Costopoulos Eurydice, Imamura Airi, Khan Nushrat, Butler Adrian, Millett Christopher, Hoque Mohammad A, Vineis Paolo, Belesova Kristine, Khan Aneire
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 90 Wood Lane, London, W12 0BZ, UK.
School of Medicine, University College Dublin UCD Health Sciences Centre, Belfield, Dublin 4, D04 V1W8, Ireland.
Eur J Epidemiol. 2025 Sep 29. doi: 10.1007/s10654-025-01307-9.
In climate change-affected coastal areas, sea level rise, storm surges, droughts and altered rainfalls are significantly increasing salinity levels in drinking water sources. This is a major public health problem that affects many millions of people. We systematically reviewed and assessed the strength and quality of the evidence on the relationship between drinking water with high sodium levels (> 200 mgNa/l) and adverse cardiovascular, renal, and pregnancy-related health outcomes, following the PRISMA guidelines, the ROBINS-E Cochrane tool and the Navigation Guide. From five bibliographic databases, we identified 22 relevant studies, some of which assessed more than one health domain. The evidence was of moderate quality and strength. 14 analyses from eight studies at low risk of bias and four studies at moderate risk of bias, linked drinking high-salinity water to adverse health outcomes including hypertension and cardiovascular disease, impaired renal function, gestational hypertension and preeclampsia, and higher infant mortality. Eight studies were inconclusive. Three analyses, of which two at low risk of bias, associated drinking high-salinity water to improved health outcomes. Overall, our findings suggest that salinisation of drinking water sources is likely to increase adverse cardiovascular, renal, and pregnancy-related health outcomes. This conclusion highlights the importance of effective and timely adaptation at scale, and calls for a revision of the WHO guidelines for the intake of salt from water. The latest WHO guidelines (2022) do not set any health-based standard for sodium levels in drinking water, a problem that affects millions of people and will worsen with climate change.
在受气候变化影响的沿海地区，海平面上升、风暴潮、干旱和降雨变化正显著提高饮用水源的盐度水平。这是一个影响数百万人的重大公共卫生问题。我们按照PRISMA指南、ROBINS-E Cochrane工具和《导航指南》，系统回顾并评估了关于高钠水平（>200毫克钠/升）饮用水与不良心血管、肾脏及妊娠相关健康结果之间关系的证据强度和质量。从五个文献数据库中，我们识别出22项相关研究，其中一些研究评估了不止一个健康领域。证据质量和强度为中等。八项低偏倚风险研究和四项中等偏倚风险研究中的14项分析，将饮用高盐度水与包括高血压和心血管疾病、肾功能受损、妊娠高血压和先兆子痫以及较高婴儿死亡率在内的不良健康结果联系起来。八项研究尚无定论。三项分析（其中两项低偏倚风险）将饮用高盐度水与改善健康结果相关联。总体而言，我们的研究结果表明，饮用水源盐渍化可能会增加不良心血管、肾脏及妊娠相关健康结果。这一结论凸显了大规模有效及时适应的重要性，并呼吁修订世界卫生组织关于水中盐摄入量的指南。世界卫生组织最新指南（2022年）未对饮用水中的钠水平设定任何基于健康的标准，这一问题影响着数百万人，且会随着气候变化而恶化。
