dietary sodium, possibly in collaboration with other health advocacy groups. The World Health Organization has released a Sodium Country Score Card to track governmental progress to reduce dietary sodium that can be used by health and nutrition organizations and experts in advocacy. (https://extranet.who.int/nutrition/gina/es/scorecard/sodium accessed July 18, 2021).
Provide opportunities for members to be involved in advocacy. Reach the public and policy makers by promoting and advocating through media releases and social media campaigns on dietary sodium reduction.
Promote coalition building, increase organizational capacity for advocacy, and develop advocacy tools to promote civil society actions.
Be cautious about the role of low-quality research, research from domains that are not publicly accessible to be independently validated, and of investigators with commercial conflicts of interest in generating controversy related to dietary sodium reduction.
Global networks of concerned health care professionals and scientists have formed to help support reductions in dietary sodium. World Action on Salt, Sugar and Health (WASSH) sponsors World Salt Awareness Week annually during the second week of March (www.worldactiononsalt.com/, accessed June 12, 2021). Other organizations with a similar goal include the European Salt Action Network (euro.who.int/en/health-topics/disease-prevention/nutrition/policy/member-states-action-networks/reducing-salt-intake-in-the-population), WHO Collaborating Centre on Population Salt Reduction at the George Institute for Global Health (https://www.georgeinstitute.org/projects/world-health-organization-collaborating-centre-for-population-salt-reduction-who-cc-salt, accessed July 18, 2021), and Action on Salt (http://www.actiononsalt.org.uk/, accessed June 12, 2021).
Resolve to Save Lives, a global initiative to save 100 million lives in 30 years, has reducing dietary sodium as one of its four pillars .
Public health dietary sodium research priorities
Research is urgently required to accelerate the reduction of dietary sodium in populations. Priorities include research to:
Better define optimal policies and interventions for reducing dietary sodium in populations including discretionary sodium, sodium from street foods, sodium from packaged foods, and sodium from restaurants. This research is needed in a wide variety of settings and cultures to better understand the obstacles and facilitators to dietary sodium reduction programs.
Better define optimal interventions for reducing dietary sodium in individuals including discretionary sodium, sodium from street foods, sodium from packaged foods, and sodium from restaurants.
Develop more rapid, feasible and accurate methods to assess individual and population average sodium intake, sources of dietary sodium and levels of sodium in specific foods.
Better define potential interactions between dietary sodium and potassium in causing disease.
Implement large scale randomized controlled trials to define optimal levels of sodium and potassium intake in the general population to prevent disease, if feasible designs can be developed.
Implement large scale randomized controlled trials to assess long term health and common non-CVD diseases reported to be associated with high sodium intake if feasible designs can be developed.
Define the role of salt (consumed in excess) as a vehicle for providing nutrients that are deficient in the diet (e.g., iodine, fluoride, folate).
Better identify individuals more or less prone to adverse health consequences from dietary sodium (‘salt sensitivity’).
Explore the intake of sodium and vulnerability to and complications from COVID -19 infection.
Uncover the causes and solutions for misinformation on dietary sodium, the role of low-quality research and the role of commercial conflicts of interest in hindering dietary sodium reduction programs.
World Hypertension League Actions
The World Hypertension League, Resolve to Save Lives and the International Society of Hypertension have led the development of this fact sheet and call to action targeted at hypertension, cardiovascular, nutrition and health experts and scientists and their organizations to support achievement of the WHO recommended sodium intake levels.
The World Hypertension League has developed the Graham MacGregor Award and Excellence Awards to recognize organizations and individuals who have contributed to efforts to reduce dietary sodium at the population level. (http://www.whleague.org/index.php/news-awards-recognition, accessed June 1, 2021).
Assisting the global and national efforts to reduce dietary sodium is a top priority of the World Hypertension League.
Campbell NRC, Schutte AE, Varghese CV, Ordunez P, Zhang X-H, Khan T, et al. São Paulo call to action for the prevention and control of high blood pressure: 2020. J Clin Hypertens. 2019;21:1744–52.
Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017;317:165–82.
Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76:2982–3021.
Fuchs FD, Whelton PK. High blood pressure and cardiovascular disease. Hypertension. 2020;75:285–92.
Institute of Medicine (US) Committee on Public Health Priorities to Reduce and Control Hypertension. A population-based policy and systems change approach to prevent and control hypertension. Washington, DC, USA: National Academies Press; 2010. Report No.: 0-309-14810-3.
