Normal range of human dietary sodium intake: a perspective based on 24-hour urinary sodium excretion worldwide

• Published in: American journal of hypertension 2013-10, Vol.26 (10), p.1218-1223
• Main Authors: McCarron, David A, Kazaks, Alexandra G, Geerling, Joel C, Stern, Judith S, Graudal, Niels A
• Format: Article
• Language: English
• Subjects: Cardiovascular Diseases - drug therapy; Female; Global Health; Humans; Hypertension - diet therapy; Male; Reference Values; Sodium - physiology; Sodium - urine; Sodium, Dietary - administration & dosage
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1093/ajh/hpt139

The recommendation to restrict dietary sodium for management of hypertensive cardiovascular disease assumes that sodium intake exceeds physiologic need, that it can be significantly reduced, and that the reduction can be maintained over time. In contrast, neuroscientists have identified neural circuits in vertebrate animals that regulate sodium appetite within a narrow physiologic range. This study further validates our previous report that sodium intake, consistent with the neuroscience, tracks within a narrow range, consistent over time and across cultures. Peer-reviewed publications reporting 24-hour urinary sodium excretion (UNaV) in a defined population that were not included in our 2009 publication were identified from the medical literature. These datasets were combined with those in our previous report of worldwide dietary sodium consumption. The new data included 129 surveys, representing 50,060 participants. The mean value and range of 24-hour UNaV in each of these datasets were within 1 SD of our previous estimate. The combined mean and normal range of sodium intake of the 129 datasets were nearly identical to that we previously reported (mean = 158.3±22.5 vs. 162.4±22.4 mmol/d). Merging the previous and new datasets (n = 190) yielded sodium consumption of 159.4±22.3 mmol/d (range = 114-210 mmol/d; 2,622-4,830mg/d). Human sodium intake, as defined by 24-hour UNaV, is characterized by a narrow range that is remarkably reproducible over at least 5 decades and across 45 countries. As documented here, this range is determined by physiologic needs rather than environmental factors. Future guidelines should be based on this biologically determined range.