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Dietary Sodium 'Controversy'—Issues and Potential Solutions

Abstract

Purpose of Review

High dietary sodium is estimated to be the leading dietary risk for death attributed to 1.8 million deaths in 2019. There are uniform recommendations to reduce sodium consumption based on evidence that increased dietary sodium is responsible for approximately a third of the prevalence of hypertension, and meta-analyses of randomized controlled trials show that sodium reduction lowers blood pressure, cardiovascular disease, and total mortality. Nevertheless, there is a perception that the beneficial effect of reducing dietary sodium is controversial. We provide experiential evidence relating to some sources of the controversy and propose potential solutions.

Recent Findings

Inappropriate research methodology, lack of rigor in research, conflicts of interest and commercial bias, questions of professional conduct, and lack of policies to protect public interests are likely to contribute to the controversy about reducing dietary sodium.

Summary

There is a failure to protect policies to reduce dietary sodium from nonscientific threats. Significant efforts need to be made to ensure the integrity of nutritional research and maintain public trust.

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References

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Correspondence to N. R. C. Campbell.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest

NRCC reports personal fees from Resolve to Save Lives and the World Bank (RTSL), outside the submitted work; and is an unpaid member of World Action on Salt, Sugar and Health and an unpaid consultant on dietary sodium and hypertension control to numerous governmental and non-governmental organizations. NRCC chairs the International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) which is an unpaid voluntary position. FJH is an unpaid member of Action on Salt, and World Action on Salt, Sugar and Health (WASSH). FH is partially funded by the National Institute for Health Research (NIHR) and the Medical Research Council (MRC). FPC has the following unpaid activities; immediate-Past President and Trustee of the British and Irish Hypertension Society (2017-19), member of Action on Salt, Sugar and Health, member of the TRUE Consortium, and Advisor to the World Health Organization. FPC reports speaker fees from Omron Healthcare and book royalties from Oxford University Press, both unrelated to the present topic. GAM is the unpaid Chair of Action on Salt, Sugar and Health, World Action on Salt, Sugar and Health (WASSH) and Blood Pressure UK. GAM is partially funded by the National Institute for Health Research (NIHR) and the Medical Research Council (MRC).

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Campbell, N.R.C., He, F.J., Cappuccio, F.P. et al. Dietary Sodium 'Controversy'—Issues and Potential Solutions. Curr Nutr Rep 10, 188–199 (2021). https://doi.org/10.1007/s13668-021-00357-1

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Keywords

  • Public health policy
  • Conflicts of interest
  • Ethics
  • Dietary sodium
  • Dietary salt
  • Nutrition