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Are the new guidelines on salt intake too extreme? A high salt intake has been linked to increased blood pressure and greater intxke for heart problems. But according to new research, low Sodium intake and stroke risk intake intak be just Gestational diabetes and gestational depression harmful. Published Carbohydrate metabolism and weight loss The Lancet stdoke, the study found that low salt, or sodium, intake may raise the risk of heart attackstrokeand death, compared with an average salt intake. Lead author Andrew Mente, of the Michael G. DeGroote School of Medicine at McMaster University in Canada, and colleagues say their results indicate only people with high blood pressure hypertension who have a high salt intake should reduce their salt consumption.Sodium intake and stroke risk -
There is a connection between high sodium intake and stroke risk. Sodium intake is mostly through sodium in our diet, in the form of table salt, which can be one of the contributing factors to stroke if taken in excess.
However, other processed foods like bread, sandwiches, hotdogs, and snacks may also contain a high sodium level. Keep reading to find out more about how high sodium intake is a risk factor for stroke and how it can be prevented. However, our primary focus is on sodium as a risk factor for stroke.
How exactly does sodium cause stroke? Some people constantly consume more than twice the recommended amount of sodium, putting them at risk of having high blood pressure, which consequently increases the chances of stroke. High blood pressure is when there is increased tension in the arteries, which transports blood from the heart to the rest of the body.
There are symptoms to look out for in high blood pressure, which are:. According to the World Health Organization , the recommended amount of salt to consume per day is 5 grams, about one teaspoon.
The kidney is meant to regulate the balance of sodium and water in the body to keep you healthy. When there is excess sodium in the body, for instance, after taking a high salt diet, the kidneys have to do more work to maintain a balance, consequently leading to reduced kidney function.
Therefore the body holds more water to dilute the excess sodium in your body instead of the normal removal of water from the body.
As sodium increases, the blood pressure increases, and then blood vessels become tightened and narrow, resulting in high blood pressure and consequently leading to stroke. Different complications can occur due to a stroke. These complications can either be temporal or permanent, depending on the part of the brain affected.
They include:. By now, you already know that reduced dietary salt intake will reduce the chances of high blood pressure and consequently minimize your chances of having a stroke.
You can avoid having a stroke by seeking and following professional medical advice and maintaining a healthy lifestyle and diet. If you have had a stroke before, these measures might help in preventing a recurrence. Meanwhile, the same preventive measures for heart disease are the ones for stroke.
The essential things you can do to reduce stroke risks are:. The treatment for heart disease is the same for stroke. There are medications used to treat stroke. Some of them include:. You might have had different misconceptions about salt like:.
Foods that contain plenty of salt are salty, but sometimes some other things may be mixed with the food, which will mask the salty taste even though the salt content of the food is high.
Therefore, always ensure you check food labels to know the sodium or salt quantity. Please reduce salt intake in your diet by maintaining a minimal dietary salt intake and a healthy lifestyle. There are ways you can minimize your salt intake. All the retrospective observational studies were excluded as various confounding factors could bias the results.
In addition, the effect estimates that were maximally adjusted for potential confounders, if the study provided several adjusted effect estimates, were selected. The comprehensive Newcastle—Ottawa Scale NOS has been partially validated for evaluating the quality of the observational studies in the meta-analysis, and hence, was used to evaluate the quality of the study method [ 20 ].
The NOS evaluated the quality of the observational studies based on selection 4 items , comparability 1 item , and outcome 3 items. The maximum score was 9, and the minimum score was 0 Additional file : Table S1. The data were extracted and quality assessed by 2 authors independently, and any inconsistencies were referred to the original studies by an additional author.
and the minimized intake of sodium and the risk of major cardiovascular outcomes were calculated using the random-effects model [ 21 , 22 ]. The mid-point for closed categories and median for open categories putatively determined each sodium intake category, presuming a normal distribution for sodium intake.
Subgroup analyses were conducted for cardiac death, total mortality, and stroke according to publication year, sample size, percentage male, assessment of exposure, following-up duration, and with or without adjusted body mass index BMI , smoking, alcohol, previous CVD, diabetes mellitus DM , physical activity PA , and level of potassium.
