Effect of lower sodium intake on health: systematic review and meta-analyses.
Effect of lower sodium intake on health: systematic review and meta-analyses.
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DOI：
10.1136/bmj.f1326
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发表时间：
2013-04-03
期刊：
影响因子：
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通讯作者：
Meerpohl JJ
中科院分区：
文献类型：
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作者：
Aburto NJ;Ziolkovska A;Hooper L;Elliott P;Cappuccio FP;Meerpohl JJ
目的探讨减少钠摄入对血压、相关心血管疾病的影响，以及对血脂、儿茶酚胺水平和肾功能的影响。设计系统综述和荟萃分析。数据来源：科克伦对照试验中心注册中心、Medline、Embase、WHO国际临床试验注册平台、拉丁美洲和加勒比健康科学文献数据库以及既往综述的参考文献列表。随机对照试验和前瞻性队列研究，在非急性疾病的成人和儿童中评估钠摄入量与血压、肾功能、血脂和儿茶酚胺水平之间的关系，在非急性疾病的成人中评估钠摄入量与死亡率、心血管疾病、中风和冠心病之间的关系。研究评价和综合对潜在研究进行了独立筛选，一式两份，并提取了研究特征和结果。在可能的情况下，我们使用逆方差法和随机效应模型进行了荟萃分析，以估计低钠摄入量的影响。我们将结果表示为平均差异或风险比，置信区间为95%。我们纳入了14项队列研究和5项随机对照试验，报告了全因死亡率、心血管疾病、中风或冠心病;以及37项随机对照试验，测量了成人的血压、肾功能、血脂和儿茶酚胺水平。还纳入了9项对照试验和1项儿童血压队列研究。在成人中，钠摄入量的减少显著降低了静息收缩压3.39 mm Hg（95%置信区间2.46至4.31）和静息舒张压1.54 mm Hg（0.98至2.11）。当钠摄入量<2 g/d与≥2 g/d时，收缩压降低3.47 mm Hg（0.76至6.18），舒张压降低1.81 mm Hg（0.54至3.08）。钠摄入量减少对成人的血脂、儿茶酚胺水平或肾功能无显著不良影响（P>0.05）。没有足够的随机对照试验来评估减少钠摄入对死亡率和发病率的影响。在队列研究中，钠摄入量与全因死亡率、致死性和非致死性心血管疾病以及冠心病之间的相关性不显著（P>0.05）。钠摄入量增加与卒中风险（风险比1.24，95%置信区间1.08 - 1.43）、卒中死亡率（1.63，1.27 - 2.10）和冠心病死亡率（1.32，1.13 - 1.53）增加相关。在儿童中，钠摄入量的减少显著降低了收缩压0.84 mm Hg（0.25至1.43）和舒张压0.87 mm Hg（0.14至1.60）。结论：在非急性病成人中，高质量证据表明，减少钠摄入可降低血压，对血脂、儿茶酚胺水平或肾功能无不良影响;在儿童中，中等质量证据表明，减少钠摄入可降低血压。较低的钠摄入量还与成年人中风和致命冠心病的风险降低有关。所有证据表明，大多数人可能会从减少钠摄入量中受益。
Objective To assess the effect of decreased sodium intake on blood pressure, related cardiovascular diseases, and potential adverse effects such as changes in blood lipids, catecholamine levels, and renal function. Design Systematic review and meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, the Latin American and Caribbean health science literature database, and the reference lists of previous reviews. Study selection Randomised controlled trials and prospective cohort studies in non-acutely ill adults and children assessing the relations between sodium intake and blood pressure, renal function, blood lipids, and catecholamine levels, and in non-acutely ill adults all cause mortality, cardiovascular disease, stroke, and coronary heart disease. Study appraisal and synthesis Potential studies were screened independently and in duplicate and study characteristics and outcomes extracted. When possible we conducted a meta-analysis to estimate the effect of lower sodium intake using the inverse variance method and a random effects model. We present results as mean differences or risk ratios, with 95% confidence intervals. Results We included 14 cohort studies and five randomised controlled trials reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease; and 37 randomised controlled trials measuring blood pressure, renal function, blood lipids, and catecholamine levels in adults. Nine controlled trials and one cohort study in children reporting on blood pressure were also included. In adults a reduction in sodium intake significantly reduced resting systolic blood pressure by 3.39 mm Hg (95% confidence interval 2.46 to 4.31) and resting diastolic blood pressure by 1.54 mm Hg (0.98 to 2.11). When sodium intake was <2 g/day versus ≥2 g/day, systolic blood pressure was reduced by 3.47 mm Hg (0.76 to 6.18) and diastolic blood pressure by 1.81 mm Hg (0.54 to 3.08). Decreased sodium intake had no significant adverse effect on blood lipids, catecholamine levels, or renal function in adults (P>0.05). There were insufficient randomised controlled trials to assess the effects of reduced sodium intake on mortality and morbidity. The associations in cohort studies between sodium intake and all cause mortality, incident fatal and non-fatal cardiovascular disease, and coronary heart disease were non-significant (P>0.05). Increased sodium intake was associated with an increased risk of stroke (risk ratio 1.24, 95% confidence interval 1.08 to 1.43), stroke mortality (1.63, 1.27 to 2.10), and coronary heart disease mortality (1.32, 1.13 to 1.53). In children, a reduction in sodium intake significantly reduced systolic blood pressure by 0.84 mm Hg (0.25 to 1.43) and diastolic blood pressure by 0.87 mm Hg (0.14 to 1.60). Conclusions High quality evidence in non-acutely ill adults shows that reduced sodium intake reduces blood pressure and has no adverse effect on blood lipids, catecholamine levels, or renal function, and moderate quality evidence in children shows that a reduction in sodium intake reduces blood pressure. Lower sodium intake is also associated with a reduced risk of stroke and fatal coronary heart disease in adults. The totality of evidence suggests that most people will likely benefit from reducing sodium intake.