Skip to main content

Thank you for visiting 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.

  • Review Article
  • Published:

Special Issue: Current evidence and perspectives for hypertension management in Asia

Dietary salt intake in Japan - past, present, and future


Salt reduction is the most important lifestyle modification, especially in Japanese individuals who still consume a significant amount of salt. The Dietary Reference Intakes for Japanese 2020, issued by the Ministry of Health, Labour and Welfare, propose a salt intake goal of <7.5 g/day for men and <6.5 g/day for women. Regarding the goal of salt reduction in hypertensive patients, the hypertension guideline by the Japanese Society of Hypertension 2019 (JSH2019) proposes a goal of <6 g/day. Although the average salt intake in Japan gradually decreased in the early 2000s, the declining trend has not been seen in recent years, and thus, it seems difficult to achieve these target salt intake levels. To overcome this challenge, the JSH announced the ‘JSH Tokyo Declaration’ and pledged to create a specific action plan to achieve the target salt intake level of <6 g/day. The six strategies to achieve the target salt intake level are as follows: (1) educating citizens on the harms of excessive salt intake and the importance of reducing salt intake; (2) recommending the assessment of the salt intake of individuals or populations and proposing adequate methods to reduce salt intake; (3) promoting salt reduction for children as a part of dietary education at school; (4) promoting salt reduction in takeout food, prepared dishes, canteens, and school lunches; (5) encouraging companies to develop and promote low-salt foods; and (6) encouraging the government to take measures to promote salt reduction. Through these activities, a society with a low salt intake will be expected in the near future.

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

Access options

Buy this article

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. INTERSALT Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 h urinary sodium and potassium excretion. BMJ. 1988;297:319–28.

    Article  Google Scholar 

  2. Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S.Engell RE, Global Burden of Diseases Nutrition and Chronic Diseases Expert Group et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014;371:624–34.

  3. He FJ, Macgregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009;23:363–84.

    Article  CAS  PubMed  Google Scholar 

  4. Ikeda N, Saito E, Kondo N, Inoue M, Ikeda S, Satoh T, et al. What has made the population of Japan healthy? Lancet. 2011;378:1094–105.

    Article  PubMed  Google Scholar 

  5. Tomonari T, Fukuda M, Miura T, Mizuno M, Wakamatsu T, Ichikawa T, et al. Is salt intake an independent risk factor of stroke mortality? Demographic analysis by regions in Japan. J Am Soc Hypertens. 2011;5:456–62.

    Article  PubMed  Google Scholar 

  6. Shikata K, KiyoharaY, Kubo M, Yonemoto K, NinomiyaT, Shirota T, et al. A prospective study of dietary salt intake and gastric cancer incidence in a defined Japanese population: the Hisayama study. Int J Cancer. 2006;119:196–201.

    Article  CAS  PubMed  Google Scholar 

  7. Ma Y, He FJ, Sun Q, Yuan C, Kieneker LM, Curhan GC, et al. 24-hour sodium and potassium excretion and cardiovascular risk. N Eng J Med. 2021.

  8. Poorolajal J, Zeraati F, Soltanian AR, Sheikh V, Hooshmand E, Maleki A, et al. Oral potassium supplementation for management of essential hypertension: a meta-analysis of randomized controlled trials. PLoS One. 2017;12:e0174967.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Vinceti M, Filippini T, Crippa A, de Sesmaisons A, Wise LA, Orsini N. Meta-analysis of potassium intake and the risk of stroke. J Am Heart Assoc. 2016;5:e004210.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kogure M, Nakaya N, Hirata T, Tsuchiya N, Nakamura T, Narita A, et al. Sodium/potassium ratio change was associated with blood pressure change: possibility of population approach for sodium/potassium ratio reduction in health checkup. Hypertens Res. 2021;44:225–31.

    Article  CAS  PubMed  Google Scholar 

  11. Okayama A, Okuda N, Miura K, Okamura T, Hayakawa T, Akasaka H, et al. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study. BMJ Open. 2016;6:e011632.

    Article  PubMed  PubMed Central  Google Scholar 

  12. The Ministry of Health, Labour and Welfare. The National Health and Nutrition Survey in Japan, 2019. (in Japanese)

  13. Oniki H, Tsuchihashi T, Sakaki M, Arakawa K. Trends in salt intake in hypertensive patients and the effectiveness of guidance on salt reduction. J Blood Press. 2013;20:626–9. (in Japanese)

    Google Scholar 

  14. The Japanese Society of Hypertension. Guidelines for the Management of Hypertension 2019 (JSH2019). Tokyo, Japan: Life Science Publishing Co., Ltd.; 2019.

