Beyond blood pressure: new paradigms in sodium intake reduction and health outcomes.

Since 1980, when inaugural national dietary guidance was to “avoid too much sodium,” recommendations have evolved to the 2010 Dietary Guidelines for Americans’ quantified guidance of 2300 and 1500 mg/d [USDA and U.S. Department of Health and Human Services. Dietary guidelines for Americans, 1st (http://www.cnpp.usda.gov/DGAs1980Guidelines.htm) and 7th (http://www.health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf) eds.]. Too much sodium remains a valid concern, but are current targets too low for optimal health? New research moves beyond sodium’s effect on the surrogate marker of blood pressure to examine the relation between sodium intake and cardiovascular morbidity and mortality. Results show that sodium intakes both less than and greater than ∼3000–5000 mg/d increase the risk of negative health outcomes. Additionally, newly compiled sodium intake data across populations show a uniformity that suggests that intake is physiologically set. Perhaps not coincidentally, the observed intakes fall within the range related to lowest risk. These findings are highly relevant to current efforts to achieve low sodium intakes across populations, because the data suggest that the efforts will be unsuccessful for healthy people and may cause harm to vulnerable populations. Remaining mindful of risks associated with both excessive and inadequate intakes is imperative with all nutrients, and sodium is no exception. Avoiding too much, and too little, sodium may be the best advice for Americans.