Joffres M, Campbell NR, Manns B, Tu K. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Can J Cardiol. 2007;23:437–43.
Fan W-G, Xie F, Wan Y-R, Campbell NRC, Su H. The impact of changes in population blood pressure on hypertension prevalence and control in China. J Clin Hypertens. 2020;22:150–6.
World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. Geneva: World Health Organization; 2021.
Elliott P, Stamler J, Nichols R, Dyer AR, Stamler R, Kesteloot H, et al. INTERSALT revisited: further analyses of 24 h sodium excretion and blood pressure within and across populations. BMJ. 1996;312:1249–53.
Van Vliet BN, Montani JP. The time course of salt-induced hypertension, and why it matters. Int J Obes(Lond). 2008;32:S35–47.
Institute for Health Metrics and Evaluation, Global Burden of Disease Study. [updated 2021; cited June 8 2021]. “Global Burden of Disease Study.”]. Available from: http://vizhub.healthdata.org/gbd-compare/
Campbell NR, Correa-Rotter R, Cappuccio FP, Webster J, Lackland DT, Neal B, et al. Proposed nomenclature for salt intake and for reductions in dietary salt. J Clin Hypertens. 2015;17:247–51.
Mancilha-Carvalho Jde J, Souza e Silva NA. The Yanomami Indians in the INTERSALT Study. Arq Bras Cardiol. 2003;80:289–300.
Gleibermann L. Blood pressure and dietary salt in human populations. Ecol Food Nutr. 1973;2:143–56.
Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, et al. Hypertension. Nat Rev Dis Primers. 2018;4:18014.
He FJ, Tan M, Ma Y, MacGregor GA. Salt reduction to prevent hypertension and cardiovascular disease: JACC State-of-the-art review. J Am Coll Cardiol. 2020;75:6632–47.
Filippini T, Malavolti M, Whelton PK, Naska A, Orsini N, Vinceti M. Blood pressure effects of sodium reduction: dose-response meta-analysis of experimental studies. Circulation. 2021;143:1542–67.
Huang L, Trieu K, Yoshimura S, Neal B, Woodward M, Campbell NRC, et al. Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials. BMJ. 2020;368:m315.
National, Academies of Sciences, Engineering, and, Medicine, 2019. Dietary reference intakes for sodium and potassium. Washington (DC): National Academies Press (US).
Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;346:f1326.
Cook NR, Appel LJ, Whelton PK. Lower levels of sodium intake and reduced cardiovascular risk. Circulation. 2014;129:981–9.
Ma Y, He FJ, Sun Q, Yuan C, Kieneker LM, Curhan GC, et al. 24-hour urinary sodium and potassium excretion and cardiovascular risk. N Engl J Med. 2021. https://doi.org/10.1056/NEJMoa2109794.
D’Elia L, Galletti F, Strazzullo P. Dietary salt intake and risk of gastric cancer. Cancer Treat Res. 2014;159:83–95.
D’Elia L, Rossi G, Ippolito R, Cappuccio FP, Strazzullo P. Habitual salt intake and risk of gastric cancer: a meta-analysis of prospective studies. Clin Nutr. 2012;31:489–98.
Cappuccio FP, Kalaitzidis R, Duneclift S, Eastwood JB. Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. J Nephrol. 2000;13:169–77.
Teucher B, Dainty JR, Spinks CA, Majsak-Newman G, Berry DJ, Hoogewerff JA, et al. Sodium and bone health: impact of moderately high and low salt intakes on calcium metabolism in postmenopausal women. J Bone Miner Res. 2008;23:1477–85.
Bolhuis DP, Costanzo A, Newman LP, Keast RS. Salt promotes passive overconsumption of dietary fat in humans. J Nutr. 2016;146:838–45.
Moosavian SP, Haghighatdoost F, Surkan PJ, Azadbakht L. Salt and obesity: a systematic review and meta-analysis of observational studies. Int J Food Sci Nutr. 2017;68:265–77.
Hussain K, Murdin L, Schilder AG. Restriction of salt, caffeine and alcohol intake for the treatment of Ménière’s disease or syndrome. Cochrane Database Syst Rev. 2018;12:Cd012173.
Luxford E, Berliner KI, Lee J, Luxford WM. Dietary modification as adjunct treatment in Ménière’s disease: patient willingness and ability to comply. Otol Neurotol. 2013;34:1438–43.
Amer M, Woodward M, Appel LJ. Effects of dietary sodium and the DASH diet on the occurrence of headaches: results from randomised multicentre DASH-Sodium clinical trial. BMJ Open. 2014;4:e006671.
