Salt wars: WHO statement throws cold water on CVD claims

  • Nutr Metab Cardiovasc Dis

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In a scientific statement on salt and cardiovascular disease (CVD), a WHO-affiliated group says 4 controversial studies are an “inappropriate” basis for overturning public health efforts to reduce global salt consumption.

Why this matters

  • The high-profile studies were all published by the same group: 1 in  New England Journal of Medicine , 1 in JAMA , and a pair of them in The Lancet. 
  • Authors of the 4 studies suggest salt intake at WHO target levels (12 g/day) for CVD.
  • WHO European Salt Action network says methodology is flawed.
  • A salty editorial  in The Lancet with the fourth of these studies noted some shortcomings.

Key critiques

  • About the 4 studies, the WHO statement authors say that:
    • Spot urine samples are not valid measures of salt intake.
    • A single urine test cannot inform about long-term effects of salt intake.
    • Results of the 4 studies are not generalizable, show no causal relationship of low salt intake and CVD mortality.
    • BP population comparisons in these studies were not biologically meaningful.
    • Salt intake that the 4 studies identify as “least dangerous” is current level in many Western countries, where randomized controlled trials have shown that halving this amount meaningfully reduces BP.

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