Adding salt to your food at the table is a link

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image: The risk of premature death from adding salt to food
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Credit: Please credit European Heart Journal

People who add extra salt to their food at the table are at a higher risk of dying prematurely from any cause, according to a study of more than 500,000 people, published in the European journal of the heart [1] today (Monday).

Compared with those who never or rarely added salt, those who always added salt to their food had a 28% increased risk of dying prematurely. In the general population, about three out of every hundred people between the ages of 40 and 69 die prematurely. The increased risk of always adding salt to food observed in the current study suggests that one more person in a hundred could die prematurely in this age group.

Additionally, the study found a lower life expectancy in people who always added salt compared to those who never or rarely added salt. At age 50, 1.5 years and 2.28 years were respectively subtracted from the life expectancy of women and men who always added salt to their diet compared to those who never did or rarely.

The researchers, led by Professor Lu Qi, from Tulane University’s School of Public Health and Tropical Medicine, New Orleans, US, say their findings have several implications for public health .

“To my knowledge, our study is the first to assess the relationship between the addition of salt to foods and premature death,” he said. “This provides new evidence in support of recommendations to modify eating behaviors to improve health. Even a modest reduction in sodium intake, by adding less or no salt to foods at the table, is likely to lead to substantial health benefits, especially when obtained in the general population.

Assessing overall sodium intake is notoriously difficult because many foods, especially pre-prepared and processed foods, contain high levels of added salt before they even reach the table. Studies assessing salt intake using urine tests often take only one urine test and therefore do not necessarily reflect typical behavior. In addition, foods high in salt are often accompanied by foods high in potassium, such as fruits and vegetables, which is good for us. [2]. Potassium is known to protect against the risk of heart disease and metabolic diseases such as diabetes, while sodium increases the risk of diseases such as cancer, high blood pressure and stroke.

For these reasons, the researchers chose to examine whether or not people added salt to their foods at the table, independent of any salt added during cooking.

“Adding salt to foods at the table is a common eating behavior that is directly related to an individual’s long-term preference for salty-tasting foods and habitual salt intake,” Professor Qi said. “In the Western diet, the addition of salt at the table accounts for 6-20% of total salt intake and is a unique way to assess the association between usual sodium intake and risk of death. “

Researchers analyzed data from 501,379 people participating in the UK Biobank study. When entering the study between 2006 and 2010, participants were asked, via a touchscreen questionnaire, if they added salt to their foods (i) never/rarely, (ii) sometimes, (iii ) usually, (iv) always, or (v) prefer not to answer. Those who preferred not to respond were not included in the analysis. The researchers adjusted their analyzes to account for factors that could affect the results, such as age, gender, race, deprivation, body mass index (BMI), smoking, alcohol consumption , physical activity, diet and medical conditions such as diabetes, cancer and diseases of the heart and blood vessels. They followed the participants for a median (average) of nine years. Premature death was defined as death before age 75.

In addition to finding that always adding salt to food was linked to a higher risk of premature death from all causes and reduced life expectancy, the researchers found that these risks tended to be slightly reduced in people who ate the highest amounts of fruits and vegetables. vegetables, although these results are not statistically significant.

“We were not surprised by this finding because fruits and vegetables are major sources of potassium, which has protective effects and is associated with a lower risk of premature death,” Professor Qi said.

He added: “Because our study is the first to report a relationship between the addition of salt to foods and mortality, further studies are needed to validate the results before making any recommendations.”

In an editorial accompanying the newspaper [3]Professor Annika Rosengren, senior researcher and professor of medicine at the Sahlgrenska Academy at the University of Gothenburg, Sweden, who was not involved in the research, writes that the net effect of a drastic reduction in consumption of salt in individuals remains controversial.

“Given the various indications that very low sodium intake may not be beneficial or even harmful, it is important to distinguish between individual-based recommendations and population-level actions,” she writes. .

She concludes: “Classical epidemiology argues that a greater net benefit is obtained by the population-wide approach (achieving a small effect in many people) than by targeting high-risk individuals (a significant effect but only obtained in a small number of people). The obvious and evidence-based strategy for preventing cardiovascular disease in individuals is the early detection and treatment of hypertension, including lifestyle modifications, while strategies for reducing the consumption of salt at the societal level will lower the average blood pressure levels of the population, which will reduce the number of people developing hypertension. , requiring treatment and falling ill. Not adding extra salt to foods is unlikely to be harmful and could contribute to strategies to lower people’s blood pressure levels.

A strength of Professor Qi’s study is the large number of people included. It also has some limitations, including: the possibility that the addition of salt to foods is an indication of an unhealthy lifestyle and lower socioeconomic status, although analyzes have attempted to accommodate this ; there was no information on the amount of salt added; salt addition can be related to total energy intake and related to intake of other foods; participation in UK Biobank is voluntary and therefore the results are not representative of the general population. Further studies are therefore needed to confirm the results in other populations.

Professor Qi and his colleagues will conduct further studies on the relationship between the addition of salt to foods and various chronic diseases such as cardiovascular disease and diabetes. They also expect potential clinical trials to test the effects of reduced salt addition on health outcomes.

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[1] “Addition of salt to foods and risk of premature mortality”, by Hao Ma et al. European journal of the heart. doi:10.1093/eurheartj/ehac208

[2] An example of a typically savory food that also contains vegetables are tacos, which are often filled with beans and vegetables.

[3] “Salt – the sweet spot?”, by Annika Rosengren. European journal of the heart. doi:10.1093/eurheartj/ehac336


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