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ACC 2023: Extra Dietary Sodium Restrictions May Not Lead to Better Outcomes
Restriction beyond current guidelines of approximately 2.3 g/day linked to increased in-hospital mortality
MONDAY, March 13, 2023 (HealthDay News) – Restricting dietary sodium below recommended levels may not be helpful and was linked to an increase in in-hospital mortality, according to research presented at the annual meeting of the American College of Cardiology together with the World Congress of Cardiology, held from March 4 to 6 in New Orleans.
U.S. Dietary Guidelines for Americans recommend a dietary sodium intake of 2.3 g/day or less for most adults. “The current meta-analysis of randomized trials showed that, in patients with heart failure, sodium restriction resulted in increased mortality. In the absence of benefit of salt restriction and [given the] increased harm, there should be a reconsideration of such recommendation,” Anirudh Palicherla, M.D., of the Creighton School of Medicine in Omaha, Nebraska, told Elsevier’s PracticeUpdate.
Palicherla and colleagues searched multiple databases for randomized clinical trials to compare additional dietary sodium restriction (below 2.5 g/day) and a standard low-sodium diet, or usual care. The researchers found a total of nine studies, which included 3,499 patients.
Compared with the usual care group, the additional sodium restriction group showed a significant increase in in-hospital mortality (relative risk [RR], 1.84; 95 percent confidence interval [CI], 1.46 to 2.31; P < 0.001), but there was no significant difference in hospitalization between the two groups (RR, 1.45; 95 percent CI, 0.99 to 2.11; P = 0.05).
“Limiting sodium is still the way to go to help manage heart failure, but the amount of restriction has been up for debate,” Palicherla said in a press release. “This study shows that the focus should be on establishing a safe level of sodium consumption instead of overly restricting sodium.”
A possible explanation for these results could be activation of downstream antidiuretic and antinatriuretic systems, Palicherla said. Additionally, sodium improves the taste of food exponentially and its restriction may reduce the overall intake of total calories and required nutrients, which may lead to worse nutritional status.
According to Palicherla, future research should be targeted to specific groups based on factors such as age, inpatient versus outpatient care, and degree of heart failure.