The P -value between subgroups was evaluated by chi-square test and meta-regression [ 27 ]. A sensitivity analysis was evaluated the impact of individual studies by removing individual study from the meta-analysis [ 28 ]. Funnel plot and Egger [ 29 ] and Begg [ 30 ] tests investigated the outcomes that were also used to evaluate any potential publication bias.
The statistical analyses were conducted using STATA software version The results of the study selection process were presented in Fig. A total of articles were identified in the initial electronic search.
Of these, were excluded as they were duplicates and irrelevant studies. Thus, a total of 47 potentially eligible studies were selected. After a detailed evaluation, 16 prospective cohort studies were selected for the final meta-analysis [ 14 , 16 , 18 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ].
A manual search of the reference lists of these studies did not yield any new eligible studies. The general characteristics of the included studies were presented in Table 1.
A total of 16 prospective cohort studies with , individuals were eligible for this study. The follow-up period of the participants ranged from 3. Seven studies used h urine collection [ 18 , 31 , 32 , 33 , 34 , 38 , 39 ], and the remaining 9 studies used food frequency questionnaires FFQ to assess the dietary sodium exposure [ 14 , 16 , 35 , 36 , 37 , 40 , 41 , 42 , 43 ].
The study quality was assessed using the NOS Table 1. A total of 7 studies reported an association between sodium intake and cardiac death. The summary RR showed that a mmol increment per day in sodium intake was not associated with cardiac death RR, 1. Sensitivity analysis indicated that the conclusion was unaffected after sequential exclusion of each study from the pooled analysis.
Furthermore, the low sodium intake was found to be associated with an increased risk of cardiac death RR: 1. Conversely, increased sodium intake was associated with the reduced risk of cardiac death if the study was not adjusted for BMI RR: 0.
a Association between sodium intake and cardiac death. b Association between sodium intake and total mortality. A total of 8 studies reported a correlation between sodium intake and total mortality.
However, the results did not reveal any significant association of mmol increments per day in sodium intake with the total mortality risk RR: 1. Furthermore, the low RR: 1. A total of 7 studies reported an association between sodium intake and stroke, and 3 studies reported the association of sodium intake and stroke mortality.
Pooled analysis of stroke and stroke mortality indicated that a mmol increment per day in sodium intake exerted a harmful effect stroke: RR, 1. However, the conclusion was not affected by excluding any specific study after sequential exclusion of each study from all the pooled analyses.
Furthermore, low RR: 1. In addition, low sodium intake did not affect the stroke mortality RR: 1. The subgroup analysis for stroke mortality was not conducted due to the small number of studies included in this investigation on the association of sodium intake and stroke mortality.
a Association between sodium intake and stroke. b Association between sodium intake and stroke mortality. The review of the funnel plots did not exclude the potential for publication bias for cardiac death, total mortality, stroke, and stroke mortality Fig.
Publication bias tests for cardiac death, total mortality, stroke, and stroke mortality. Each point represents an independent study of the indicated association. The current study included the prospective cohort studies and explored the possible correlations between sodium intake and the outcomes of cardiac death, total mortality, stroke, and stroke mortality.
This quantitative meta-analysis included a total of , individuals from 16 prospective cohort studies with a broad range of populations. However, a mmol per day increment in sodium intake significantly increased the risk of stroke and stroke mortality. Furthermore, parameters such as sample size, the proportion of males, assessment of exposure, follow-up duration, and several other adjusted factors were found to be associated with the correlation between sodium intake and major cardiovascular outcomes.
A previous meta-analysis suggested that high sodium intake was associated with a significantly increased risk of stroke and total cardiovascular diseases [ 44 ].
However, other 2 meta-analysis studies based on randomized controlled trials suggested that the reduced dietary salt did not affect the cardiovascular morbidity or mortality [ 45 , 46 ]. The inherent limitation of this study included shorter duration of follow-up period than that required to show a clinical benefit, especially when the rate of events was lower than expected, which without any statistically significant difference.
