Consumo de sal: Beneficios y riesgos para la salud según la dosis
Nuevos datos sobre el consumo de sal han conducido a la publicación de dos informes en el "New England Journal of Medicine". La cuestión es que el consumo de sal por defecto o por exceso puede ser perjudicial para la salud de las personas.
En el estudio PURE (Prospective Urban & Rural Epidemiological), llevado a cabo por investigadores del grupo Hamilton Health Sciences de la Universidad McMaster, se hizo un seguimiento de más de 100.000 personas durante cerca de cuatro años. En él se evaluó el consumo de sodio y potasio, y se relacionó con la tensión arterial, las muertes, las cardiopatías y los accidentes cerebrovasculares. El consumo actual de sodio en Canadá es típicamente de entre 3,5 y 4 gramos al día; algunas directrices han recomendado que la totalidad de la población reduzca su consumo de sodio a menos de 2,3 gramos al día, una cantidad que menos del 5 por ciento de los canadienses (y personas de todo el mundo) consume actualmente.
El aumento del consumo de sodio por encima de los 5 gramos al día también provoca un aumento significativo de la tensión arterial, lo cual es especialmente drástico en las personas que ya tienen hipertensión, tienen más de 55 años, o ambos. Los efectos son más moderados con los niveles promedio de consumo de sodio (de 3 a 5 gramos al día), y no son aparentes en los niveles bajos de consumo, por debajo de los 3 gramos (un nivel que es superior al máximo recomendado por muchas directrices actuales), según el autor principal, Andrew Mente. .
"Si bien ha habido mucho énfasis en la reducción de sal en la dieta, un método importante e ignorado para reducir la tensión arterial es aumentar la cantidad de potasio consumido", afirma Mente. "Ello se puede lograr moderando el consumo de sal y tomando gran cantidad de frutas y verduras".
Sin embargo, los investigadores han descubierto también que quizá el consumo insuficiente de sal puede comportar un riesgo, según el autor principal del segundo informe, Martin O'Donnell. Él sugiere que la cantidad recomendada generalmente hoy en día como límite saludable para el consumo de sal parece ser demasiado escasa. Entre otras cosas, el bajo consumo de sodio puede causar una elevación desfavorable de determinadas hormonas, asociada a un incremento del riesgo de muerte y enfermedades cardiovasculares.
"En el estudio PURE, observamos el menor riesgo de muerte y acontecimientos cardiovasculares en los que consumían cantidades moderadas de sodio (de 3 a 6 gramos al día), así como un aumento del riesgo por encima y por debajo de dicho intervalo. Aunque este resultado ha sido notificado en estudios anteriores a menor escala, PURE es el mayor estudio internacional de evaluación del consumo de sodio y los resultados para la salud, y añade una solidez considerable a la afirmación de que el consumo moderado de sodio es óptimo", enfatizaba O'Donnell.
Referencias
Association of Urinary Sodium and Potassium Excretion with Blood Pressure
Comments open through August 20, 2014- Abstract
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BACKGROUND
Higher levels of sodium intake are reported to be associated with higher blood pressure. Whether this relationship varies according to levels of sodium or potassium intake and in different populations is unknown.METHODS
We studied 102,216 adults from 18 countries. Estimates of 24-hour sodium and potassium excretion were made from a single fasting morning urine specimen and were used as surrogates for intake. We assessed the relationship between electrolyte excretion and blood pressure, as measured with an automated device.RESULTS
Regression analyses showed increments of 2.11 mm Hg in systolic blood pressure and 0.78 mm Hg in diastolic blood pressure for each 1-g increment in estimated sodium excretion. The slope of this association was steeper with higher sodium intake (an increment of 2.58 mm Hg in systolic blood pressure per gram for sodium excretion >5 g per day, 1.74 mm Hg per gram for 3 to 5 g per day, and 0.74 mm Hg per gram for <3 g per day; P<0.001 for interaction). The slope of association was steeper for persons with hypertension (2.49 mm Hg per gram) than for those without hypertension (1.30 mm Hg per gram, P<0.001 for interaction) and was steeper with increased age (2.97 mm Hg per gram at >55 years of age, 2.43 mm Hg per gram at 45 to 55 years of age, and 1.96 mm Hg per gram at <45 years of age; P<0.001 for interaction). Potassium excretion was inversely associated with systolic blood pressure, with a steeper slope of association for persons with hypertension than for those without it (P<0.001) and a steeper slope with increased age (P<0.001).CONCLUSIONS
In this study, the association of estimated intake of sodium and potassium, as determined from measurements of excretion of these cations, with blood pressure was nonlinear and was most pronounced in persons consuming high-sodium diets, persons with hypertension, and older persons. (Funded by the Heart and Stroke Foundation of Ontario and others.)
Global Sodium Consumption and Death from Cardiovascular Causes
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BACKGROUND
High sodium intake increases blood pressure, a risk factor for cardiovascular disease, but the effects of sodium intake on global cardiovascular mortality are uncertain.METHODS
We collected data from surveys on sodium intake as determined by urinary excretion and diet in persons from 66 countries (accounting for 74.1% of adults throughout the world), and we used these data to quantify the global consumption of sodium according to age, sex, and country. The effects of sodium on blood pressure, according to age, race, and the presence or absence of hypertension, were calculated from data in a new meta-analysis of 107 randomized interventions, and the effects of blood pressure on cardiovascular mortality, according to age, were calculated from a meta-analysis of cohorts. Cause-specific mortality was derived from the Global Burden of Disease Study 2010. Using comparative risk assessment, we estimated the cardiovascular effects of current sodium intake, as compared with a reference intake of 2.0 g of sodium per day, according to age, sex, and country.RESULTS
In 2010, the estimated mean level of global sodium consumption was 3.95 g per day, and regional mean levels ranged from 2.18 to 5.51 g per day. Globally, 1.65 million annual deaths from cardiovascular causes (95% uncertainty interval [confidence interval], 1.10 million to 2.22 million) were attributed to sodium intake above the reference level; 61.9% of these deaths occurred in men and 38.1% occurred in women. These deaths accounted for nearly 1 of every 10 deaths from cardiovascular causes (9.5%). Four of every 5 deaths (84.3%) occurred in low- and middle-income countries, and 2 of every 5 deaths (40.4%) were premature (before 70 years of age). The rate of death from cardiovascular causes associated with sodium intake above the reference level was highest in the country of Georgia and lowest in Kenya.CONCLUSIONS
In this modeling study, 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day. (Funded by the Bill and Melinda Gates Foundation.)
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