Low-frequency additions of excess salt to foods are associated with an increased risk of heart disease, heart failure and ischemic heart disease, according to a new study published today. Journal of the American College of Cardiology. Even among those following a DASH-style diet, behavioral interventions to reduce salt intake may further improve heart health.
There is substantial evidence linking high sodium intake with hypertension, a major risk factor for cardiovascular disease. However, epidemiologic studies investigating this link have produced conflicting results due to a lack of practical methods for assessing long-term dietary sodium intake. Recent research has shown that the frequency with which a person adds salt to their food can be used to predict their individual sodium intake over time.
“Overall, we found that people who didn’t add even a little extra salt to their diet often had a much lower risk of heart disease, regardless of lifestyle factors and pre-existing diseases,” said Lu Cui, MD, PhD, HCA Regents Distinguished Chair and School of Medicine at Tulane University in New Orleans. Professor of Public Health and Tropical Medicine. “We also found that when patients combined a DASH diet with a low frequency of added salt, they had the lowest risk of heart disease. This makes sense because reducing excess salt in the diet, not eliminating salt completely, is an incredibly modifiable risk factor that we expect.” Kari can encourage our patients to do without much sacrifice.”
In the current study, the authors assessed whether the frequency of added salt to food was associated with heart disease risk among 176,570 UK Biobank participants. The study also examined the relationship between the frequency of added salt to food and the DASH diet as it relates to heart disease risk.
The study used a questionnaire at baseline to collect data on the frequency of adding salt to food, not including salt used in cooking. Participants were asked whether they had made any major changes in their diet in the past 5 years, as well as completed rounds 1–5 of a 24-hour dietary recall over a three-year period.
The DASH-style diet was developed to prevent high blood pressure by limiting consumption of red and processed meat and focusing on vegetables, fruits, whole grains, low-fat dairy foods, nuts, and legumes. Although the DASH diet has shown benefits in reducing the risk of cardiovascular disease, a recent clinical trial found that combining the DASH diet with sodium reduction is more beneficial for specific cardiac biomarkers, including cardiac injury, strain, and inflammation. The researchers calculated a modified DASH score that does not take into account sodium intake based on seven foods and nutrients emphasized or minimized in the DASH-style diet.
Data on cardiac events were collected through medical history and hospital admissions, questionnaires and death registration data.
Overall, study participants with a low frequency of adding salt to food were more likely to be female; white; have a low body mass index; Moderate alcohol consumption is more likely; Less likely to be current smokers; and more physically active. They also had a higher incidence of high blood pressure and chronic kidney disease, but a lower incidence of cancer. These participants were also more likely to adhere to a DASH-style diet and were more likely to eat more fruits, vegetables, nuts and legumes, whole grains, a low-fat diet but less sugar-sweetened beverages, or red/processed meat with added salt in the diet.
The researchers found that the association of added salt in foods with heart disease risk was stronger among participants of lower socioeconomic status as well as among current smokers. A higher modified DASH diet score was associated with a lower risk of cardiovascular events.
In a related editorial comment, Sarah Ghonim, MD, a gastroenterology fellow at the University of Nebraska Medical Center, wrote that the study is promising, builds on previous reports, and indicates a potential impact of long-term salt choices on total cardiovascular risk. .
“A major limitation of the study is the self-reported frequency of adding salt to food and the enrollment of participants only from the UK, limiting generalizability to other populations with different eating behaviours,” said Ghonim. “The results of the current study are encouraging and poised to expand our understanding of salt-related behavioral interventions on cardiovascular health.”