In Asian countries, a major source of salt intake is from seasoning or table salt added at home. However, little is known about the adverse effects of salt intake evaluated according to household unit. We investigated the relationship between household salt intake level and mortality from all-cause and cardiovascular diseases (CVDs). Participants included 8702 individuals (56% women) who were living with someone else and who were aged 30–79 years and enrolled in the National Nutritional Survey of Japan in 1980 with a 24-year follow-up. Household nutrient intake was evaluated using a 3-day weighing record method in which all foods and beverages consumed by any of the household members were recorded. The household salt intake level was defined as the amount of salt consumed (g) per 1000 kcal of total energy intake in each household, and its average was 6.25 (2.02) g/1000 kcal. During the follow-up, there were 2360 deaths (787 CVD, 168 coronary heart disease [CHD], and 361 stroke). Cox proportional hazard ratios (HRs) for an increment of 2 g/1000 kcal in household salt intake were calculated and adjusting for sex, age, body mass index, smoking status, alcohol consumption status, self-reported work exertion level, household potassium intake, household saturated fatty acid intake, and household long-chain n-3 polyunsaturated fatty acid intake. The HRs (95% confidence intervals) were 1.07 (1.02, 1.12) for all-cause mortality, 1.11 (1.03, 1.19) for CVD, 1.25 (1.08, 1.44) for CHD, and 1.12 (1.00, 1.25) for stroke. The household salt intake level was significantly associated with long-term risk of all-cause, CVD, CHD, and stroke mortality in a representative Japanese population.
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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. Intersalt Cooperative Research Group. Br Med J. 1996;312:1249–53. https://doi.org/10.1136/bmj.312.7041.1249.
He FJ, Li J, MacGregor GA. Effect of longer term modest salt reduction on blood pressure: cochrane systematic review and meta-analysis of randomised trials. Br Med J. 2013;346:f1325–f1325. https://doi.org/10.1136/bmj.f1325.
Miura K, Okuda N, Turin TC, Takashima N, Nakagawa H, Nakamura K, et al. Dietary salt intake and blood pressure in a representative Japanese population: baseline analyses of NIPPON DATA80. J Epidemiol. 2010;20 Suppl 3:S524–30.
Strazzullo P, D’Elia L, Kandala N-B, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. Br Med J. 2009;339:b4567–b4567. https://doi.org/10.1136/bmj.b4567.
Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014;371:624–34. https://doi.org/10.1056/NEJMoa1304127.
Takachi R, Inoue M, Shimazu T, Sasazuki S, Ishihara J, Sawada N, et al. Consumption of sodium and salted foods in relation to cancer and cardiovascular disease: The Japan public health center-based prospective study. Am J Clin Nutr. 2010;91:456–64. https://doi.org/10.3945/ajcn.2009.28587.
Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. Br Med J. 2013;346:1–20. https://doi.org/10.1136/bmj.f1326.
Nagata C, Takatsuka N, Shimizu N, Shimizu H. Sodium intake and risk of death from stroke in Japanese men and women. Stroke. 2004;35:1543–7. https://doi.org/10.1161/01.STR.0000130425.50441.b0.
Umesawa M, Iso H, Date C, Yamamoto A, Toyoshima H, Watanabe Y, et al. Relations between dietary sodium and potassium intakes and mortality from cardiovascular disease: the Japan Collaborative Cohort study for evaluation of cancer risks. Am J Clin Nutr. 2008;88:195–202. https://doi.org/10.1093/ajcn/88.1.195
Cook NR, Appel LJ, Whelton PK. Sodium intake and all-cause mortality over 20 years in the trials of hypertension prevention. J Am Coll Cardiol. 2016;68:1609–17. https://doi.org/10.1016/j.jacc.2016.07.745.
Liu H, Gao X, Zhou L, Wu Y, Li Y, Mai J, et al. Urinary sodium excretion and risk of cardiovascular disease in the Chinese population: a prospective study. Hypertens Res. 2018;41:849–55. https://doi.org/10.1038/s41440-018-0091-8.
Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344:3–10. https://doi.org/10.1056/NEJM200101043440101.
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). Br Med J. 2007;334:885–8. https://doi.org/10.1136/bmj.39147.604896.55.