  15. Graudal N, Hubeck-Graudal T, Jurgens G, McCarron DA. The significance of duration and amount of sodium reduction intervention in normotensive and hypertensive individuals: a meta-analysis. Adv Nutr. 2015;6:169–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. He FJ, Li J, MacGregor GA. Effect of longer-term modest salt reductions on blood pressure. Cochrane Database Syst Rev. 2013;30:CD004937.

  17. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lennon SL, DellaValle DM, Rodder SG, Prest M, Sinley RC, Hoy MK, et al. 2015 evidence analysis library evidence-based nutrition practice guideline for the management of hypertension in adults. J Acad Nutr Diet. 2017;117:1445–58.

    Article  PubMed  Google Scholar 

  19. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Himmelfarb CD, et al. 2017 ACC/ AHA/ AAPA/ ABC/ ACPM/ AGS/ APhA/ ASH/ ASPC/ NMA/ PCNA guidelines 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. 2018;71:e13–e115.

    CAS  PubMed  Google Scholar 

  20. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. ESC Scientific Document Group. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  PubMed  Google Scholar 

  21. The Ministry of Health, Labour and Welfare. Tokyo, Japan; Dietary Reference Intakes for Japanese; 2020. (in Japanese)

  22. WHO. Guideline: Sodium intake for adults and children. Geneva, Switzerland: World Health Organization (WHO); 2012.

  23. National Institute of Health and Nutrition. Health Japan 21 (the second term) Analysis and Assessment Project.

  24. Tsuchihashi T, Ishimitsu T, Ando K, Kusaka M, Ichihara A, Miura K, et al. JSH Statement: Tokyo declaration promoting salt reduction by the Japanese Society of Hypertension—the JSH Tokyo declaration. Hypertens Res. 2020; 43:1133–4.

  25. Ohta Y, Tsuchihashi T, Ueno M, Kajioka T, Onaka U, Tominaga M, et al. Relationship between the awareness of salt restriction and the actual salt intake in hypertensive patients. Hypertens Res. 2004;27:243–6.

    Article  PubMed  Google Scholar 

  26. Tsuchihashi T, Kai H, Kusaka M, Kawamura M, Matsuura H, Miura K, et al. (3) Assessment and application of salt intake in the management of hypertension. The Salt Reduction Committee of the Japanese Society of Hypertension. Rep. Salt Reduct Comm Jpn Soc Hypertension. 2012;2012:39–50.

    Google Scholar 

  27. Tsuchihashi T, Masuda K, Oniki H, Sakaki M, Arakawa K, Kameda W, et al. Assessment of salt intake by using a simple check sheet in hypertensive patients. J Blood Press. 2013;20:1239–43. (in Japanese)

    Google Scholar 

  28. Kobayashi S, Murakami K, Sasaki S, Okubo H, Hirota N, Notsu A, et al. Comparison of relative validity of food group intakes estimated by comprehensive and brief-type self-administered diet history questionnaires against 16 d dietary records in Japanese adults. Public Health Nutr. 2011;14:1200–11.

    Article  PubMed  Google Scholar 

  29. Kobayashi S, Honda S, Murakami K, Sasaki S, Okubo H, Hirota N, et al. Both comprehensive and brief self-administered diet history questionnaires satisfactorily rank nutrient intakes in Japanese adults. J Epidemiol. 2012;22:151–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sakata S, Tsuchihashi T, Ohta Y, Tominaga M, Arakawa K, Sakaki M, et al. Relationship between salt intake as estimated by a brief self-administered diet-history questionnaire (BDHQ) and 24-h urinary salt excretion in hypertensive patients. Hypertens Res. 2015;38:560–3.

    Article  CAS  PubMed  Google Scholar 

  31. Yasutake K, Miyoshi E, Kajiyama T, Umeki Y, Misumi Y, Horita N, et al. Comparison of a salt check sheet with 24-h urinary salt excretion measurement in local residents. Hypertens Res. 2016;39:879–85.

    Article  CAS  PubMed  Google Scholar 

  32. Yamasue K, Tochikubo O, Kono E, Maeda H. Self-monitoring of home blood pressure with estimation of daily salt intake using a new electrical device. J Hum Hypertens. 2006;20:593–8.