Evans RDR, Antonelou M, Henderson S, Walsh SB, Salama AD. Emerging evidence of an effect of salt on innate and adaptive immunity. Nephrol Dial Transplant. 2019;34:2007–14.
Faraco G, Brea D, Garcia-Bonilla L, Wang G, Racchumi G, Chang H, et al. Dietary salt promotes neurovascular and cognitive dysfunction through a gut-initiated TH17 response. Nat Neurosci. 2018;21:240–9.
Imaizumi Y, Eguchi K, Murakami T, Arakawa K, Tsuchihashi T, Kario K. High salt intake is independently associated with hypertensive target organ damage. J Clin Hypertens. 2016;18:315–21.
Balan Y, Packirisamy RM, Mohanraj PS. High dietary salt intake activates inflammatory cascades via Th17 immune cells: impact on health and diseases. Arch Med Sci. 2020;18. https://doi.org/10.5114/aoms.2020.96344.
Cappuccio FP, Beer M, Strazzullo P, on behalf of the European Salt Action Network. Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network. Nutr Metab Cardiovasc Dis. 2018;29:107–14.
EFSA Panel on Nutrition Novel Foods and Food Allergens, Turck D, Castenmiller J, de Henauw S, Hirsch-Ernst K-I, Kearney J, et al. Dietary reference values for sodium. EFSA Journal. 2019;17:e05778.
World Health Organization. WHO Guideline: Sodium intake for adults and children. Geneva, Switzerland: WHO Press; 2012. Report No.: 978 92 4 150483 6.
National Health and Medical Research Council, Australian Government Department of Health and Ageing, New Zealand Ministry of Health. Nutrient reference values for Australia and New Zealand including recommended dietary intakes. Australia; 2006. updated September 2017. Report No.: 1864962437.
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75:1334–57.
Joint Committee for Guideline Revision. 2018 Chinese guidelines for prevention and treatment of hypertension-A report of the Revision Committee of Chinese Guidelines for prevention and treatment of hypertension. J Geriatr Cardiol. 2019;16:182–241.
Cappuccio FP, Sever PS. The importance of a valid assessment of salt intake in individuals and populations. A scientific statement of the British and Irish Hypertension Society. J Hum Hypertens. 2019;33:345–8.
Aydoğdu S, Güler K, Bayram F, Altun B, Derici Ü, Abacı A, et al. [2019 Turkish hypertension consensus report]. Turk Kardiyol Dern Ars. 2019;47:535–46.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017;71:e13–e115.
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.
Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa ADM, et al. Brazilian guidelines of hypertension - 2020. Arq Bras Cardiol. 2021;116:516–658.
Powles J, Fahimi S, Micha R, Khatibzadeh S, Shi P, Ezzati M, et al. Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ. 2013;3:e003733.
Thout SR, Santos JA, McKenzie B, Trieu K, Johnson C, McLean R, et al. The Science of Salt: updating the evidence on global estimates of salt intake. J Clin Hypertens. 2019;21:710–21.
Huang L, Crino M, Wu JH, Woodward M, Barzi F, Land MA, et al. Mean population salt intake estimated from 24-h urine samples and spot urine samples: a systematic review and meta-analysis. IntJ Epidemiol. 2016;45:239–50.
Eaton SB, Konner M. Paleolithic nutrition. A consideration of its nature and current implications. N Engl J Med. 1985;312:283–9.
Bhat S, Marklund M, Henry ME, Appel LJ, Croft KD, Neal B, et al. A systematic review of the sources of dietary salt around the world. Adv Nutr. 2020;11:677–86.
Anderson CA, Appel LJ, Okuda N, Brown IJ, Chan Q, Zhao L, et al. Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study. J Am Diet Assoc. 2010;110:736–45.
Appel LJ, Foti K. Sources of dietary sodium. Circulation. 2017;135:1784–7.
Blanco-Metzler A, Moreira Claro R, Heredia-Blonval K, Caravaca Rodríguez I, Montero-Campos MDlA, Legetic B, et al. Baseline and estimated trends of sodium availability and food sources in the Costa Rican population during 2004–2005 and 2012–2013. Nutrients. 2017;9:1020. https://doi.org/10.3390/nu9091020.
World Health Organization. Global status report on noncommunicable disease 2014. Geneva, Switzerland: World Health Organization; 2014. Report No.: 978 92 4 156485 4.
