Article Text

Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide
  1. John Powles1,
  2. Saman Fahimi1,
  3. Renata Micha2,3,
  4. Shahab Khatibzadeh2,
  5. Peilin Shi2,
  6. Majid Ezzati4,
  7. Rebecca E Engell5,
  8. Stephen S Lim5,
  9. Goodarz Danaei2,6,
  10. Dariush Mozaffarian2,7,
  11. on behalf of the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE)
  1. 1Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge, UK
  2. 2Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  3. 3Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
  4. 4MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
  5. 5Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  6. 6Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
  7. 7Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr John Powles; jwp11{at}


Objectives To estimate global, regional (21 regions) and national (187 countries) sodium intakes in adults in 1990 and 2010.

Design Bayesian hierarchical modelling using all identifiable primary sources.

Data sources and eligibility We searched and obtained published and unpublished data from 142 surveys of 24 h urinary sodium and 103 of dietary sodium conducted between 1980 and 2010 across 66 countries. Dietary estimates were converted to urine equivalents based on 79 pairs of dual measurements.

Modelling methods Bayesian hierarchical modelling used survey data and their characteristics to estimate mean sodium intake, by sex, 5 years age group and associated uncertainty for persons aged 20+ in 187 countries in 1990 and 2010. Country-level covariates were national income/person and composition of food supplies.

Main outcome measures Mean sodium intake (g/day) as estimable by 24 h urine collections, without adjustment for non-urinary losses.

Results In 2010, global mean sodium intake was 3.95 g/day (95% uncertainty interval: 3.89 to 4.01). This was nearly twice the WHO recommended limit of 2 g/day and equivalent to 10.06 (9.88–10.21) g/day of salt. Intake in men was ∼10% higher than in women; differences by age were small. Intakes were highest in East Asia, Central Asia and Eastern Europe (mean >4.2 g/day) and in Central Europe and Middle East/North Africa (3.9–4.2 g/day). Regional mean intakes in North America, Western Europe and Australia/New Zealand ranged from 3.4 to 3.8 g/day. Intakes were lower (<3.3 g/day), but more uncertain, in sub-Saharan Africa and Latin America. Between 1990 and 2010, modest, but uncertain, increases in sodium intakes were identified.

Conclusions Sodium intakes exceed the recommended levels in almost all countries with small differences by age and sex. Virtually all populations would benefit from sodium reduction, supported by enhanced surveillance.

  • Nutrition & Dietetics
  • Epidemiology
  • Hypertension < Cardiology
  • Preventive Medicine

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