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on public health strategies that effectively reduce sodium intake and others that increase potassium intake in the general population.

Highest priority is given to research that has the potential to prevent or retard human disease processes and to prevent deficiencies with functional consequences. The following broad areas for research were deemed the highest priority (specific research recommendations are found at the conclusions of Chapters 4 through 7):

  • Research on effective public health strategies to achieve and sustain a reduced sodium and increased potassium intake in the general population, including

    • behavioral change studies in individuals, and

    • community-based intervention studies.

  • Research on alternative technologies that reduce the sodium content of foods, with a special emphasis on maintaining flavor, texture, consumer acceptability, safety, and low cost.

  • Studies that test the effects of reduced sodium and increased potassium intake, alone and combined, on clinical outcomes (e.g., stroke, bone mineral density, and kidney stones). To the extent possible, clinical trials should be conducted. A formal assessment of the feasibility of a sodium reduction trial with clinical cardiovascular outcomes should be undertaken. In the absence of trials, methodologically rigorous observational studies that concomitantly collect electrolyte intake, other dietary information, and genetic information should be conducted.

  • Studies to assess the potential for increased potassium intake to mitigate the adverse consequences of excess sodium intake and, vice versa, the potential for a reduced sodium intake to mitigate the adverse consequences of inadequate potassium intake. Potential outcomes include blood pressure, salt sensitivity, bone demineralization, and bone mineral density.

  • Studies on the adverse effects of chronic, low-grade metabolic acidosis that results from an inadequate intake of potassium and its bicarbonate precursors. Potential outcomes include bone mineral density and kidney stones.

  • Water, sodium, and potassium balance studies that enroll broad populations and that vary climate and physical activity levels. Populations of particular interest are children, as well as older persons with chronic, but stable, illnesses.

  • Research to improve the assessment of sodium and potassium intake and total body stores.

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