Association Between Sodium Excretion and Cardiovascular Disease and Mortality in the Elderly: A Cohort Study.
Diana Lelli, Raffaele Antonelli-Incalzi, Stefania Bandinelli and 2 others
PMID 29042264WHAT IT FOUND
Low sodium excretion in older adults was associated with higher mortality, especially below 6.25 g/d.
High sodium excretion was not associated with new cardiovascular events.
Key findings
01Lower sodium excretion below 6.25 g/d was associated with higher adjusted mortality risk (HR 1.12).
02The adjusted mortality association was higher in frail participants (HR 1.23) than in robust participants (HR 1.11).
03Sodium excretion was not associated with incident cardiovascular events after adjustment (RR 0.96).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is an observational cohort, not a trial. It cannot show that changing sodium intake causes any outcome. Sodium excretion was measured only at baseline, so later diet changes were not captured. Lower sodium excretion was linked to lower energy intake, older age, frailty, dementia, and other conditions, so it may mark poor health or reduced eating rather than salt restriction. The authors note possible reverse causation: older people may eat and drink less near the end of life. For incident cardiovascular events, only 514 participants without baseline cardiovascular disease were analyzed, and the adjusted result was null. Frailty subgroup analyses were limited by small numbers, especially in the sensitivity sample without cardiovascular disease or hypertension, where only 24 frail people were available.
Declared interests
The authors declare no conflicts of interest. The baseline study was supported by the Italian Ministry of Health and partly by the US National Institute on Aging.
The easy way to misread this
Do not conclude that reducing salt intake causes higher mortality. This observational study did not assign sodium intake, and low sodium excretion may reflect lower food intake, frailty, illness, or reverse causation.