World Health Organization. The updated Appendix 3 of the WHO Global NCD Action Plan 2013-2020. Best Buys. Geneva: World Health Organization; 2017.
Wang G, Labarthe D. The cost-effectiveness of interventions designed to reduce sodium intake. J Hypertens. 2011;29:1693–9.
Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007;370:2044–53.
Kontis V, Cobb LK, Mathers CD, Frieden TR, Ezzati M, Danaei G. Three public health interventions could save 94 million lives in 25 years global impact assessment analysis. Circulation. 2019;140:715–25.
World Health Organization. Saving lives, spending less: a strategic response to noncommunicable diseases. Geneva, Switzerland; 2018 (WHO/NMH/NVI/18.8). Licence: CC BY-NC-SA 3.0 IGO. Contract No.: WHO/NMH/NVI/18.8.
Nugent R. Benefits and costs of the non-communicable disease targets for the post-2015 development agenda. Copenhagen Consensus Center. 2015:I–II, 1–25.
Nilson EAF, Pearson-Stuttard J, Collins B, Guzman-Castillo M, Capewell S, O’Flaherty M, et al. Estimating the health and economic effects of the voluntary sodium reduction targets in Brazil: microsimulation analysis. BMC Medicine. 2021;19:225.
O’Donnell M, Mente A, Alderman MH, Brady AJB, Diaz R, Gupta R, et al. Salt and cardiovascular disease: insufficient evidence to recommend low sodium intake. Eur Heart J. 2020;41:3363–73.
Strazzullo P. Benefit assessment of dietary salt reduction: while the doctors study, should more people die? J Hypertens. 2011;29:829–31.
Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007;334:885–92.
O’Donnell M, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med. 2014;371:612–23.
Mente A, O’Donnell M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study. Lancet. 2018;392:496–506.
Cobb LK, Anderson CA, Elliott P, Hu FB, Liu K, Neaton JD, et al. Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes: a science advisory from the American Heart Association. Circulation. 2014;129:1173–86.
Ji C, Sykes L, Paul C, Dary O, Legetic B, Campbell NRC, et al. Systematic review of studies comparing 24-hour and spot urine collections for estimating population salt intake. Rev Panam Salud Publica. 2012;32:307–15.
Cogswell ME, Wang CY, Chen TC, Pfeiffer CM, Elliott P, Gillespie CD, et al. Validity of predictive equations for 24-h urinary sodium excretion in adults aged 18-39 y. Am J Clin Nutr. 2013;98:1502–13.
He FJ, Campbell NRC, Ma Y, MacGregor GA, Cogswell ME, Cook NR. Errors in estimating usual sodium intake by the Kawasaki formula alter its relationship with mortality: implications for public health. Int J Epidemiol. 2018;47:1784–95.
He FJ, Ma Y, Campbell NRC, MacGregor GA, Cogswell ME, Cook NR. Formulas to estimate dietary sodium intake from spot urine alter sodium-mortality relationship. Hypertension. 2019;74:572–80.
Naser AM, He FJ, Rahman M, Campbell NRC. Spot urine formulas to estimate 24-hour urinary sodium excretion alter the dietary sodium and blood pressure relationship. Hypertension. 2021;77:2127–37.
Campbell NRC, He FJ, Cappuccio FP, MacGregor GA. Sources of controversy relating to dietary sodium. Issues and potential solutions. Cur Nutr Rep. 2021;10:188–99.
Campbell NR, Appel LJ, Cappuccio FP, Correa-Rotter R, Hankey GJ, Lackland DT, et al. A call for quality research on salt intake and health: From the World Hypertension League and supporting organizations. J Clin Hypertens. 2014;16:469–71.
Campbell NRC, He FJ, Tan M, Cappuccio FP, Neal B, Woodward M, et al. The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) position statement on the use of 24-hour, spot, and short duration (<24 h) timed urine collections to assess dietary sodium intake. J Clin Hypertens. 2019;21:700–9.
Campbell NR, Lackland DT, Niebylski ML, Nilsson PM. Is reducing dietary sodium controversial? Is it the conduct of studies with flawed research methods that is controversial? A perspective from the World Hypertension League Executive. J Clin Hypertens. 2015;17:85–6.
Birukov A, Rakova N, Lerchl K, Engberink RH, Johannes B, Wabel P, et al. Ultra-long-term human salt balance studies reveal interrelations between sodium, potassium, and chloride intake and excretion. Am J Clin Nutr. 2016;104:49–57.
McLean RM. Measuring population sodium intake: a review of methods. Nutrients. 2014;6:4651–62.
