Sodium Reduction Is a Public Health Priority: Reflections on the Institute of Medicine's Report, Sodium Intake in Populations: Assessment of Evidence

sodium interventions. The IOM committee determined that sodium intake impacts health outcomes through pathways in addition to the blood pressure pathway. The report included recommendations to strengthen research to understand the extent of the effect of sodium on blood pressure and then to events and mortality and for more studies addressing mechanisms. The committee limited its evaluation, and therefore conclusions, to studies published from 2003 to 2012—that is, the period since the 2005 Dietary Reference Intakes for Water, Sodium, Chloride, and Sulfate (DRI) were developed. Based on available scientific literature at the time, the 2005 DRI report established adequate intakes for sodium across all life stages and sex groups and specifically determined that the highest level of sodium intake not likely to pose a risk of adverse health effects for almost all individuals in the general population (tolerable upper intake level) is 2,300 mg/day for persons aged ≥14 years. 5 (Based on the food supply, the AI for sodium (including sweat loss) was established to ensure the minimum level needed for sodium and to provide an adequate intake of other essential nutrients.) In the 2013 report, the committee concluded that there is a positive relationship between higher levels of sodium intake and the risk of cardiovascular disease (e.g., heart disease and stroke). 12 This is consistent with prior knowledge of the adverse effects of sodium intake on blood pressure. The IOM committee also concluded that there is substantial population benefit to be gained—and no evidence of harm— from reducing sodium intake to a level of 2,300 mg/day. (As a result of how this report and its findings were misinterpreted in some media outlets, IOM President Dr Harvey Fineberg wrote a letter to the Honorable Secretary Sebelius to restate the conclusions. Additionally, 3 IOM committee members