Furthermore, reduced dietary sodium intake seems to be associated with the degree of control achieved. Finally, the range of sodium intake and the cut-off values for the three categories differed among various studies.
Therefore, we conducted a dose-response meta-analysis of these prospective studies for evaluating the optimal dose of sodium intake. The current findings were in agreement with a recently published large cohort study conducted in Manhattan [ 40 ].
He et al. suggested that high sodium intake was strongly and independently associated with an increased risk of stroke mortality in overweight individuals, thereby significantly increasing the risk of total mortality [ 33 ].
Also, the current study indicated that increased sodium intake significantly elevated the risk of stroke and stroke mortality, while no effect on cardiac death and total mortality was demonstrated, which might be attributed to the increased blood pressure and hypertension due to high sodium levels by stiffening the endothelial cells, thickening and narrowing of resistance arteries, and blocking of nitric oxide synthesis [ 47 ].
The current study did not demonstrate a significant difference between mmol increments of sodium intake per day and the risk of cardiac death. However, inconsistent results were reported by individual studies. Furthermore, TunstallPedoe et al. This phenomenon might be attributed to the inclusion of other prospective studies encompassing general individuals; however, these 2 studies specifically included individuals with high risk of cardiovascular disease, rendering them susceptible to extreme sodium intake.
However, these conclusions might be unreliable due to the inclusion of small cohorts in each subset. Therefore, this study provided a relative result as well as a synthetic and comprehensive review. The three strengths of our study should be highlighted. Firstly, only prospective cohort studies were included, which eliminated the selection as well as recall bias and could be a concern for retrospective case-control studies.
Secondly, a large sample size allowed us to quantitatively assess the association of sodium intake with the risk of cardiovascular morbidity and mortality, which in turn, demonstrated that our findings are potentially more robust than any individual studies.
Thirdly, the pooled analysis included a wide range of sodium intake levels, which subsequently allowed an accurate assessment of the relation of sodium intake and major cardiovascular risk outcomes.
Nevertheless, the present study had some limitations as follows: 1 the adjusted models used in the included studies are different, and these factors might play a critical role in the development of CVDs; 2 the minimal intake of sodium in individual study varied, which might introduce uncontrolled biases and potential heterogeneity; 3 heterogeneity across included studies was high, and hence, the results of publication bias test were not reliable; 4 high heterogeneity was not investigated by subgroup analysis due to the minimal intake of sodium and cutoff value, and the adjusted factors were not consistent among included studies; 5 the meta-analysis used pooled data due to the unavailability of individual data, which restricted a detailed and relevant analysis in order to obtain comprehensive results.
In conclusion, the results of this study suggested that increased sodium intake might play a major role in the risk of stroke morbidity and mortality. However, the increased sodium intake did not have a significant effect on cardiac death and total mortality. Nevertheless, future studies focusing on specific populations for analyzing the secondary prevention of major cardiovascular outcomes are warranted.
Collaborators GMaCoD. Global, regional, and national age-sex specific all-cause and cause-specific mortality for causes of death, a systematic analysis for the global burden of disease study Article Google Scholar.
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BMC Med. Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, et al. Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies.
Li B, Zhang G, Tan M, Zhao L, Jin L, Tang X, et al. Consumption of whole grains in relation to mortality from all causes, cardiovascular disease, and diabetes: dose-response meta-analysis of prospective cohort studies. Medicine Baltimore.
Article CAS Google Scholar. Kim Y, Je Y. Dietary fibre intake and mortality from cardiovascular disease and all cancers: a meta-analysis of prospective cohort studies. Arch Cardiovasc Dis. Larsson SC, Crippa A, Orsini N, Wolk A, Michaelsson K.
Milk consumption and mortality from all causes, cardiovascular disease, and Cancer: a systematic review and meta-analysis. de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al.
Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. Group ICR. Intersalt: an international study of electrolyte excretion and blood pressure.
Results for 24 hour urinary sodium and potassium excretion. Intersalt cooperative research group. Iso H, Stampfer MJ, Manson JE, Rexrode K, Hennekens CH, Colditz GA, et al. Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH Jr, Kostis JB, et al.