Lucko AM, Doktorchik C, Woodward M, Cogswell M, Neal B, Rabi D, et al. Percentage of ingested sodium excreted in 24-hour urine collections: a systematic review and meta-analysis. J Clin Hypertens. 2018;20:1220–9.
McLean R, Cameron C, Butcher E, Cook NR, Woodward M, Campbell NRC. Comparison of 24-hour urine and 24-hour diet recall for estimating dietary sodium intake in populations: a systematic review and meta-analysis. J Clin Hypertens. 2019;21:1753–62.
McLean RM, Farmer VL, Nettleton A, Cameron CM, Cook NR, Campbell NRC. Assessment of dietary sodium intake using a food frequency questionnaire and 24-hour urinary sodium excretion: a systematic literature review. J Clin Hypertens. 2017;19:1214–30.
McLean RM, Farmer VL, Nettleton A, Cameron CM, Cook NR, Woodward M, et al. Twenty-four-hour diet recall and diet records compared with 24-hour urinary excretion to predict an individual’s sodium consumption: a systematic review. J Clin Hypertens. 2018;20:1360–76.
Olde Engberink RHG, van den Hoek TC, van Noordenne ND, van den Born BH, Peters-Sengers H, Vogt L. Use of a single baseline versus multiyear 24-hour urine collection for estimation of long-term sodium intake and associated cardiovascular and renal risk. Circulation. 2017;136:917–26.
Wong MM, Arcand J, Leung AA, Thout SR, Campbell NR, Webster J. The Science of Salt: a regularly updated systematic review of salt and health outcomes (December 2015-March 2016). J Clin Hypertens. 2017;19:322–32.
Webster J, Waqanivalu T, Arcand J, Trieu K, Cappuccio FP, Appel LJ, et al. Understanding the science that supports population-wide salt reduction programs. J Clin Hypertens. 2017;19:569–76.
Johnson C, Raj TS, Trudeau L, Bacon SL, Padwal R, Webster J, et al. The Science of Salt: a systematic review of clinical salt studies 2013 to 2014. J Clin Hypertens. 2015;17:401–11.
Johnson C, Raj TS, Trieu K, Arcand J, Wong MM, McLean R, et al. The Science of Salt: a systematic review of quality clinical salt outcome studies June 2014 to May 2015. J Clin Hypertens. 2016;18:832–9.
Arcand J, Wong MMY, Santos JA, Leung AA, Trieu K, Thout SR, et al. More evidence that salt increases blood pressure and risk of kidney disease from the Science of Salt: a regularly updated systematic review of salt and health outcomes (April-July 2016). J Clin Hypertens. 2017;19:813–23.
Arcand J, Wong MM, Trieu K, Leung AA, Campbell NR, Webster J, et al. The Science of Salt: a regularly updated systematic review of salt and health outcomes (June and July 2015). J Clin Hypertens. 2016;18:371–7.
Arcand J, Webster J, Johnson C, Raj TS, Neal B, McLean R, et al. Announcing “Up to Date in the Science of Sodium”. J Clin Hypertens. 2016;18:85–8.
Santos JA, Tekle D, Rosewarne E, Flexner N, Cobb L, Al-Jawaldeh A, et al. A systematic review of salt reduction initiatives around the world: a midterm evaluation of progress towards the 2025 global non-communicable diseases salt reduction target. Adv Nutr. 2021;12:1768–80.
Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O’Flaherty M, McGill R, et al. Systematic review of dietary salt reduction policies: evidence for an effectiveness hierarchy? PloS ONE. 2017;12:e0177535.
Ide N, Ajenikoko A, Steele L, Cohn J, J. Curtis C, Frieden TR, et al. Priority actions to advance population sodium reduction. Nutrients. 2020;12:2543.
World Health Organization. WHO global sodium benchmarks for different food categories. Geneva 2021.
Campbell N, Legowski B, Legetic B, Ferrante D, Nilson E, Campbell C, et al. Targets and timelines for reducing salt in processed food in the Americas. J Clin Hypertens. 2014;16:619–23.
Campbell N, Legowski B, Legetic B, Nilson E, L’Abbe M. Inaugural maximum values for sodium in processed food products in the Americas. J Clin Hypertens. 2015;17:611–3.
Pan American Health Organization. Updated PAHO regional sodium reduction targets. Washington DC. 2021. p. 1–19.
Pan American Health Organization. Salt-Smart Americas: a guide for country-level action. Washington, DC: Pan American Health Organization; 2013. Report No.: 978-75-31769-3.
