Adding salt to foods and hazard of premature mortality

The relationship between dietary salt intake and health remains a subject of longstanding debate. A recent ecological study has rekindled this controversy by reporting that sodium intake was inversely associated with the risk of all-cause mortality and positively associated with healthy life expectancy in 181 countries worldwide.1 Notably, previous studies investigating the association between sodium intake and risk of mortality have produced conflicting results, showing positively linear,2–4 J-shaped,5,6 or inversely linear associations.

The low accuracy of sodium measurement is an important reason for the inconsistent results related to sodium intake and disease outcomes in previous studies.10,11 Sodium intake varies widely from day to day. However, the majority of previous studies has largely relied on a single day’s urine collection or dietary survey for estimating the sodium intake, which is inadequate to assess an individual’s usual consumption levels.10,12 Moreover, it is difficult to separate the contributions of intakes of sodium and potassium to health based on current methods for measuring dietary sodium and dietary potassium,2,5,13,14 since both the dietary intake and metabolism of sodium in the kidneys are closely related to potassium.15–17 Notably, such two essential cations have opposite biological effects on the human health,17–20 thus their collinearity may confound the association between sodium intake and health outcomes. 

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