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TONE collaborative research group. Group ToHPCR. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The trials of hypertension prevention, phase II. The trials of hypertension prevention collaborative research group.
He added that the role of civil society is equally important in advocating for healthy public policies and monitoring compliance with established regulations. This year's World Health Day 7 April was dedicated to hypertension. WHO issued a call to intensify efforts to prevent and control high blood pressure, which is the main risk factor for cardiovascular deaths and is estimated to affect more than 1 in 3 adults worldwide, or some 1 billion people.
Many people could improve their eating habits by selecting products with lower sodium levels. Reading and understanding food labels can help consumers evaluate nutritional content as well as the amount of salt in foods. Foods in the Americas that typically contain more salt include bread and other bakery goods, soup cubes, processed meats, sausages, cheese, prepared and canned foods, soups, snacks such as French fries , and sauces.
Copied to clipboard. Salt is the leading risk factor for hypertension, which affects nearly one in three people in the Americas Washington, D.
There's Gestational diabetes and gestational depression rism for salt sttroke a healthy eating plan, Athlete meal prep most of us consume two or even three times the recommended amount, often without Gestational diabetes and gestational depression realizing it. We riks, however, need small amounts of salt for healthy Sports nutrition snacks, such as maintaining a riek fluid balance in the body. About one-third of people are sensitive to the sodium component of salt. This means that eating foods with too much salt can increase the amount of blood in the arteries, raising blood pressure and increasing the risk of heart disease and stroke. If you can lower your intake little by little each day, you can reduce blood pressure. Because our diets are generally so high in salt, everybody — even those with normal blood pressure — can benefit from reducing salt intake. Sodium intake and stroke risk -
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Goldstein P, Leshem M. Dietary sodium, added salt, and serum sodium associations with growth and depression in the U. general population. Download references. This study was supported by Hypertension Disease Tai Ge Special Scientific Research Project of Sichuan Medical Association TG34 ; Guizhou Health Committee gzwjkj— ; Science and Technology Department of Guizhou Province QKHJC [] 1Y The funding body played no role in this study.
Department of Neurology, Sichuan Mianyang Hospital, Mianyang, , Sichuan, China. Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, , Sichuan, China.
Department of Operations Management Division, Sichuan Mianyang Hospital, Mianyang, , Sichuan, China. School of Pharmacy, and Engineering Research Center for the Development and Application of Ethnic Medicine and TCM Ministry of Education , Guizhou Medical University, Guiyang, Guizhou, , China. You can also search for this author in PubMed Google Scholar.
ZQL and YLZ designed the study. ZQL wrote the manuscript. LH, XXR, JL and XJX collected, analyzed and interpreted the data. YLZ critically reviewed, edited and approved the manuscript. All authors read and approved the final manuscript. Correspondence to Yonglong Zhao. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background To assess the associations between no table salt and hypertension or stroke. Methods The data of 15, subjects were collected from National Health and Nutrition Examination Survey NHANES database.
Results After adjusting age and gender, other salt intake was associated with 1. Conclusion Other salt intake or no table salt were associated with a higher risk of hypertension or hypertension and stroke.
Background Hypertension is reported to be a major cause of premature deaths and a heavy burden of cardiovascular morbidity and mortality, which resulted in approximately 7. Methods Study population The NHANES database included a multifaceted health examination on a nationally representative sample of the civilian, non-institutionalized population in the United States based on complex multistage stratified probability sampling methods [ 16 ].
Screen process of participants in this study. Full size image. Results The characteristics of participants In total, 22, subjects from NHANES between and were involved in this study.
Table 1 The baseline data of all participants in the study Full size table. Table 2 Comparisons of characteristics among different groups Full size table. Discussion In the present study, the data of 15, participants were collected from the NHANES database to analyze the associations of salt types added at table with hypertension and stroke.
Conclusions This study analyzed the associations of different salt types and no table salt with hypertension and stroke based on the data of 15, subjects NHANES database. References Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al.