World Health Organization Regional Office for Europe. Accelerating salt reduction in Europe. 2020.
Jaenke R, Barzi F, McMahon E, Webster J, Brimblecombe J. Consumer acceptance of reformulated food products: a systematic review and meta-analysis of salt-reduced foods. Critical Rev Food Sci Nutr. 2017;57:3357–72.
Karppanen H, Mervaala E. Sodium intake and hypertension. Prog Cardiovasc Dis. 2006;49:59–75.
He FJ, Pombo-Rodrigues S, MacGregor GA. Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open. 2014;4:e004549.
Uechi K, Sugimoto M, Kobayashi S, Sasaki S. Urine 24-Hour sodium excretion decreased between 1953 and 2014 in Japan, but estimated intake still exceeds the WHO recommendation. J Nutr. 2017;147:390–7.
Chalmers J, Arima H, Hata J. Cost-effective reduction in stroke: lessons from the Japanese hypertension detection and control program. J Hypertens. 2012;30:1706–7.
Nakagawa H, Miura K. Salt reduction in a population for the prevention of hypertension. Environ Health and Prev Med. 2004;9:123.
Law MR, Frost CD, Wald NJ. By how much does dietary salt reduction lower blood pressure? III - Analysis of data from trials of salt reduction. BMJ. 1991;302:819–24.
World Health Organization. SHAKE the salt habit. The SHAKE Technical Package for Salt Reduction. Geneva: World Health Organization. 2016. p. 1–60.
Theobald S, Brandes N, Gyapong M, El-Saharty S, Proctor E, Diaz T, et al. Implementation research: new imperatives and opportunities in global health. Lancet. 2018;392:2214–28.
Jacobson MF, Havas S, McCarter R. Changes in sodium levels in processed and restaurant foods, 2005 to 2001. JAMA Intern Med. 2013;173:1285–91.
Cobiac LJ, Vos T, Veerman JL. Cost-effectiveness of interventions to reduce dietary salt intake. Heart. 2010;96:1920–5.
Khalig M, Sommariva S, Bardfield L, Blanco-Metzler A, Benítez GSL, Gomes A, et al. Salt reduction in Latin America. A regional social marketing & communication plan. Project - IDRC 108167 Scaling up and evaluating salt reduction policies and programs in Latin American countries. 2016–2020. In: (INCIENSA) CRIoRaTiHaN, editor. Tres Ríos, Costa Rica: INCIENSA; 2019.
Xu A, Ma J, Guo X, Wang L, Wu J, Zhang J, et al. Association of a province-wide intervention with salt intake and hypertension in Shandong Province, China, 2011–2016. JAMA Intern Med. 2020;180:877–86.
Trieu K, McMahon E, Santos JA, Bauman A, Jolly KA, Bolam B, et al. Review of behaviour change interventions to reduce population salt intake. Int J Behav Nutr Phys Act. 2017;14:17.
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.
Bardfield L Applying a social marketing framework to salt reduction In: fhi360, editor. Washington DC: fhi360; 2012.
Neal B, Wu Y, Feng X, Zhang R, Zhang Y, Shi J, et al. Effect of salt substitution on cardiovascular events and death. N Engl J Med. 2021;385:1067–77.
Greer RC, Marklund M, Anderson CAM, Cobb LK, Dalcin AT, Henry M, et al. Potassium-enriched salt substitutes as a means to lower blood pressure. Hypertension. 2020;75:266–74.
Hernandez AV, Emonds EE, Chen BA, Zavala-Loayza AJ, Thota P, Pasupuleti V, et al. Effect of low-sodium salt substitutes on blood pressure, detected hypertension, stroke and mortality. Heart. 2019;105:653–960.
Chang HY, Hu YW, Yue CS, Wen YW, Yeh WT, Hsu LS, et al. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr. 2006;83:1289–96.
Bernabe-Ortiz A, Sal y Rosas VG, Ponce-Lucero V, Cárdenas MK, Carrillo-Larco RM, Diez-Canseco F, et al. Effect of salt substitution on community-wide blood pressure and hypertension incidence. Nat Med. 2020;26:374–8.
Marklund M, Singh G, Greer R, Cudhea F, Matsushita K, Micha R, et al. Estimated population wide benefits and risks in China of lowering sodium through potassium enriched salt substitution: modelling study. BMJ. 2020;369:m824.
