Sodium Intake and Mortality Follow-Up in the Third National Health and Nutrition Examination Survey (NHANES III)

• Published in: Journal of general internal medicine : JGIM Vol. 23; no. 9; pp. 1297 - 1302
• Main Authors: Cohen, Hillel W., Hailpern, Susan M., Alderman, Michael H.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-09-2008; Springer; Springer Nature B.V
• Subjects: Adult; Biological and medical sciences; Cardiovascular disease; Cardiovascular Diseases - mortality; Diet; Energy Intake; Epidemiology; Female; General aspects; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Mortality; Nutrition Surveys; Original; Original Article; Polls & surveys; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Sodium; Sodium, Dietary - adverse effects; United States - epidemiology; United States; mortality; cardiovascular disease; sodium intake; Third National Health and Nutrition Examination Survey (NHANES III); Endocrinopathy; Human; Nutrition; Nutrition survey; Diabetes mellitus; Mortality; Cardiovascular disease; Epidemiology; Feeding; Medicine; Salt; Health status; Food intake; Public health
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-008-0645-6

Background
Sodium restriction is commonly recommended as a measure to lower blood pressure and thus reduce cardiovascular disease (CVD) and all-cause mortality. However, some studies have observed higher mortality associated with lower sodium intake.
Objective
To test the hypothesis that lower sodium is associated with subsequent higher cardiovascular disease (CVD) and all cause mortality in the Third National Health and Nutrition Examination Survey (NHANES III).
Design
Observational cohort study of mortality subsequent to a baseline survey.
Participants
Representative sample (n = 8,699) of non-institutionalized US adults age ≥30, without history of CVD events, recruited between 1988–1994.
Measurements and main results
Dietary sodium and calorie intakes estimated from a single baseline 24-h dietary recall. Vital status and cause of death were obtained from the National Death Index through the year 2000. Hazard ratio (HR) for CVD mortality of lowest to highest quartile of sodium, adjusted for calories and other CVD risk factors, in a Cox model, was 1.80 (95% CI 1.05, 3.08, p = 0.03). Non-significant trends of an inverse association of continuous sodium (per 1,000 mg) intake with CVD and all-cause mortality were observed with a 99% CI of 0.73, 1.06 (p = 0.07) and 0.86, 1.04 (p = 0.11), respectively, while trends for a direct association were not observed.
Conclusion
Observed associations of lower sodium with higher mortality were modest and mostly not statistically significant. However, these findings also suggest that for the general US adult population, higher sodium is unlikely to be independently associated with higher CVD or all-cause mortality.