World Health Organization (WHO). Guideline: Sodium intake for adults and children. Geneva, Switzerland, 2012. 1–46. http://www.who.int/nutrition/publications/guidelines/sodium_intake/en/.
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 Open. 2013;3. https://doi.org/10.1136/bmjopen-2013-003733.
Anderson CAM, 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. https://doi.org/10.1016/j.jada.2010.02.007.
Asakura K, Uechi K, Masayasu S, Sasaki S. Sodium sources in the Japanese diet: difference between generations and sexes. Public Health Nutr. 2016;19:2011–23. https://doi.org/10.1017/S1368980015003249.
Beauchamp GK, Cowart BJ, Mennella JA, Marsh RR. Infant salt taste: developmental, methodological, and contextual factors. Dev Psychobiol. 1994;27:353–65. https://doi.org/10.1002/dev.420270604.
Mattes RD. The taste for salt in humans. Am J Clin Nutr. 1997;65:692S–697S. https://doi.org/10.1093/ajcn/65.2.692S.
Service C, Grimes C, Riddell L, He F, Campbell K, Nowson C. Association between parent and child dietary sodium and potassium intakes as assessed by 24-h urinary excretion. Nutrients. 2016;8:191 https://doi.org/10.3390/nu8040191.
Patterson TL, Rupp JW, Sallis JF, Atkins CJ, Nader PR. Aggregation of dietary calories, fats, and sodium in Mexican-American and Anglo families. Am J Prev Med. 1988;4:75–82. http://www.ncbi.nlm.nih.gov/pubmed/3395494.
Ikehara S, Iso H, Date C, Kikuchi S, Watanabe Y, Inaba Y, et al. Salt preference and mortality from stroke and coronary heart disease for Japanese men and women: the JACC study. Prev Med. 2012;54:32–7. https://doi.org/10.1016/j.ypmed.2011.10.013.
Takachi R, Ishihara J, Iwasaki M, Ishii Y, Tsugane S. Self-reported taste preference can be a proxy for daily sodium intake in middle-aged Japanese adults. J Acad Nutr Diet. 2014;114:781–7. https://doi.org/10.1016/j.jand.2013.07.043.
Ueshima H, Choudhury SR, Okayama A, Hayakawa T, Kita Y, Kadowaki T, et al. Cigarette smoking as a risk factor for stroke death in Japan NIPPON DATA80. Stroke. 2004;35:1836–41. https://doi.org/10.1161/01.STR.0000131747.84423.74.
Okuda N, Miura K, Yoshita K, Matsumura Y, Okayama A, Nakamura Y, et al. Integration of Data from NIPPON DATA80/90 and National Nutrition Survey in Japan: for cohort studies of representative Japanese oN Nutrition. J Epidemiol. 2010;20:S506–S514. https://doi.org/10.2188/jea.JE20090218.
Okamura T, Hayakawa T, Kadowaki T, Kita Y, Okayama A, Elliott P, et al. Resting heart rate and cause-specific death in a 16.5-year cohort study of the Japanese general population. Am Heart J. 2004;147:1024–32. https://doi.org/10.1016/j.ahj.2003.12.020.
Miyagawa N, Miura K, Okuda N, Kadowaki T, Takashima N, Nagasawa S, et al. Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese: A 24-year follow-up of NIPPON DATA80. Atherosclerosis. 2014;232:384–9. https://doi.org/10.1016/j.atherosclerosis.2013.11.073.
Yoshiike N, Matsumura Y, Iwaya M, Sugiyama M, Yamaguchi M. National Nutrition Survey in Japan. J Epidemiol. 1996;6:S189–200. https://doi.org/10.2188/jea.6.3sup_189.
Saito A, Imai S, Htun NC, Okada E, Yoshita K, Yoshiike N, et al. The trends in total energy, macronutrients and sodium intake among Japanese: findings from the 1995-2016 National Health and Nutrition Survey. Br J Nutr. 2018;120:424–34. https://doi.org/10.1017/S0007114518001162.
Okuda N, Okayama A, Miura K, Yoshita K, Saito S, Nakagawa H, et al. Food sources of dietary sodium in the Japanese adult population: the international study of macro-/micronutrients and blood pressure (INTERMAP). Eur J Nutr. 2017;56:1269–80. https://doi.org/10.1007/s00394-016-1177-1.