Li N, Yan LL, Niu W, Yao C, Feng X, Zhang J, et al. The effects of a community-based sodium reduction program in rural China - A cluster-randomized trial. PloS ONE. 2016;11:e0166620–e.
Farrand C, MacGregor G, Campbell NR, Webster J. Potential use of salt substitutes to reduce blood pressure. J Clin Hypertens. 2019;21:350–4.
Campbell N, Dary O, Cappuccio FP, Neufeld LM, Harding KB, Zimmermann MB. Collaboration to optimize dietary intakes of salt and iodine: a critical but overlooked public health issue. Bull World Health Organ. 2012;90:73–4.
Campbell NRC, Dary O, Cappuccio FP, Neufeld LM, Harding KB, Zimmerman MB. Need for coordinated programs to improve global health by optimizing salt and iodine intake. Special Report. Rev Panam Salud Publica. 2012;32:281–6.
Webster J, Santos JA, Hogendorf M, Trieu K, Rosewarne E, McKenzie B, et al. Implementing effective salt reduction programs and policies in low- and middle-income countries: learning from retrospective policy analysis in Argentina, Mongolia, South Africa and Vietnam. Public Health Nutr. 2021. https://doi.org/10.1017/S136898002100344X. Online ahead of print.:1–12.
Santos JA, McKenzie B, Rosewarne E, Hogendorf M, Trieu K, Woodward M, et al. Strengthening knowledge to practice on effective salt reduction interventions in low- and middle-income countries. Curr Nutr Rep. 2021;10:211–25.
Campbell NR, Lackland DT, Niebylski ML, Orias M, Redburn KA, Nilsson PM, et al. 2016 dietary salt fact sheet and call to action: The World Hypertension League, International Society of Hypertension, and the International Council of Cardiovascular Prevention and Rehabilitation. J Clin Hypertens. 2016;18:1082–4.
National Institute of Nutrition, Indian Council of Medical Research, Ministry of Health and Family Welfare, Government of India,. Nutrient requirements of Indians. Hyderabad, India: Indian Council of Medical Research; 2020. p. 1–321.
Ministry of Health. Towards a healthy Russia. Healthy nutrition: plan of action to develop regional programmes in the Russian Federation. 2000.
Brasil. Ministério da Saúde. Estratégias para o cuidado da pessoa com doença crônica: hipertensão arterial sistêmica / Strategies for the care of the person with chronic disease: hypertension. In: Departamento de Atenção Básica, editor. 2014.
Ministry of Health. Strategic plan for the prevention and control of non-communicable diseases 2013–17. South Africa: Minstry of Health; 2013.
Federal Ministry of Health. National multi-sectoral action plan for the prevention and control of non-communicable diseases (2019–2025). Nigeria, 2019.
Genovesi S, Giussani M, Orlando A, Orgiu F, Parati G. Salt and sugar: two enemies of healthy blood pressure in children. Nutrients. 2021;13:697.
This work is an updated version of the World Hypertension League (WHL) 2016 Dietary Sodium Fact sheet . In addition to the sponsoring organizations (International Society of Hypertension, Resolve to Save Lives and World Hypertension League), the following 70 organizations have reviewed this fact sheet and provide their support for its contents: International Society of Nephrology, International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), World Stroke Organization, PATH, African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES), African Stroke Organization, American Heart Association, Argentina Society of Arterial Hypertension, Asociación Costa Rica Saludable, Asociación Costarricense de Cardiología (ASOCAR), Dr Bindu Menon Foundation (India), Brazilian Society of Hypertension, British and Irish Hypertension Society, Bulgarian League of Hypertension, Bulgarian Society of Cardiovascular Support, Canadian Cardiovascular Society, Canadian Society of Nephrology, Cardiology Branch of the Chinese Medical Doctors Association, Chilean Society of Hypertension, CIET Uruguay, Chinese Hypertension League, CLAS Coalition America Saludable, Consensus Action on Salt and Health, European Society of Cardiology Hypertension Council, European Society of Hypertension, Faculty of Medical Sciences - State University of Rio de Janeiro (Brazil), George Institute for Global Health, German Society of Hypertension, High Blood Pressure Research Council of Australia, Hungarian Society of Hypertension, Hypertension and Nutrition Core Group of the Indian Association for Parenteral and Enteral Nutrition, Heart and Stroke Foundation of Canada, Hellenic Society of Hypertension, Hong