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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn 1980, the recommendation from the Dietary Guidelines for Americans was to \u201cavoid too much sodium.\u201d Over time, however, formal guidelines have set ever-lowering intake goals, for which the scientific basis has become a matter of debate. Offering new snew perspectives on this controversy, this article discusses how dietary reference intakes are set, the relationship between sodium intake and cardiovascular disease, as well as population nutrition trends.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Enutrition physiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eprevention \u0026amp; screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EIn 1980, the recommendation from the Dietary Guidelines for Americans was to \u201cavoid too much sodium.\u201d Over time, however, formal guidelines have set ever-lowering intake goals, for which the scientific basis has become a matter of debate. Robert P. Heaney, MD, Creighton University, Omaha, Nebraska, USA, provided a new perspective on this controversy in his review of how dietary reference intakes (DRIs) are set.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIn their 2005 guidelines, the Institute of Medicine (IOM) determined the adequate intake (AI) for sodium was 1500 mg\/day for adults \u2264 50 years of age, 1300 mg\/day for those aged 50 to 70 years, and 1200 mg\/day for those aged \u0026gt;70, with an upper intake level (UL) for adults of 2300 mg\/day [IOM. \u003Cem\u003EDietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate.\u003C\/em\u003E Washington, DC: The National Academies Press, 2005]. However, on May 14, 2013, IOM issued a new report concluding that salt intake in the range recommended by the earlier guidelines could increase the risk for heart-related illness and death and acknowledged that there was no evidence that reducing intake below 2300 mg\/day was beneficial in terms of cardiovascular risk or mortality in the general population [IOM. \u003Cem\u003ESodium Intake in Populations: Assessment of Evidence\u003C\/em\u003E Washington, DC: The National Academies Press, 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EIn theory, the process for calculating a DRI begins with identifying the consequences of inadequate and excessive intake of a nutrient. Next, the data describing the intake needed to avoid those consequences are gathered, and then an intake sufficient to avoid inadequacy is recommended. Most nutrient response curves are U-shaped with a risk of deficiency at the low end and risk of toxicity at the high end (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [IOM. \u003Cem\u003EDietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate.\u003C\/em\u003E Washington, DC: The National Academies Press, 2005].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Nutrient Response and Intake Curve\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1937098512\u0022 data-figure-caption=\u0022Nutrient Response and Intake Curve\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16469\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003ENutrient Response and Intake Curve\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAdapted from IOM. \u003Cem\u003EDietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate.\u003C\/em\u003E Washington, DC: The National Academies Press, 2005.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EBecause the IOM felt there was insufficient evidence regarding the effect of sodium to use the usual DRI process, they developed their 2005 recommendations based on adequate intake (AI), a concept defined as \u003Cem\u003Ethe average intake observed in a healthy population.\u003C\/em\u003E The focus of a recommended intake is to avoid harm\u2014not to create wellness\u2014and the adverse effect the sodium intake guideline sought to avoid was elevated blood pressure (BP). By using an AI, the IOM took a linear approach, which did not account for the fact that the starting intake is an important consideration; ie, reductions from higher (toxic) levels of sodium intake would be expected to reduce risk, but reductions from lower levels may lead to an increase in risk (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The Importance of Starting Intake Levels\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1937098512\u0022 data-figure-caption=\u0022The Importance of Starting Intake Levels\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16470\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EThe Importance of Starting Intake Levels\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from RP Heaney, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe relationship between sodium and cardiovascular disease (CVD) has been studied frequently but with inconsistent outcomes. Data from the National Health and Nutrition Examination Survey (NHANES) introduced questions about the sodium\/BP connection 30 years ago when it was noted that higher intakes of calcium and potassium were associated with lower mean systolic BP and a lower absolute risk of hypertension. In a recent study, high urinary sodium excretion was not associated with increased CVD or mortality; however, low sodium excretion (in the range recommend by the 2005 guidelines) was associated with an increased risk of CVD morality (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E) [Stolarz-Skzypek K et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2011]. In another study, the lowest CVD risk occurred between 4000 and 6000 mg\/day of sodium excretion [O\u0027Donnell MI et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Cardiovascular Mortality and Morbidity and Sodium Intake\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1937098512\u0022 data-figure-caption=\u0022Cardiovascular Mortality and Morbidity and Sodium Intake\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16471\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \n               \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003ECardiovascular Mortality and Morbidity and Sodium Intake\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced from Stolarz-Skzypek K et al. Fatal and Nonfatal Outcomes, Incidence of Hypertension, and Blood Pressure Changes in Relation to Urinary Sodium Excretion. \u003Cem\u003EJAMA\u003C\/em\u003E 2011;305(17):1777\u20131785. Copyright 2011 American Medical Association. All rights reserved.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EThe approach taken by the IOM in 2005 also failed to factor in the crucial roles of calcium and potassium intake. The classic Dietary Approaches to Stop Hypertension [DASH] studies revealed that higher intakes of calcium and potassium provided by certain foods can offset the negative effects of high sodium intake on BP. In the DASH diet, diets rich in fruits, vegetables, low-fat dairy foods with reduced saturated and total fat substantially lowered BP.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThere are no randomized controlled trials (RCTs) regarding sodium intake, and the field lacks a consensus on how to define normal intakes, forcing reliance on empirical evidence. Dr. Heany proposes the use of the renin-angiotensin aldosterone system (RAAS) mechanism as a better benchmark rather than BP. Adjustments in the RAAS rescue for sodium becomes operative at sodium levels of \u00d73000 mg\/day for an adult. Among hypertensive subjects, the plasma renin activity (PRA) level (without urine sodium), is independently and directly associated with the incidence of myocardial infarction (MI). For every 2-unit increase in PRA, there is an overall 25% increase in MI incidence.