Larsson SC, Orsini N, Wolk A. Dietary potassium intake and risk of stroke. Stroke. 2011;42:2746–50. https://doi.org/10.1161/strokeaha.111.622142.
Zhao F, Zhang P, Zhang L, Niu W, Gao J, Lu L, et al. Consumption and sources of dietary salt in family members in Beijing. Nutrients. 2015;7:2719–30. https://doi.org/10.3390/nu7042719.
Ministry of Health, Labor and Welfare. The National Health and Nutrition Survey in Japan, 2017. Ministry of Health, Labor and Welfare; 2018. https://www.mhlw.go.jp/stf/houdou/0000177189_00001.html. Accessed 20 June 2019.
Ministry of Internal Affairs and Communications. Survey on Time Use and Leisure Activities (2016b). Ministry of Internal Affairs and Communications; 2017. https://www.stat.go.jp/data/shakai/2016/kekka.html. Accessed 20 June 2019.
Michikawa T, Nishiwaki Y, Okamura T, Asakura K, Nakano M, Takebayashi T. The taste of salt measured by a simple test and blood pressure in Japanese women and men. Hypertens Res. 2009;32:399–403. https://doi.org/10.1038/hr.2009.31.
Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38:791–813. https://doi.org/10.1093/ije/dyp139.
He FJ, Brinsden HC, Macgregor GA. Salt reduction in the United Kingdom: a successful experiment in public health. J Hum Hypertens. 2014;28:345–52. https://doi.org/10.1038/jhh.2013.105.
Brinsden HC, He FJ, Jenner KH, MacGregor GA. Surveys of the salt content in UK bread: progress made and further reductions possible. BMJ Open. 2013;3:1–8. https://doi.org/10.1136/bmjopen-2013-002936.
Ministry of Health, Labor and Welfare. Graphical Review of Japanese Household: From Comprehensive Survey of Living Conditions 2016. Tokyo, Japan, 2018. https://www.mhlw.go.jp/toukei/list/dl/20-21-h28.pdf.
The authors are deeply indebted to public health centers that cooperated in this study and the staff members of the NIPPON DATA80 research group. We also thank Analisa Avila, ELS, of Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
For the NIPPON DATA80 Research Group
Hirotsugu Ueshima1,3, Akira Okayama9, Tomonori Okamura8, Shigeyuki Saitoh10, Kiyomi Sakata11, Atsushi Hozawa12, Takehito Hayakawa13, Yosikazu Nakamura14, Nobuo Nishi4, Nagako Okuda5, Takayoshi Ohkubo15, Fumiyoshi Kasagi16, Yoshitaka Murakami17, Toru Izumi18, Yasuhiro Matsumura19, Toshiyuki Ojima20, Koji Tamakoshi21, Hideaki Nakagawa22, Yoshikuni Kita23, Katsuyuki Miura1,3, Aya Kadota1, Akira Fujiyoshi7, Naomi Miyamatsu2, Yasuyuki Nakamura24, Katsushi Yoshita6, Yoshihiro Miyamoto25, Kazunori Kodama26 and Yutaka Kiyohara27
This study was supported by a grant-in-aid from the Ministry of Health, Labor and Welfare, under the auspices of the Japanese Association for Cerebro-cardiovascular Disease Control; a Research Grant for Cardiovascular Diseases (7A-2) from the Ministry of Health, Labor and Welfare; Health and Labor Sciences Research Grants, Japan (Comprehensive Research on Aging and Health) [H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014]; and Comprehensive Research on Lifestyle Related Diseases, including Cardiovascular Diseases and Diabetes Mellitus [H22-Junkankitou-Seishuu-Sitei-017, H25-Junkankitou-Seishuu-Sitei-022, H30-Junkankitou-Seishuu-Sitei-002]).
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Members of the NIPPON DATA80 Research Group are listed below Acknowledgement.
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Shima, A., Miyamatsu, N., Miura, K. et al. Relationship of household salt intake level with long-term all-cause and cardiovascular disease mortality in Japan: NIPPON DATA80. Hypertens Res 43, 132–139 (2020). https://doi.org/10.1038/s41440-019-0349-9
- Salt intake
- Cardiovascular diseases
- Cohort study