    Article  CAS  PubMed  Google Scholar 

  33. Ohta Y, Tsuchihashi T, Miyata E, Onaka U. Usefulness of self-monitoring of urinary salt excretion in hypertensive patients. Clin Exp Hypertens. 2009;31:690–7.

    Article  CAS  PubMed  Google Scholar 

  34. Takada T, Imamoto M, Sasaki S, Azuma T, Miyashita J, Hayashi M, et al. Effects of self-monitoring of daily salt intake estimated by a simple electrical device for salt reduction: a cluster randomized trial. Hypertens Res. 2018;41:524–30.

    Article  CAS  PubMed  Google Scholar 

  35. Kawasaki T, Itoh K, Uezono K, Sasaki H. A simple method for estimating 24 h urinary sodium and potassium excretion from second morning voiding urine specimen in adults. Clin Exp Pharm Physiol. 1993;20:7–14.

    Article  CAS  Google Scholar 

  36. Tanaka T, Okamura T, Miura K, Kadowaki T, Ueshima H, Nakagawa H, et al. A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen. J Hum Hypertens. 2002;16:97–103.

    Article  CAS  PubMed  Google Scholar 

  37. Kario K, Nomura A, Harada N, Okura A, Nakagawa K, Tanigawa T, et al. Efficacy of a digital therapeutics system in the management of essential hypertension: the HERB-DH1 pivotal trial. Eur Heart J. 2021;42:4111–22.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Morinaga Y, Tsuchihashi T, Ohta Y, Matsumura K. Salt intake in 3-year-old Japanese children. Hypertens Res. 2011;34:836–9.

    Article  CAS  PubMed  Google Scholar 

  39. Yasutake K, Nagafuchi M, Izu R, Kajiyama T, Imai K, Murata Y, et al. Sodium and potassium urinary excretion levels of preschool children: Individual, daily, and seasonal differences. Clin Exp Hypertens. 2017;19:577–83.

    Article  CAS  Google Scholar 

  40. Ohta Y, Iwayama K, Suzuki H, Sakata S, Hayashi S, Iwashima Y, et al. Salt intake and eating habits of school-aged children. Hypertens Res. 2016;39:812–7.

    Article  CAS  PubMed  Google Scholar 

  41. Yasutake K, Nagafuchi M, Tanaka T, Fujii K, Tsuchihashi T, Ohe K, et al. Necessity of salt intake reduction education beginning in youth: a cross-sectional survey of sodium-to-potassium ratios in mothers and their preschool children. Hypertens Res. 2021;44:1307–15.

    Article  CAS  PubMed  Google Scholar 

  42. Takimoto H, Saito A, Htun NC, Abe K. Food items contributing to high dietary salt intake among Japanese adults in the 2012 National Health and Nutrition Survey. Hypertens Res. 2018;41:209–12.

    Article  PubMed  Google Scholar 

  43. Ohta Y, Tsuchihashi T, Onaka U, Miyata E. Long-term compliance of salt restriction and blood pressure control status in hypertensive outpatients. Clin Exp Hypertens. 2010;32:234–8.

    Article  CAS  PubMed  Google Scholar 

  44. The Japanese Society of Hypertension. Starting a Low Sodium Diet-Information from the Salt Reduction Committee to general public.

  45. 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.

    Article  CAS  PubMed  Google Scholar 

  46. The Ministry of Health, Labour and Welfare. Summary of the report of the committee meeting on the promotion of a healthy and sustainable food environment.

  47. Fang K, He Y, Fang Y, Lian Y. Dietary sodium intake and food sources among Chinese adults: data from the CNNHS 2010-2012. Nutrients. 2020;12:453.

    Article  CAS  PubMed Central  Google Scholar 

  48. Park HK, Lee Y, Kang BW, Kwon KI, Kim JW, Kwon OS, et al. Progress on sodium reduction in South Korea. BMJ Glob Health. 2020;5:e002028.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 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 Geriat Cardiol. 2019;16:182–241.

    Google Scholar 

  50. Lee HY, Shin J, Kim GH, Park S, Ihm SH, Kim HC, et al. 2018 Korean society of hypertension guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension. Clin Hypertens. 2019;25:20.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Takuya Tsuchihashi.

Ethics declarations

Conflict of interest

The author declares no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsuchihashi, T. Dietary salt intake in Japan - past, present, and future. Hypertens Res 45, 748–757 (2022).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


This article is cited by


Quick links