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EContinuing the discussion of sodium intake and health outcomes, Michael Alderman, MD, Albert Einstein College of Medicine, Bronx, New York, USA, noted that there are no precise data regarding dietary sodium intake and its relationship to CVD. Advocates argue that because lowering sodium reduces average BP (a CVD surrogate) it will prevent CVD. Skeptics argue that there are many physiological surrogates for CVD and altering only one does not assure a predictable CVD outcome. While it may make sense that reducing sodium intake will improve mortality by lowering BP, there is really no evidence. In several studies in the early 1980s, when investigators lowered sodium intake by significant amounts (\u2264 70 mmol\/day) most of the participants had no significant change in BP, some had a fall in BP, but BP in a substantial portion rose (\u003Ca id=\u0022xref-fig-4-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F4\u0022\u003EFigure 4\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F4\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F4.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Heterogeneity of Blood Pressure Response in 119 Mild Hypertensive Subjects\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1937098512\u0022 data-figure-caption=\u0022Heterogeneity of Blood Pressure Response in 119 Mild Hypertensive Subjects\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 4.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F4.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F4.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 4.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F4.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16472\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 4.\u003C\/span\u003E \n               \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003EHeterogeneity of Blood Pressure Response in 119 Mild Hypertensive Subjects\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EMAP=mean arterial pressure.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003ESources: Longworth DL et al. \u003Cem\u003EClin Pharmacol Titer\u003C\/em\u003E 1980; MacGregor GA et al. \u003Cem\u003ELancet\u003C\/em\u003E 1982; Watt G et al. \u003Cem\u003EBr\u003C\/em\u003E Med\/1983.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-6\u0022\u003EReproduced with permission from M Alderman, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EReducing sodium intake has multiple physiological effects both positive and negative, and the health outcome is not predicted by one effect alone but by a network of multiple effects. Multiple RCTs support a \u201cJ-shaped\u201d relationship between sodium and CV outcomes such that intakes below 2500 mg\/day or above 6000 mg\/day are associated with increased CV risk [Alderman MH, Cohen HW. \u003Cem\u003ECurr Hypertens Rep\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EThe 2013 IOM report did not recommend an optimal range for sodium intake. However, a very recent meta-analysis investigating the association between sodium intake and health outcomes among 275,000 subjects with low, usual, or high sodium intakes found that a range of 2645 to 4945 mg\/day was associated with the most favorable outcomes [Graudal N et al. \u003Cem\u003EAm J Hypertens\u003C\/em\u003E 2014]. This compares favorably with the sodium consumption of 90% of Americans, which is between 2500 and 5000 mg\/day.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EGuidelines calling for strict reductions in sodium are based on the premise that intake exceeds physiological need and that it can and should be reduced for optimum health. David McCarron, MD, University of California, Davis, Davis, California, USA, discussed data supporting the consistency of sodium intake over time and across populations despite public policy efforts to reduce it.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003ENeuroscientists have identified neural circuits in vertebrate animals that regulate sodium appetite within a narrow physiological range, and that sodium appetite is controlled by physiological need rather than environmental factors [McCarron DA et al. \u003Cem\u003EAm J Hypertens\u003C\/em\u003E 2013]. The intake range is remarkably reproducible over at least 5 decades across 45 countries (\u003Ca id=\u0022xref-fig-5-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F5\u0022\u003EFigure 5\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F5\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F5.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Range of Human Sodium Intake Worldwide\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1937098512\u0022 data-figure-caption=\u0022Range of Human Sodium Intake Worldwide\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 5.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F5.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F5.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 5.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/24\/F5.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16473\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 5.\u003C\/span\u003E \n               \u003Cp id=\u0022p-18\u0022 class=\u0022first-child\u0022\u003ERange of Human Sodium Intake Worldwide\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-7\u0022\u003ESD=standard deviation; UNaV=urinary sodium excretion.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-8\u0022\u003EBased on 24-hour UNaV in 69,011 subjects worldwide; 5 decades, 45 countries; mean: 159.4 \u00b1 22.3 mmols\/day; range: 114\u2013210 mmols\/day (2622\u20134830 mg\/day).\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-9\u0022\u003EReproduced from McCarron DA et al. Normal Range of Human Dietary Sodium Intake: A Perspective Based on 24-Hour Urinary Sodium Excretion Worldwide. \u003Cem\u003EAm J Hypertens\u003C\/em\u003E 2013;26(10):1218\u20131223. With permission from Oxford University Press.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EThe range has definable upper and lower limits with health risks at each end; the mid-range values are associated with optimal health benefits. Intake is controlled by various stimulatory and inhibitory signals that act on the brain to regulate sodium appetite; it is not primarily determined by food. For instance, sodium appetite can be enhanced by the adrenal steroid aldosterone via an unknown brain mechanism [Geerling JC et al. \u003Cem\u003EJ Neurosci\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EDr. McCarron presented evidence showing the normal range of human sodium intake and that the intake in the United States is within that range. Future guidelines should be based on this biologically determined range of approximately 2500 to 5000 mg\/day.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/5\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlxi2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlxi2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}