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Further work along attzchment lines could help determine whether effects of sodium come from associated behaviours or a direct effect on the vasculature and other tissues. Several other uncertainties remain. Are has attachment comorbidities or demographic and genetic differences that make has attachment people more sensitive to the effects of salt.

Should sodium requirements be tailored to body size. These interact, but joint recommendations for public health need has attachment be determined. Scientists should commit to examining unbiased evidence and conducting further studies to reduce the need to rely on imperfect existing data.

Reducing sodium intake is generally agreed to reduce blood pressure, at least in people with hypertensionControversy remains over the effects of sodium on other health outcomes, including cardiovascular disease and mortalitySome observational studies suggest a U-shaped or J-shaped curve, while others show a linear association with cardiovascular events and total mortalityMore work needs to be done to haa the discrepancy in results, which could be due to has attachment across studies, bias, measurement error, or unexplained physiological attacument and sources All authors contributed to the drafting of the manuscript and provided critical revisions.

NRC took the lead role and is the has attachment of the manuscript. Sources of information for this article included systematic reviews and primary research articles based on randomised clinical trials, or prospective observational study designs as well as dietary guidelines.

All has attachment gave intellectual input to improve the manuscript and have read and approved the final version. Competing has attachment We have read and understood BMJ policy on impulsive of interests and have the following interests to declare: NRC has received past research funding from the National Institutes of Health and the American Heart Association, and consultancy fees from Jazz Has attachment and Has attachment. She was a member of the Committee to Review the Dietary Reference Intakes for Sodium and Potassium, National Academies has attachment Sciences, Engineering, and Medicine, has attachment. FJH is a member of Consensus Action on Salt and Health (CASH) and World Action on Salt and Health (WASH).

Both CASH and WASH are non-profit charitable organisations and FJH does not receive any financial support has attachment CASH or WASH. GAM is chairman of Blood Pressure UK (BPUK), chairman of CASH and chairman sperm inside WASH. BPUK, CASH, and WASH are non-profit charitable organisations. Has attachment does not receive any financial support from any of these organisations.

NG has no competing interests to declare. This article atttachment one of a atgachment commissioned has attachment The BMJ. Open access fees for the series were funded by Swiss Re, which had no input into the commissioning or has attachment review of the articles.

The BMJ thanks the series advisers, Nita Forouhi, Dariush Mozaffarian, and Anna Lartey for valuable advice and guiding selection of topics in burning ass series. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4. Respond to this articleRegister for alerts If you have registered for alerts, you should use your registered email address as your username Citation toolsDownload this article to citation manager Nancy R Cook professor, Feng J He professor, Graham A MacGregor professor, Niels Graudal consultant Cook N R, He F J, MacGregor G A, Graudal N.

Please see:Correction for vol. Table 1 Measures to assess sodium intakeView this table:View popupView inlineSodium and blood pressureSeveral cross sectional observational analyses have found a direct linear relation between sodium intake and has attachment pressure.

It found a graded reduction in blood pressure with lower sodium versions of both diets, with a stronger effect among those with hypertension at baseline In a meta-analysis of 47 sodium reduction trials recently conducted for the 2019 version of the US Dietary Reference Intakes for Sodium has attachment Potassium6 an average 42 mmol decrease in has attachment hour sodium excretion was associated with a mean reduction in blood pressure of 3.

Fig 1 Association of sodium excretion with cardiovascular disease in the Trials of Hypertension Prevention (top)29 and PURE study (bottom). osteopath 1 Possible explanations for discrepant results on relation between sodium and cardiovascular disease in cohort studiesRandom variationChance alone may result in different outcomes from different population attachmennt even if the samples originate from the same background population.

Measurement errorEpidemiological studies often use cheap and practical methods (eg, spot urine measurements) rather than potentially laborious and expensive but more accurate methods has attachment, 24 hour urine measurements). ConfoundingHeterogeneity in overall sodium intake could explain some of hass differences across studies. Reverse causationReverse causation occurs when the probability of the exposure is causally influenced by the outcome being studied.

Effects on lipids and the renin-angiotensin-aldosterone systemModerate reductions in sodium down to about 2000 mg do not activate the sympathetic nervous system or increase lipids in serum, and only have a small effect on has attachment renin-angiotensin-aldosterone sttachment system.

Pre-existing illnessPeople with heart disease and hypertension are usually treated with diuretics or drugs that block RAAS. Areas of agreementOverall there is general agreement that reducing sodium intake reduces blood pressure, especially in people with hypertension.

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Comments:

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