National Academies Report Reduces Daily Sodium Limits

Megan Brooks

March 06, 2019

The National Academies of Sciences, Engineering, and Medicine (NAS) has released updated recommendations on sodium intake and for the first time ties lower daily sodium limits to a reduction in risk for chronic disease.

Notably, the report says that adults can lower their risk for hypertension and cardiovascular disease by limiting sodium intake to 2300 mg daily (the same upper limit as in 2005) and can further reduce risk by targeting an intake of 1500 mg daily — the chronic disease risk reduction (CDRR) target.

"There is sufficient evidence to characterize the relationship between sodium intake and risk of chronic disease," the report states. The committee established a CDRR intake for sodium using evidence of the beneficial effect of reducing sodium intake on risk for hypertension and cardiovascular disease.

"Reductions in intakes that exceed the sodium CDRR are expected to reduce chronic disease risk within the apparently healthy population," the report says.

The report notes that the effect of cutting back on sodium is greater for adults with hypertension than for normotensive adults, but the benefits of reducing sodium intake toward the CDRR target holds for both groups.

In a written statement, Nancy Brown, chief executive officer of the American Heart Association (AHA), said the new sodium recommendations align with what the AHA and other prominent public health organizations have been saying for years — "we must eat less salt." The AHA also recommends limiting sodium intake to 2300 mg daily, but also says that for most adults, the ideal limit is no more than 1500 mg.

For infants up to 6 months of age, the updated sodium intake level is 110 mg daily; for children up to 13 years of age, it is 110 mg daily.

The report also updates adequate intake levels for potassium, which range from 2300 to 3400 mg daily, depending on sex, pregnancy status, and stage of life. It is now 2600 mg daily for most women and 3400 mg daily for most men. These adequate intake levels for potassium are lower than those established in 2005, the report notes.

"This report reaffirms that there is insufficient evidence to establish a potassium UL [upper limit] for apparently healthy individuals. The absence of a potassium UL does not mean that there is no risk from excessive supplemental potassium intake, either overall or for segments of the population. Caution against high intake through supplemental potassium is warranted for certain population groups, particularly those with or at high risk for compromised kidney function," the report says.

Despite moderately strong evidence that potassium supplementation reduces blood pressure, particularly among adults with hypertension, a potassium CDRR target cannot be established, owing to "unexplained inconsistencies in the body of evidence, a lack of intake-response relationship, and limited evidence for relationships between potassium intake and chronic disease risk," the report states.

The report says research on the interrelationship between potassium and sodium intake is needed. Because most US and Canadian populations consume sodium at levels above the CDRR targets, "opportunities exist to find solutions to reduce population sodium intakes," it states.

Love Affair With Salt

Brown noted that the average US adult eats about 50% more sodium every day than is recommended. "Now is the time to break up our nation's love affair with salt to improve public health," she said.

"The new dietary reference intake for sodium and the additional category focused specifically on chronic disease prevention will give people a better picture of how much — or how little — sodium they should consume for ideal health. It also reinforces the need to lower the amount of sodium in the food supply," said Brown.

"Our excessive sodium intake isn't entirely driven by the salt shaker; it's largely controlled by the food industry," said Brown. She noted that more than 70% of the sodium that is consumed is added in restaurants and during the manufacturing of processed and prepackaged foods.

"We hope this report encourages the Food and Drug Administration to quickly release its voluntary sodium reduction targets for the food industry," said Brown.

Bonnie Liebman, MS, nutrition director at the Center for Science in the Public Interest, also welcomed the new report, saying it should "put an end to efforts by some food industry groups to spread misinformation and delay vital policy solutions.

"The new report also makes clear that the Trump administration's recent decision to roll back sodium limits in school meals will harm the nation's children," Liebman said in a statement.

"Today's report reinforces and strengthens what we already know to be true. High sodium intake is dangerous for our health, and consumption should be limited to no more than 2300 mg a day for adults and lower for many children. Efforts by industry and Congress to attack the science and delay progress on cutting sodium must come to an end," she said.

The report was sponsored by Health Canada, the US National Institutes of Health, the Public Health Agency of Canada, the Centers for Disease Control and Prevention, the US Department of Agriculture, and the US Food and Drug Administration.

NAS. Dietary Reference Intakes for Sodium and Potassium. Published online March 5, 2019. Abstract

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