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The impact of excessive salt intake on human health

Nature Reviews Nephrology volume 18, pages 321–335 (2022)Cite this article

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Abstract

Intake of salt is a biological imperative, inextricably woven into physiological systems, human societies and global culture. However, excessive salt intake is associated with high blood pressure. As this effect likely drives cardiovascular morbidity and mortality, excessive salt intake is estimated to cause ~5 million deaths per annum worldwide. Animal research has identified various mechanisms by which high salt intake drives disease in the kidney, brain, vasculature and immune system. The potential for therapeutic interventions in many of these pathways has yet to be tested. Salt-reduction interventions lower blood pressure, but for most individuals, ‘hidden’ salt in processed foods disconnects salt intake from discretionary control. This problem is compounded by growing inequalities in food systems, which form another hurdle to sustaining individual dietary control of salt intake. The most effective salt-reduction interventions have been implemented at the population level and comprise multi-component approaches, involving government, education and the food industry.

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Fig. 1: The pathway from salt intake to clinical outcomes.
Fig. 2: Salt consumption and the effects of interventions on blood pressure and cardiovascular risk.
Fig. 3: Guyton & Hall’s approach to studying salt sensitivity.
Fig. 4: Potential mechanisms of salt-sensitive hypertension.

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Acknowledgements

The authors have received research funding from The British Heart Foundation (PG/16/98/32568), The Chief Scientist’s Office (SCAF/19/02), Diabetes UK (17/0005685), Kidney Research UK (RP02/2019; IN001/2017), the Medical Research Council (MR/S01053X) and The Wellcome Trust (209562/Z/17/Z).

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  1. Centre for Cardiovascular Science, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK

    Robert W. Hunter, Neeraj Dhaun & Matthew A. Bailey

  2. Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh Bioquarter, Edinburgh, UK

    Robert W. Hunter & Neeraj Dhaun

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  1. Robert W. Hunter
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  2. Neeraj Dhaun
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  3. Matthew A. Bailey
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All authors contributed to researching the data, discussing the content, writing the text and reviewing or editing the manuscript before submission.

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Correspondence to Matthew A. Bailey.

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Nature Reviews Nephrology thanks Norman Campbell and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Hunter, R.W., Dhaun, N. & Bailey, M.A. The impact of excessive salt intake on human health. Nat Rev Nephrol 18, 321–335 (2022). https://doi.org/10.1038/s41581-021-00533-0

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