Kong College of Cardiology, Hospital de Clínicas de Porto Alegre (Brazil), Hypertension Canada, Indian Society of Hypertension, Indonesian Society of Hypertension, Italian Society of Arterial Hypertension, Iranian Heart Foundation, InterAmerican Heart Foundation, Japanese Society of Hypertension, Korean Society of Community Nutrition, Korean Society of Hypertension, Latin American Society of Nephrology and Hypertension, Latin American Society of Hypertension, Lebanese Hypertension League, Malaysian Society of Hypertension, Malaysian Society for World Action on Salt, Sugar and Health (MyWASSH), Mongolian Society of Hypertension, National Institute of Food and Nutrition Service (South Korea), Nigerian Cardiac Society, Nigerian Hypertension Society, Onom Foundation (Mongolia), Polish Society of Hypertension, Philippine Society of Hypertension, Portuguese Society of Hypertension, Portuguese Society of Paediatric Working Group on Blood Pressure in Children and Adolescents, Primary Aldosteronism Foundation, Salud Justa Mx (Mexico), Saudi Hypertension Management Society, Serbian Society of Hypertension, School of Medicine Universidade Federal do Rio Grande do Sul (Brazil), Stroke Investigative Research and Educational Network, Slovak League against Hypertension, Swedish Society for Hypertension, Stroke and Vascular Medicine (Africa), Thai Hypertension Society, Unidad de Cirugía Cardiovascular de Guatemala,and World Action on Salt, Sugar and Health.
NRCC reports personal fees from Resolve to Save Lives (RTSL), the Pan American Health Organization and the World Bank outside the submitted work; and is an unpaid member of World Action on Salt, Sugar and Health and an unpaid consultant on dietary sodium and hypertension control to numerous governmental and non-governmental organizations. NRCC chaired the International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) which is an unpaid voluntary position. FPC: Past President and Trustee of the British and Irish Hypertension Society (2017–19), member of Action on Salt, Sugar and Health, member of the TRUE Consortium, and Advisor to the World Health Organization, all unpaid. Speaker fees from Omron Healthcare and book royalties from Oxford University Press, both unrelated to present topic. JW is Director of the WHO Collaborating Centre on Population Salt Reduction. FJH is an unpaid member of Action on Salt and World Action on Salt, Sugar and Health (WASSH). AB-M is an unpaid member of World Action on Salt, Sugar and Health and member of the Pan American Health Organization Technical Advisory Group on Salt Reduction (2009–2020). GAM is the unpaid Chair of Action on Salt, Action on Sugar, World Action on Salt, Sugar and Health (WASSH), and Blood Pressure UK. MRL has served in the following capacities (all unpaid): Chair, Pan American Health Organization Technical Advisory Group on Sodium; Member, WHO Nutrition Advisory Group on Nutrition; Past Chair/Co-Chair, Sodium Working Group, Canada; Director, WHO Collaborating Centre on Nutrition Policy for Chronic Disease Prevention. JGW reports grants from Novartis and Omron, and lecture and consulting fees from KBP Biosciences, Merck, Novartis, Servier and Viatris. RK reports support for research by Bayer, honoraria for lectures from Bayer, Berlin-Chemie/Menarini, Boehringer Ingelheim, Daiichi Sankyo, Ferrer, Merck, Sanofi, and Servier. RTT reports personal fees from Shoppers Drug Mart, Emergent Biosolutions and Merck Canada. YCC is an unpaid president of the Malaysian Society for World Action on Salt, Sugar and Health (MyWASSH). PKW, MO, RDW, NI, BN, JC, LKC, KT, RMM, MW, NK, YK, LN, JA, MOO, LL, GP, DTL, FJC, BW, MT, CAR, BC, MAW, MPS, AF, VLF, RA, FI, BM, MS, MFN, KH, CP, SP, JG, JEJ, JW, UW, MS, MA, AP, EG, FDF, MP, AW-KC, JN, SNN, NS, MER, NY, HR, AJR, GAE, AB, C-iK, S-HI, TU, HKP, KW, HG, NJD, MI, DIDO, LBM-A, AP, ML, CS, FP, BAA, JS, SF, DL, and X-HZ have no reported financial conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Campbell, N.R.C., Whelton, P.K., Orias, M. et al. 2022 World Hypertension League, Resolve To Save Lives and International Society of Hypertension dietary sodium (salt) global call to action. J Hum Hypertens 37, 428–437 (2023). https://doi.org/10.1038/s41371-022-00690-0
This article is cited by
Weak research on dietary sodium should not generate strong conclusions on a major public health policy
Journal of Human Hypertension (2023)