Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Relationship of household salt intake level with long-term all-cause and cardiovascular disease mortality in Japan: NIPPON DATA80

Hypertension Research volume 43, pages 132–139 (2020)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  1. 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.

    Article  CAS  Google Scholar 

  2. 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.

    Article  Google Scholar 

  3. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  CAS  PubMed  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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

    Article  CAS  PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. 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.

    Article  CAS  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. 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/.

  15. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  CAS  PubMed  Google Scholar 

  19. 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.

    Article  CAS  PubMed  Google Scholar 

  20. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. 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.

    Article  CAS  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  CAS  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  CAS  PubMed  Google Scholar 

  28. 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.

    Article  CAS  PubMed  Google Scholar 

  29. 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.

    Article  CAS  PubMed  Google Scholar 

  30. 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.

    Article  CAS  PubMed  Google Scholar 

  31. 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.

    Article  CAS  PubMed  Google Scholar 

  32. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. 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.

  34. 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.

  35. 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.

    Article  PubMed  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  CAS  PubMed  Google Scholar 

  38. 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.

    Article  Google Scholar 

  39. 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.

Download references

Acknowledgements

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

Funding

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]).

Author information

Authors and Affiliations

  1. Department of Public Health, Shiga University of Medical Science, Shiga, Japan

    Azusa Shima, Katsuyuki Miura, Aya Kadota, Keiko Kondo, Hirotsugu Ueshima, Hirotsugu Ueshima, Katsuyuki Miura & Aya Kadota

  2. Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan

    Naomi Miyamatsu & Naomi Miyamatsu

  3. Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan

    Katsuyuki Miura, Hirotsugu Ueshima, Hirotsugu Ueshima & Katsuyuki Miura

  4. International Center for Nutrition and Information, National Institute of Biomedical Innovation, Health and Nutrition, Tokyo, Japan

    Naoko Miyagawa & Nobuo Nishi

  5. Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan

    Nagako Okuda & Nagako Okuda

  6. Department of Food and Human Health Science, Osaka City University, Graduate School of Human Life Science, Osaka, Japan

    Katsushi Yoshita & Katsushi Yoshita

  7. Department of Hygiene, Wakayama Medical University, Wakayama, Japan

    Harumitsu Suzuki & Akira Fujiyoshi

  8. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan

    Tomonori Okamura & Tomonori Okamura

  9. Research Institute of Strategy for Prevention, Tokyo, Japan

    Akira Okayama & Akira Okayama

  10. School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido, Japan

    Shigeyuki Saitoh

  11. Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Iwate, Japan

    Kiyomi Sakata

  12. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan

    Atsushi Hozawa

  13. Kinugasa Research Organization, Ritsumeikan University, Kyoto, Japan

    Takehito Hayakawa

  14. Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Yosikazu Nakamura

  15. Department of Hygiene and Public Health Teikyo University School of Medicine, Tokyo, Japan

    Takayoshi Ohkubo

  16. Institute of Radiation Epidemiology, Radiation Effects Association, Tokyo, Japan

    Fumiyoshi Kasagi

  17. Department of Medical Statistics, Toho University, Tokyo, Japan

    Yoshitaka Murakami

  18. Kitasato University, Sagamihara, Kanagawa, Japan

    Toru Izumi

  19. Faculty of Health and Nutrition, Bunkyo University, Chigasaki, Kanagawa, Japan

    Yasuhiro Matsumura

  20. Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Toshiyuki Ojima

  21. Department of Public Health and Health Information Dynamics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

    Koji Tamakoshi

  22. Medical Research Institute, Kanazawa Medical University, Kanazawa, Ishikawa, Japan

    Hideaki Nakagawa

  23. Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga, Fukui, Japan

    Yoshikuni Kita

  24. Department of Food Science and Human Nutrition, Ryukoku University, Otsu, Shiga, Japan

    Yasuyuki Nakamura

  25. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Yoshihiro Miyamoto

  26. Radiation Effects Research Foundation, Hiroshima, Japan

    Kazunori Kodama

  27. Hisayama Research Institute for Lifestyle Diseases, Hisayama-cho, Fukuoka, Japan

    Yutaka Kiyohara

Authors
  1. Azusa Shima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naomi Miyamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsuyuki Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naoko Miyagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nagako Okuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsushi Yoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aya Kadota
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Harumitsu Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Keiko Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tomonori Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Akira Okayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hirotsugu Ueshima
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the NIPPON DATA80 Research Group

  • Hirotsugu Ueshima
  • , Akira Okayama
  • , Tomonori Okamura
  • , Shigeyuki Saitoh
  • , Kiyomi Sakata
  • , Atsushi Hozawa
  • , Takehito Hayakawa
  • , Yosikazu Nakamura
  • , Nobuo Nishi
  • , Nagako Okuda
  • , Takayoshi Ohkubo
  • , Fumiyoshi Kasagi
  • , Yoshitaka Murakami
  • , Toru Izumi
  • , Yasuhiro Matsumura
  • , Toshiyuki Ojima
  • , Koji Tamakoshi
  • , Hideaki Nakagawa
  • , Yoshikuni Kita
  • , Katsuyuki Miura
  • , Aya Kadota
  • , Akira Fujiyoshi
  • , Naomi Miyamatsu
  • , Yasuyuki Nakamura
  • , Katsushi Yoshita
  • , Yoshihiro Miyamoto
  • , Kazunori Kodama
  •  & Yutaka Kiyohara

Corresponding author

Correspondence to Katsuyuki Miura.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

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.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-019-0349-9

Keywords

  • Household
  • Salt intake
  • Cardiovascular diseases
  • Cohort study

Search

Advanced search

Quick links