July 3, 2013

Sodium Reduction in PopulationsInsights From the Institute of Medicine Committee

Author Affiliations
  • 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 2University of California San Diego, La Jolla
  • 3Veterans Affairs San Diego Healthcare System, La Jolla, California

Copyright 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2013;310(1):31-32. doi:10.1001/jama.2013.7687

The recent Institute of Medicine (IOM) report regarding dietary sodium1 has generated considerable interest and debate, as well as misinterpretation by advocates on both sides. Further discussion is necessary to inform the public and the health care community and to inform public health strategies for sodium reduction.

Dietary sodium intake averages approximately 3400 mg/d in US adults, far in excess of the Dietary Guidelines for Americans (DGA) recommendation of less than 2300 mg/d for those older than 2 years and less than 1500 mg/d for certain high-risk subgroups, including African Americans, individuals with hypertension, diabetes, or chronic kidney disease (CKD), or those older than 50 years.2 In contrast, the 2005 IOM Panel on Dietary Reference Intakes (DRI) for Water, Potassium, Sodium, Chloride, and Sulfate3 found insufficient evidence to derive a “recommended dietary allowance” for sodium. Instead, an “adequate intake” of 1500 mg/d of dietary sodium was determined, reflecting the minimum needed to achieve a diet adequate in essential nutrients and to cover sweat losses. Additionally, the 2005 IOM panel established a “tolerable upper intake level,” using projections from available data on the effects on blood pressure, that consumption up to 2300 mg/d was unlikely to cause harm.

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