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Comment & Response
September 2015

Dietary Sodium Intake and Risk of Cardiovascular Disease—Reply

Author Affiliations
  • 1Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, Georgia
  • 2Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
JAMA Intern Med. 2015;175(9):1579-1580. doi:10.1001/jamainternmed.2015.2571

In Reply We thank Liu and Zhang as well as Yi and colleagues for their interest in our work. We agree that food frequency questionnaires (FFQ) underestimate sodium intake. However, if this underestimation is similar across the range of intake, then the overall dose-response association should be valid, albeit at higher actual levels of dietary sodium intake. The latter is supported by findings from recent large-scale studies that point to a higher J point than previously thought for the dose-response association between sodium intake and outcomes.1,2 On the other hand, limited precision does dilute regression estimates, and this might have weakened the association with the outcomes of interest in our study. We also agree that statistical power was limited in the high sodium intake group. We categorized sodium intake using cutoff points driven by the current US recommendations to facilitate clinical interpretation. We would have liked to analyze a very high sodium intake subgroup, but the number of participants was too small to provide stable estimates. The small numbers in the very high sodium subgroup are potentially related to underestimation of sodium intake with FFQ. On the other hand, the dose-response association across the range of reported intakes is evident in the spline graph (Figure 1) provided in the main article.3

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