Journal
NEPHROLOGY DIALYSIS TRANSPLANTATION
Volume 31, Issue 9, Pages 1398-1403Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfw280
Keywords
blood pressure; cardiovascular; clinical trial; epidemiology; meta-analysis
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Scientific evidence to support the recommended salt intake of < 5.8 g/day is virtually non-existingent. There are no randomized controlled trials (RCTs) to investigate the effect of salt reduction (SR) below 5.8 g on health outcomes. The effect of SR on blood pressure (BP) reaches maximal efficacy at 1 week. RCTs in healthy individuals lasting at least 1 week show that the effect of SR on BP is < 1 mmHg, but that SR has significant side effects, including increases in renin, aldosterone, noradrenalin, adrenalin, cholesterol and triglyceride. Still, disregarding confounders and side effects, health authorities use BP effects obtained in studies of pre-hypertensive and hypertensive patients to recommend SR in the healthy population and use these biased BP effects in statistical models indirectly to project millions of saved lives. These fantasy projections are in contrast to real data from prospective observational population studies directly associating salt intake with mortality, which show that salt intake < 5.8 g/day is associated with an increased mortality of 15%. The population studies also show that a very high salt intake > 12.2 g is associated with increased mortality. However, since < 5% of populations consume such high amounts of salt, SR at the population level should not be a public health priority. Consequently, this policy should be abolished, not because any attempt to implement it has failed, and not because it costs taxpayers and food consumers unnecessary billions of dollars, but because-if implemented-it might kill people instead of saving them.
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