JoAnne Arcand

Announcing "Up to Date in the Science of Sodium"

From the Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; George Institute for Global Health India, Hyderabad, India; The George Institute for Global Health, University of Sydney and the Royal Prince Alfred Hospital, Sydney, NSW, Australia; Departments of Preventive & Social Medicine/Human Nutrition, University of Otago, Dunedin, New Zealand; Arbor Research Collaborative for Health, Ann Arbor, MI; Department of Medicine, University of Calgary, Calgary, AB, Canada; and Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O’Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary,Calgary, AB, Canada

The Science of Salt: A Systematic Review of Quality Clinical Salt Outcome Studies June 2014 to May 2015

Studies identified from an updated systematic review (from June 2014 to May 2015) on the impact of dietary salt intake on clinical and population health are reviewed. Randomized controlled trials, cohort studies, and meta‐analyses of these study types on the effect of sodium intake on blood pressure, or any substantive adverse health outcomes were identified from MEDLINE searches and quality indicators were used to select studies that were relevant to clinical and public health. From 6920 studies identified in the literature search, 144 studies were selected for review, of which only three (n=233,680) met inclusion criteria. Between them, the three studies demonstrated a harmful association between excess dietary salt and all‐cause mortality, noncardiovascular and cardiovascular disease mortality, and headache. None of the included studies found harm from lowering dietary salt. The findings of this systematic review are consistent with the large body of research supportive of efforts to reduce population salt intake and congruent with our last annual review from June 2013 to May 2014.

The Science of Salt: A Regularly Updated Systematic Review of the Implementation of Salt Reduction Interventions (June–October 2015)

From the George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Departments of Preventive & Social Medicine/Human Nutrition, University of Otago, Dunedin, New Zealand; Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; The George Institute for Global Health India, Hyderabad, India; Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O’Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Arbor Research Collaborative for Health, Ann Arbor, MI; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; and The Royal Prince Alfred Hospital, Sydney, NSW, Australia

The science of salt: A regularly updated systematic review of salt and health outcomes (December 2015-March 2016).

The purpose of this review was to identify, summarize, and critically appraise studies on dietary salt relating to health outcomes that were published from December 2015 to March 2016. The search strategy was adapted from a previous systematic review on dietary salt and health. Overall, 13 studies were included in the review: one study assessed cardiovascular events, nine studies assessed prevalence or incidence of blood pressure or hypertension, one study assessed kidney disease, and two studies assessed other health outcomes (obesity and nonalcoholic fatty liver disease). Four studies were selected for detailed appraisal and commentary. One study met the minimum methodologic criteria and found an increased risk associated with lower sodium intake in patients with heart failure. All other studies identified in this review demonstrated positive associations between dietary salt and adverse health outcomes.

Understanding the science that supports population-wide salt reduction programs.

Independent systematic reviews of the totality of the evidence by governments and international agencies throughout the world uniformly conclude that population-wide interventions to reduce salt are beneficial for health. However, some scientists continue to produce and cite studies with paradoxical findings that conflict with the evidence base used to develop national and World Health Organization (WHO) guidelines on salt reduction.[1-5] While conflicting studies are not uncommon in any area of research,[6] in the case of salt, such studies attract widespread attention in the media; misinform program leaders, clinicians, and the general public; and impede program implementation. Such impediments to progress have occurred despite the fact that the designs and methods of studies with paradoxical findings have been criticized by international experts who highlight the fact that the results are not valid.[7-9]

The Science of Salt: A Regularly Updated Systematic Review of Salt and Health Outcomes (June and July 2015)

From the Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Arbor Research Collaborative for Health, Ann Arbor, MI; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Department of Medicine; Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O’Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada; George Institute for Global Health India, Hyderabad, India; Departments of Preventive & Social Medicine/Human Nutrition, University of Otago, Dunedin, New Zealand; and The George Institute for Global Health, University of Sydney and the Royal Prince Alfred Hospital, Sydney, NSW, Australia

Estimates of Dietary Sodium Consumption in Patients With Chronic Heart Failure.

Estimating dietary sodium intake is a key component of dietary assessment in the clinical setting of HF to effectively implement appropriate dietary interventions for sodium reduction and monitor adherence to the dietary treatment. In a research setting, assessment of sodium intake is crucial to an essential methodology to evaluate outcomes after a dietary or behavioral intervention. Current available sodium intake assessment methods include 24-hour urine collection, spot urine collections, multiple day food records, food recalls, and food frequency questionnaires. However, these methods have inherent limitations that make assessment of sodium intake challenging, and the utility of traditional methods may be questionable for estimating sodium intake in patients with HF. Thus, there are remaining questions about how to best assess dietary sodium intake in this patient population, and there is a need to identify a reliable method to assess and monitor sodium intake in the research and clinical setting of HF. This paper provides a comprehensive review of the current methods for sodium intake assessment, addresses the challenges for its accurate evaluation, and highlights the relevance of applying the highest-quality measurement methods in the research setting to minimize the risk of biased data.

Recommended standards for assessing blood pressure in human research where blood pressure or hypertension is a major focus

Recommended standards for assessing blood pressure in human research where blood pressure or hypertension is a major focus

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March-August 2016)

This review aims to identify, summarize, and appraise studies reporting on the implementation of salt reduction interventions that were published between March and August 2016. Overall, 40 studies were included: four studies evaluated the impact of salt reduction interventions, while 36 studies were identified as relevant to the design, assessment, and implementation of salt reduction strategies. Detailed appraisal and commentary were undertaken on the four studies that measured the impact of the interventions. Among them, different evaluation approaches were adopted; however, all demonstrated positive health outcomes relating to dietary salt reduction. Three of the four studies measured sodium in breads and provided consistent evidence that sodium reduction in breads is feasible and different intervention options are available. None of the studies were conducted in low‐ or lower middle–income countries, which stresses the need for more resources and research support for the implementation of salt reduction interventions in these countries.

The Science of Salt: A Regularly Updated Systematic Review of Salt and Health Outcomes (August to November 2015)

The purpose of this review was to systematically identify, summarize, and critically appraise studies on dietary salt relating to health outcomes that were published from August to November 2015. The search strategy was adapted from a previous systematic review on dietary salt and health. Overall, 15 studies were included in the review: one study assessed cardiovascular events, five studies assessed blood pressure or hypertension incidence, six studies assessed surrogate outcomes for cardiovascular or kidney diseases, and three studies assessed other outcomes (age‐related cataracts, rheumatoid arthritis, and bone mineral density, respectively). Four studies were selected for detailed appraisal and commentary.