Sodium Intake and Metabolic Health

Sodium Intake and Metabolic Health

Sodium, commonly known as “salt” (usually in the form of sodium chloride), is an essential part of diet and necessary for the normal functioning and health of the body.1 However, sodium is closely related to metabolic health and can have various negative health effects when consumed in excess.

Excess Salt Increases Risk of Heart Disease – Greater sodium intake is associated with higher blood pressure.2 Increased sodium consumption can lead to water retention, increased sympathetic nervous system activity, and increased stiffness of the arteries, which, among other changes, lead to increased blood pressure.3 As hypertension (blood pressure defined as >130 mm Hg/80 mm Hg) is the greatest risk factor for developing cardiovascular (ie, heart and blood vessel) disease (CVD), blood pressure control is imperative in maintaining cardiovascular health.4,5 Numerous studies have demonstrated that reduced sodium intake leads to lowered blood pressure, and in some cases, lower CVD risk.2 Furthermore, meta-analyses of prospective cohort studies have consistently found that higher salt intake was associated with increased risk of stroke, CVD, and fatal coronary (ie, artery-related) events.6,7

Salt Should Especially Be Limited in Diabetes – Limiting sodium intake is especially important in individuals with type 2 diabetes mellitus (T2DM) because of the high prevalence of hypertension in this population.8,9 Current research hypothesizes that obesity-induced insulin resistance, hyperinsulinemia (ie, high levels of insulin), changes to kidney function, and other factors may contribute to hypertension in diabetes.9 Additionally, T2DM is associated with increased risk of developing CVD. The American Heart Association, in light of these evidence, recommends that sodium intake be limited to less than 1,500 mg per day for individuals at risk of heart disease, including those with T2DM.8 

Excess Salt May Contribute to Weight Gain and Obesity – Recent evidence is pointing that high sodium consumption is directly and indirectly linked to weight gain.10 Analyses of population data have shown that adults who consumed more sodium than the recommended amount were at an increased risk of obesity and central obesity.10,11 High sodium intake can stimulate thirst and increase extracellular volume from increased fluid intake. Moreover, high-salt foods are generally higher in calories and can increase consumption of soft drinks. Animal studies have shown that high sodium consumption can also affect hunger-related hormones and insulin and glucose metabolism, potentially explaining how high sodium intake may lead to weight gain on a physiologic level.10

Reduce Salt Intake for Metabolic Health – In light of current research, it is important for both healthy individuals and individuals at risk of heart disease to be watchful of their daily sodium intake. The 2020-2025 Dietary Guidelines for Americans recommends daily sodium intake of less than 2,300 mg in healthy adults,12 but it should be noted that the average global sodium intake often exceeds twice the recommendation.3 Easy ways to begin lowering sodium intake is to avoid or lower consumption of foods generally high in dietary sodium: processed foods, packaged foods, and restaurant foods, which account for most of dietary sodium intake.2



1. Mente A, O’Donnell M, Yusuf S. Sodium Intake and Health: What Should We Recommend Based on the Current Evidence? Nutrients. 2021;13(9):3232. doi:10.3390/nu13093232
2. Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2021;144(23):e472-e487. doi:10.1161/CIR.0000000000001031
3. Grillo A, Salvi L, Coruzzi P, Salvi P, Parati G. Sodium Intake and Hypertension. Nutrients. 2019;11(9):1970. doi:10.3390/nu11091970
4. Fuchs FD, Whelton PK. High Blood Pressure and Cardiovascular Disease. Hypertension. 2020;75(2):285-292. doi:10.1161/HYPERTENSIONAHA.119.14240
5. Wu CY, Hu HY, Chou YJ, Huang N, Chou YC, Li CP. High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults. Medicine (Baltimore). 2015;94(47):e2160. doi:10.1097/MD.0000000000002160
6. O’Donnell M, Mente A, Yusuf S. Sodium Intake and Cardiovascular Health. Circ Res. 2015;116(6):1046-1057. doi:10.1161/CIRCRESAHA.116.303771
7. Wang YJ, Yeh TL, Shih MC, Tu YK, Chien KL. Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis. Nutrients. 2020;12(10):2934. doi:10.3390/nu12102934
8. Provenzano LF, Stark S, Steenkiste A, Piraino B, Sevick MA. Dietary Sodium Intake in Type 2 Diabetes. Clin Diabetes. 2014;32(3):106-112. doi:10.2337/diaclin.32.3.106
9. Feldstein CA. Salt Intake, Hypertension and Diabetes Mellitus. J Hum Hypertens. 2002;16(1):S48-S51. doi:10.1038/sj.jhh.1001342
10. Zhang X, Wang J, Li J, Yu Y, Song Y. A Positive Association Between Dietary Sodium Intake and Obesity and Central Obesity: Results from the National Health and Nutrition Examination Survey 1999-2006. Nutr Res. 2018;55:33-44. doi:10.1016/j.nutres.2018.04.008
11. Oh SW, Koo HS, Han KH, Han SY, Chin HJ. Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age. PLOS ONE. 2017;12(12):e0188770. doi:10.1371/journal.pone.0188770
12. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at



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