ReviewRole of Dietary Salt and Potassium Intake in Cardiovascular Health and Disease: A Review of the Evidence
Section snippets
Methods and Evidence Base
Studies in this review include randomized controlled trials (RCTs) linking dietary salt and potassium intakes to subsequent morbidity and mortality, which determine the health outcomes of reducing salt intake and increasing potassium intake by diet or supplementation. The following databases (January 1, 1990, to January 31, 2013) were examined: Cochrane Central Register of Controlled Trials, MEDLINE (Pubmed and Quertle), EMBASE, Cumulative Index to Nursing & Allied Health Literature, Database
Results
From the literature evaluated, 52 studies met the criteria for this review (Table 3 and Supplemental Table [available online at http://www.mayoclinicproceedings.org]). Of these studies, 28 involved modification of dietary salt intake,15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 12 involved modification of dietary potassium intake,51, 52, 53, 54, 43, 44, 45, 46, 47, 48, 49, 50 and 12 involved modification of both dietary salt and
Discussion
This analysis focused specifically on RCTs. The quality of the evidence of the included studies was then graded using published guidelines. Although many of these RCTs received a grade less than “A,” a sufficient number of studies were graded “A” (Supplemental Table, available online at http://www.mayoclinicproceedings.org), resulting in a level 1 recommendation for salt restriction and potassium supplementation. For some investigators, the relationship between dietary salt intake and health
Implications for Clinicians and the General Public
In the United States, current recommendations and guidelines81, 82 emphasize a reduction in dietary salt intake and a simultaneous increase in dietary potassium consumption. The Institute of Medicine, the American Heart Association, and the US Department of Health and Human Services/US Department of Agriculture recommend limiting salt intake. For potassium, the data suggest that supplementation is best achieved through alterations in the diet. The analyses provided in the present study support
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Grant Support: Dr Sanders is supported by the Nephrology Research and Training Center at the University of Alabama at Birmingham; the Office of Research and Development, Medical Research Service, Department of Veterans Affairs; a George M. O'Brien Kidney and Urological Research Centers Program (grant P30 DK079337); and NIH grant R01 DK04699.