O'Donnell Martin, Mente Andrew, Alderman Michael H, Brady Adrian J B, Diaz Rafael, Gupta Rajeev, López-Jaramillo Patricio, Luft Friedrich C, Lüscher Thomas F, Mancia Giuseppe, Mann Johannes F E, McCarron David, McKee Martin, Messerli Franz H, Moore Lynn L, Narula Jagat, Oparil Suzanne, Packer Milton, Prabhakaran Dorairaj, Schutte Alta, Sliwa Karen, Staessen Jan A, Yancy Clyde, Yusuf Salim
HRB-Clinical Research Facility, NUI Galway, Newcastle Road, Galway, Ireland.
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Eur Heart J. 2020 Sep 14;41(35):3363-3373. doi: 10.1093/eurheartj/ehaa586.
Several blood pressure guidelines recommend low sodium intake (<2.3 g/day, 100 mmol, 5.8 g/day of salt) for the entire population, on the premise that reductions in sodium intake, irrespective of the levels, will lower blood pressure, and, in turn, reduce cardiovascular disease occurrence. These guidelines have been developed without effective interventions to achieve sustained low sodium intake in free-living individuals, without a feasible method to estimate sodium intake reliably in individuals, and without high-quality evidence that low sodium intake reduces cardiovascular events (compared with moderate intake). In this review, we examine whether the recommendation for low sodium intake, reached by current guideline panels, is supported by robust evidence. Our review provides a counterpoint to the current recommendation for low sodium intake and suggests that a specific low sodium intake target (e.g. <2.3 g/day) for individuals may be unfeasible, of uncertain effect on other dietary factors and of unproven effectiveness in reducing cardiovascular disease. We contend that current evidence, despite methodological limitations, suggests that most of the world's population consume a moderate range of dietary sodium (2.3-4.6g/day; 1-2 teaspoons of salt) that is not associated with increased cardiovascular risk, and that the risk of cardiovascular disease increases when sodium intakes exceed 5 g/day. While current evidence has limitations, and there are differences of opinion in interpretation of existing evidence, it is reasonable, based upon observational studies, to suggest a population-level mean target of <5 g/day in populations with mean sodium intake of >5 g/day, while awaiting the results of large randomized controlled trials of sodium reduction on incidence of cardiovascular events and mortality.
多项血压指南建议全体人群低钠摄入（<2.3克/天，100毫摩尔，5.8克/天的盐），前提是无论钠摄入量处于何种水平，减少钠摄入都会降低血压，进而减少心血管疾病的发生。这些指南制定时，并未采取有效的干预措施以实现自由生活个体持续的低钠摄入，没有一种可行的方法来可靠地估计个体的钠摄入量，也没有高质量的证据表明低钠摄入可减少心血管事件（与适度摄入相比）。在本综述中，我们研究当前指南小组提出的低钠摄入建议是否有充分的证据支持。我们的综述对当前低钠摄入建议提出了不同观点，并表明为个体设定特定的低钠摄入目标（如<2.3克/天）可能不可行，对其他饮食因素的影响不确定，且在降低心血管疾病方面的有效性未经证实。我们认为，尽管存在方法学上的局限性，但当前证据表明，世界上大多数人口摄入的膳食钠处于适度范围（2.3 - 4.6克/天；1 - 2茶匙盐），这与心血管风险增加无关，而当钠摄入量超过5克/天时，心血管疾病风险会增加。虽然当前证据存在局限性，且对现有证据的解释存在意见分歧，但基于观察性研究，在平均钠摄入量>5克/天的人群中，建议设定<5克/天的人群水平平均目标是合理的，同时等待关于降低钠摄入量对心血管事件发生率和死亡率影响的大型随机对照试验结果。
