51 years of age and older and African Americans). In studies that explored interactions, race, age, or prevalence of hypertension or diabetes did not change the effect of sodium on health outcomes.

Conclusion 2: The committee concluded that, with the exception of the CHF patients described above, the current body of evidence addressing the association between low sodium intake and health outcomes in the population subgroups considered is limited. The evidence available is inconsistent and limited in its approaches to measuring sodium intake. The evidence also is limited by small numbers of health outcomes and the methodological constraints of observational study designs, including the potential for reverse causality and confounding.

The committee further concluded that, while the current literature provides some evidence for adverse health effects of low sodium intake among individuals with diabetes, CKD, or preexisting CVD, the evidence on both the benefit and harm is not strong enough to indicate that these subgroups should be treated differently from the general U.S. population. Thus, the committee concluded that the evidence on direct health outcomes does not support recommendations to lower sodium intake within these subgroups to, or even below, 1,500 mg per day.

Implications for Population-Based Strategies to Gradually Reduce Sodium Intake in the U.S. Population

As noted in Chapter 1, recommendations of the Panel on Dietary Reference Intakes for Electrolytes and Water of an Adequate Intake for sodium of 1,500 mg per day for all individuals 9 years of age up to 51 years of age was set as an amount necessary to achieve an overall diet that provides an adequate intake of other nutrients and also covers sodium sweat losses. A Tolerable Upper Intake Level for sodium was set at 2,300 mg per day based on evidence showing associations between high sodium intakes and risk of high blood pressure and consequent risk of CVD, stroke, and mortality.

Given this background, overall, the committee found that the available evidence on associations between sodium intake and direct health outcomes is consistent with population-based efforts to lower excessive dietary sodium intakes, but it is not consistent with recommendations that encourage lowering of dietary sodium in the general population to 1,500 mg per day. Further, as noted in the 2010 DGAC report, population subgroups, including those with diabetes, CKD, or preexisting CVD, individuals with hypertension, prehypertension, persons 51 years of age and older, and African Americans represent, in aggregate, a majority of the general U.S. population. Thus, when considered in light of the current state of the



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