CNS 2019: Should Canadians change their sodium intakes?

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Speakers: JoAnne Arcand and Andrew Mente

The Dietary Reference Intakes for Sodium and Potassium published earlier this year highlighted the challenges in setting the DRI for sodium. This report reaffirmed the AI for sodium of 1500 mg/d for adults. An AI was set because there were no indicators of sodium requirements that offered sufficient evidence to establish EAR and RDA values. There also was insufficient evidence of sodium toxicity risk within the healthy population to establish a UL for sodium, but the panel introduced the Chronic Disease Risk Reduction Intake (CDRR) term, which was set at 2300 mg/d for sodium. The committee indicated that the sodium DRI would “benefit from additional research that identifies requirements for sodium and better characterizes negative health effects from high levels, to the extent that safety can be assessed", and that “methodologically rigorous randomized controlled trials that study the effect of sodium on chronic disease endpoints are also needed". The discussants in this symposium will provide diverging views on the interpretation of the evidence for sodium requirements and the implications for dietary recommendations for sodium for Canadians.

JoAnne Arcand: The need for dietary sodium reduction in Canada

Dr. Arcand will discuss the latest evidence that supports dietary sodium reduction. This includes an overview of evidence on dietary sodium and health outcomes used to establish the 2019 Dietary Reference Intake recommendations for sodium, and an examination of sodium intakes assessed from the 2015 Canadian Community Health Survey data.

Andrew Mente: Sodium intake and cardiovascular disease and mortality: What is the current evidence?

Sodium is an essential nutrient required for normal physiological function. Short-term randomized controlled trials have reported reductions in blood pressure with reduced sodium intake to <1.5 g/day. Population recommendations for low sodium intake (<2.0 g/day) have been achieved in short-term feeding clinical trials, but not sustained in longer-term clinical trials (>6 months). No randomized trials have determined whether low sodium intake reduces CVD events or deaths compared with moderate intake. No study (observational or randomized trial) has ever shown that low sodium (<2.5 g/day, or lower), compared to average sodium (3-5 g/day), is associated with lower cardiovascular disease or mortality. There are however more than a dozen prospective cohort studies showing either a J-shaped or INVERSE association between sodium intake and CVD events or death, consistent across methods of sodium estimation (24-hour urines, overnight urines, or diet assessment). In a recent Cochrane Review of 23 epidemiological studies (n=274,683), the lowest risk of CVD events and deaths occurs at an intake between 2.7 and 5.0 g/day. PURE study findings are consistent with this evidence, with sodium excretion both >5 g/day and <3 g/day being associated with higher mortality and CVD events compared to 3 to 5 g/day, despite an overall positive association between sodium excretion and blood pressure. Further, regardless of whether people have high blood pressure, low-sodium intake is related to more heart attacks, strokes, and deaths compared to average intake. Large appropriately designed randomized controlled trials are needed to help better inform optimal sodium intake for populations.

** Original Source: "CNS 2019 Annual Conference" Friday, May 3, 2019

Length: 1:05:47

Type: Video

Last Updated: June 18, 2019

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CNS 2019: Should Canadians change their sodium intakes? Video
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