Response to: ‘More on dissidents and dietary sodium’

Most of Campbell’s comments have been addressed in our previous response.1 We have reported all relevant disclosures in previous publications and would again clarify that we have not received funding (personally or through grants) from the salt industry. In our view, Campbell’s letters attempt to divert discussion away from the scientific debate. Perhaps this is because the evidence does not support his position of advocating for low sodium intake in the entire population, given the lack of studies reporting significantly lower rates of cardiovascular events or mortality in those consuming a low sodium intake (< 2.3 g/day sodium), compared with a moderate intake.2 The reported J-shaped association between sodium intake and health is based on numerous studies of different populations employing different approaches to sodium intake measurement.3 Even among studies with repeated 24-h urine measures, no study has demonstrated a significantly lower risk of cardiovascular events with low sodium intake (below 2.3 g/day) compared with those consuming moderate intake (2.3 to 4.6 g/day) in the general population.4–7 The points Campbell raises about measurement of sodium intake in the Prospective Urban Rural Epidemiology (PURE) study have been addressed thoroughly in previous communications.8–10 Campbell’s approach is to criticize studies (and their authors) that challenge his view (i.e. those studies reporting an increased cardiovascular risk with low salt intake), while ignoring the absence of studies supporting his view (i.e. lack of studies reporting a lower cardiovascular risk with low sodium intake). For example, he places emphasis on findings from the observational follow-up of the Trials of Hypertension Prevention (TOHP) trial control group, but no analysis of that study reported a significantly lower cardiovascular event rate in those with low sodium intake (< 2.3 g/day) compared with moderate intake.4–6,11 The burden of proof required to recommend population-wide low sodium intake is clear evidence of cardiovascular benefit, rather than merely disputing evidence of harm. We re-state that we support reducing sodium intake in populations who consume high sodium diets to moderate intake levels, for which position there is sufficient evidence of benefit (and none for harm). However, we consider it unwise to recommend lowering sodium intake from moderate to low levels until such time as there is solid evidence that it reduces cardiovascular disease. Our position of recommending moderate sodium intake is consistent with the recently published technical report from the joint working group of the World Heart Federation, European Society of Hypertension and European Public Health Association, which included an international panel with diverse perspectives on optimal sodium intake.2

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.