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Article CAS Google Scholar Ilatovskaya DV, Levchenko V, Pavlov TS, Isaeva E, Klemens CA, Johnson J, et al. Article Google Scholar Goldstein P, Leshem M. Article Google Scholar Download references. Acknowledgements None. Funding This study was supported by Hypertension Disease Tai Ge Special Scientific Research Project of Sichuan Medical Association TG34 ; Guizhou Health Committee gzwjkj— ; Science and Technology Department of Guizhou Province QKHJC [] 1Y View author publications.
Ethics declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Supplementary Information.
Additional file 1: Supplementary Figure 1. The detailed process of data analysis in this study. Additional file 2: Supplementary Figure 2. Firstly, only prospective cohort studies were included, which eliminated the selection as well as recall bias and could be a concern for retrospective case-control studies.
Secondly, a large sample size allowed us to quantitatively assess the association of sodium intake with the risk of cardiovascular morbidity and mortality, which in turn, demonstrated that our findings are potentially more robust than any individual studies.
Thirdly, the pooled analysis included a wide range of sodium intake levels, which subsequently allowed an accurate assessment of the relation of sodium intake and major cardiovascular risk outcomes.
Nevertheless, the present study had some limitations as follows: 1 the adjusted models used in the included studies are different, and these factors might play a critical role in the development of CVDs; 2 the minimal intake of sodium in individual study varied, which might introduce uncontrolled biases and potential heterogeneity; 3 heterogeneity across included studies was high, and hence, the results of publication bias test were not reliable; 4 high heterogeneity was not investigated by subgroup analysis due to the minimal intake of sodium and cutoff value, and the adjusted factors were not consistent among included studies; 5 the meta-analysis used pooled data due to the unavailability of individual data, which restricted a detailed and relevant analysis in order to obtain comprehensive results.
In conclusion, the results of this study suggested that increased sodium intake might play a major role in the risk of stroke morbidity and mortality.
However, the increased sodium intake did not have a significant effect on cardiac death and total mortality. Nevertheless, future studies focusing on specific populations for analyzing the secondary prevention of major cardiovascular outcomes are warranted. Collaborators GMaCoD.
Global, regional, and national age-sex specific all-cause and cause-specific mortality for causes of death, a systematic analysis for the global burden of disease study Article Google Scholar. Wu L, Sun D. Consumption of yogurt and the incident risk of cardiovascular disease: a meta-analysis of nine cohort studies.
Google Scholar. Fang X, Wang K, Han D, He X, Wei J, Zhao L, et al. Dietary magnesium intake and the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies.
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This study was supported by the Beijing Natural Science Foundation No. Pediatric Heart Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, , China.
The Heart Center, Beijing Friendship Hospital, Capital Medical University, Beijing, , China. National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, , China.
You can also search for this author in PubMed Google Scholar. YBZ1 YZ and JZ conducted the studies, participated in data collection, and drafted the manuscript. ZQL and YL performed the statistical analysis and participated in the experimental design.
XF, YPZ, and YBZ2 YZ helped in drafting the manuscript. All authors read and approved the final manuscript. Correspondence to Zhiqiang Li or Yanbo Zhang. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.
Reprints and permissions. Zhu, Y. et al. Association of sodium intake and major cardiovascular outcomes: a dose-response meta-analysis of prospective cohort studies.
BMC Cardiovasc Disord 18 , Download citation. Received : 07 March Accepted : 27 September Published : 19 October Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.
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We riso random urine samples Gestational diabetes and gestational depression 9, cases of acute first stroke Body composition measuring instrument 9, matched controls from 27 countries and estimated the hour sodium and potassium excretion, a surrogate for intake, using the Strooe formula. Using multivariable conditional logistic regression, adn determined the Sodium intake and stroke risk of Intakee hour urinary sodium and potassium excretion with stroke and its subtypes. Compared with an estimated urinary sodium excretion of 2. The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for ICH than ischemic stroke. Our data suggest that moderate sodium intake—rather than low sodium intake—combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target. Hypertension is the key modifiable risk factor for stroke and increasing sodium intake is positively associated with blood pressure.
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