Journal of General Internal Medicine

, Volume 23, Issue 9, pp 1297–1302 | Cite as

Sodium Intake and Mortality Follow-Up in the Third National Health and Nutrition Examination Survey (NHANES III)

  • Hillel W. Cohen
  • Susan M. Hailpern
  • Michael H. Alderman
Original Article

Abstract

Background

Sodium restriction is commonly recommended as a measure to lower blood pressure and thus reduce cardiovascular disease (CVD) and all-cause mortality. However, some studies have observed higher mortality associated with lower sodium intake.

Objective

To test the hypothesis that lower sodium is associated with subsequent higher cardiovascular disease (CVD) and all cause mortality in the Third National Health and Nutrition Examination Survey (NHANES III).

Design

Observational cohort study of mortality subsequent to a baseline survey.

Participants

Representative sample (n = 8,699) of non-institutionalized US adults age ≥30, without history of CVD events, recruited between 1988–1994.

Measurements and main results

Dietary sodium and calorie intakes estimated from a single baseline 24-h dietary recall. Vital status and cause of death were obtained from the National Death Index through the year 2000. Hazard ratio (HR) for CVD mortality of lowest to highest quartile of sodium, adjusted for calories and other CVD risk factors, in a Cox model, was 1.80 (95% CI 1.05, 3.08, p = 0.03). Non-significant trends of an inverse association of continuous sodium (per 1,000 mg) intake with CVD and all-cause mortality were observed with a 99% CI of 0.73, 1.06 (p = 0.07) and 0.86, 1.04 (p = 0.11), respectively, while trends for a direct association were not observed.

Conclusion

Observed associations of lower sodium with higher mortality were modest and mostly not statistically significant. However, these findings also suggest that for the general US adult population, higher sodium is unlikely to be independently associated with higher CVD or all-cause mortality.

KEY WORDS

sodium intake mortality cardiovascular disease Third National Health and Nutrition Examination Survey (NHANES III) 

References

  1. 1.
    U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. Available at: http://www.health.gov/dietaryguidelines/dga2005/. Last accessed February 16, 2007.
  2. 2.
    Joint National Committee for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee for the prevention, detection, evaluation, and treatment of high blood pressure (JNC VII). JAMA. 2003;289:2560–72.CrossRefGoogle Scholar
  3. 3.
    Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, Franklin BA, Goldstein LB, Greenland P, Grundy SM, Hong Y, Miller NH, Lauer RM, Ockene IS, Sacco RL, Sallis JF Jr, Smith SC Jr, Stone NJ, Taubert KA. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation. 2002;106(33):88–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Hooper L, Bartlett C, Davey Smith G, Ebrahim S. Advice to reduce dietary salt for prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003656. DOI 10.1002/14651858.CD003656.pub2.
  5. 5.
    Tunstall-Pedoe H, Woodward M, Tavendale R, A’Brook R, McCluskey MK. Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish heart health study: cohort study. BMJ. 1997;315:722–9.PubMedGoogle Scholar
  6. 6.
    He J, Ogden LG, Vupputuri S, Bassano LA, Loria C, Whelton PK. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA. 1999;282:2027–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Tuomilehto J, Jousilahti P, Rastenyte D, et al. Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet. 2001;347:848–51.CrossRefGoogle Scholar
  8. 8.
    Nagata C, Takatsuka N, Shimizu N, Shimizu H. Sodium intake and risk of death from stroke in Japanese men and women. Stroke. 2004;15:1543–7.CrossRefGoogle Scholar
  9. 9.
    Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK, Appel LJ, Whelton PK. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of trials of hypertension prevention (TOHP). BMJ 2007 DOI 10.1136/bmj.39147.604896.55.
  10. 10.
    Kagen A, Popper JS, Rhoads GG, Yano K. Dietary and other risk factors for stroke in Hawaiian Japanese men. Stroke. 1985;16:390–6.Google Scholar
  11. 11.
    Cohen JD, Grandis G, Cutler JA, Neaton JD, Juller LH, Stamler J. Dietary sodium intake and mortality: MRFIT Follow-up Study Results (abstract). Circulation. 1999;100(suppl 1):1–524.Google Scholar
  12. 12.
    Alderman MH, Madhavan S, Cohen H, Sealey JE, Laragh JH. Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men. Hypertension. 1995;25:1144–52.PubMedGoogle Scholar
  13. 13.
    Alderman MH, Cohen H, Madhavan S. Dietary sodium intake and mortality: the National Health and Nutrition Survey (NHANES I)>. Lancet. 1998;351:781–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Cohen HW, Hailpern SM, Fang J, Alderman MH. Sodium intake and mortality in the NHANES II Follow-up Study. Am J Med. 2006;119:274e7–5e14.Google Scholar
  15. 15.
    Cohen HW, Alderman MH. Sodium, blood pressure, and cardiovascular disease. Curr Opin Cardiol. 2007;22:306–10.PubMedCrossRefGoogle Scholar
  16. 16.
    National Center for Health Statistics, Plan and Operation of the Third National Health and Nutrition Examination Survey 1988–94, Hyaftsville, MD, July 1994 DHHS Publication No, (PHS) 94-1308. Available at http://www.cdc.gov/nchs/data/series/sr_01/sr01_032.pdf Last accessed April 16, 2008.
  17. 17.
    National Death Index, Division of Vital Statistics, National Center for Health Statistics. What is the NDI? Hyattsville, MD, 1999. Available at http://www.cdc.gov/nchs/r&d/ndi/what_is_ndi.htm Last accessed April 16, 2008.
  18. 18.
    National Center for Health Statistics. Research Data Center Website, Hyattsville, MD, 2007. Available at http://www.cdc.gov/nchs/r&d/rdc.htm. Last accessed April 16, 2008.
  19. 19.
    National Center for Health Statistics. International Classification of Diseases, Ninth Revision (ICD-9). Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/ NCHS/Publications/ICD-9. Last accessed April 16, 2008.Google Scholar
  20. 20.
    World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision. WHO, 2007. Available at: http://www.who.int/classifications/apps/icd/icd10online/. Last accessed April 16, 2008.
  21. 21.
    Willett W, Stampfer MF. Total energy intake: implications for epidemiologic analyses. Am J Epidemiology. 1986;124:17–27.Google Scholar
  22. 22.
    Willett W. Nutritional Epidemiology. 2nd ed. Oxford, England: Oxford University Press; 1998.Google Scholar
  23. 23.
    Alderman MH. Presidential address: 21st Scientific Meeting of the International Society of Hypertension: dietary sodium and cardiovascular disease: the ‘J’-shaped relation. J Hypertens. 2007;25(5):903–7.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Hillel W. Cohen
    • 1
  • Susan M. Hailpern
    • 1
  • Michael H. Alderman
    • 1
  1. 1.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA

Personalised recommendations