Conflicting Evidence on Health Effects Associated With Salt Reduction Calls for a Redesign of the Salt Dietary Guidelines

Prog Cardiovasc Dis. May-Jun 2018;61(1):20-26. doi: 10.1016/j.pcad.2018.04.008. Epub 2018 May 2.


Ninety-five percent of the World's populations have a mean salt intake between 6 and 12 g, which is much lower than the tolerated daily level of up to 55 g/d. In spite of this, the recommended upper level by many health institutions is as low as 5.8 g/day. When reviewing the evidence for an upper level of 5.8 g/day, it becomes apparent that neither the supporting studies selected by the health institutions, nor randomized controlled trials and prospective observational studies disregarded by the health institutions, document that a salt intake below this 5.8 g, has beneficial health effects. Although there is an association between salt intake and blood pressure, both in randomized controlled trials and in observational studies, this association is weak, especially in non-obese individuals with normal blood pressure. Furthermore a salt intake below 5.8 g is associated with the activation of the renin-angiotensin-aldosteron system, an increase in plasma lipids and increased mortality. A redesign of the salt dietary guidelines, therefore, seems to be needed.

Keywords: And mortality; Blood pressure; Lipids; Renin-angiotensin-aldosterone; Salt.

Publication types

  • Review

MeSH terms

  • Blood Pressure
  • Diet, Sodium-Restricted / adverse effects*
  • Diet, Sodium-Restricted / standards
  • Dietary Approaches To Stop Hypertension / adverse effects*
  • Evidence-Based Medicine
  • Hormones / blood
  • Humans
  • Hypertension / diet therapy*
  • Hypertension / epidemiology
  • Hypertension / physiopathology
  • Lipids / blood
  • Recommended Dietary Allowances*
  • Renin-Angiotensin System
  • Risk Factors
  • Sodium Chloride, Dietary / adverse effects*


  • Hormones
  • Lipids
  • Sodium Chloride, Dietary