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Reply to Chiolero: Salt intake monitoring at a population level

Journal of Human Hypertension volume 34, pages 666–667 (2020)Cite this article

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We thank Dr Chiolero for his comments [1] on our statement [2]. We seem to agree that estimated sodium excretion using urine spot samples is inadequate to assess individuals’ salt consumption and the health risks associated with high salt intake. This position is shared by other international panels [3, 4].

The stated goal no. 2 is “to estimate salt intake at the group or population level, e.g., for the monitoring of salt intake in a given population.” As we state in our piece, there are four objectives for measuring average population salt intake, one of which is to evaluate the effectiveness of intervention in populations, by assessing the average “change” in population salt consumption over time. Evidence from a randomized clinical trial in China confirms the inadequacy of urinary sodium assessed in spot samples to detect small but meaningful changes in average salt consumption in a head-to-head comparison with urinary sodium, assessed using 24 h collections [5] [see Fig. 2b in our statement] [2]. This is a fundamental limitation that does not make this method fit to evaluate the effectiveness of interventions in populations.

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References

  1. Chiolero A. Salt intake monitoring at a population level. J Hum Hypertens. 2019. https://doi.org/10.1038/s41371-019-0249-0.

  2. Cappuccio FP, Sever PS. On behalf of the British and Irish Hypertension Society. The importance of a valid assessment of salt intake in individuals and populations. A scientific statement of the British and Irish Hypertension. Society. J Hum Hypertens. 2019;33:345–8.

    Article  Google Scholar 

  3. Cappuccio FP, Beer M, Strazzullo P on behalf of the European Salt Action Network. Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network. Nutr Metab Cardiovasc Dis. 2019;29:107–14.

    Article  Google Scholar 

  4. Campbell NRC, He FJ, Tan M, Cappuccio FP, Neal B, Woodward M, et al. The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) position statement on the use of 24-hour, spot and short duration (less than 24-hours) timed urine collections to assess dietary sodium intake. J Clin Hypertens. 2019;21:700–9.

  5. Huang L, Woodward M, Stepien S, Tian M, Yiu X, Hao Z, et al. Spot urine samples compared to 24-h urine samples for estimating changes in urinary sodium and potassium excretion in the China Salt Substitute and Stroke Study. Int J Epidemiol. 2018;47:1811–20.

    Article  Google Scholar 

  6. World Health Organization. How to obtain measures of population-level sodium intake in 24-hour urine samples. WHO-EM/NUT/279/E. World Health Organization/Regional Office of the Eastern Mediterranean; 2018. p. 1–51.

  7. World Health Organization. Dietary intake salt survey in the Republic of Moldova 2016. World Health Organization, Regional Office for Europe; 2018. p. 1–108.

  8. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organization; 2013. p. 1–102.

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Authors and Affiliations

  1. WHO Collaborating Centre for Nutrition, Warwick Medical School, and UHCW NHS Trust, University of Warwick, Coventry, UK

    Francesco P. Cappuccio

  2. Imperial College London, National Heart & Lung Institute, London, UK

    Peter S. Sever

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  1. Francesco P. Cappuccio
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  2. Peter S. Sever
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on behalf of the British and Irish Hypertension Society

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FPC is a Technical Advisor to the World Health Organization, and President and Trustee of the British and Irish Hypertension Society. PSS declares that he has no conflict of interest.

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Cappuccio, F.P., Sever, P.S. & on behalf of the British and Irish Hypertension Society. Reply to Chiolero: Salt intake monitoring at a population level. J Hum Hypertens 34, 666–667 (2020). https://doi.org/10.1038/s41371-019-0271-2

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