# High sodium intake Risk factor · id `cardio:high-sodium-intake` · Cardiovascular Atlas · release `2b2017b84496b985` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Also called: High salt intake Browse, organ or system: Blood vessels Browse, condition area: Risk and prevention; High blood pressure; Stroke ## In plain language Sodium is the part of table salt linked with higher blood pressure when people eat a lot of it. The World Health Organization advises adults to keep sodium below 2 grams a day, which is about 5 grams of salt. It estimated that average sodium intake worldwide in 2019 was more than double that limit. ## Technical summary Exposure defined here as dietary sodium above the WHO limit of less than 2 g a day of sodium (5 g of salt) in adults, a strong WHO recommendation. The MeSH heading "Sodium Chloride, Dietary" names the substance, not an intake level. Evidence recorded here is the WHO 2012 summary of observational associations (very low to low quality ratings) and the WHO 2025 restatement of the limit. The WHO 2012 text also reports an association with hypertension, recorded as a discovery link because the passage does not state raised risk. SSaSS tested a different thing: replacing salt with a potassium-containing substitute. ## Claims, with the population each applies to ## Context: Adults in general populations (WHO sodium intake guidance, 2012 and its 2025 restatement) Recipient: Adult; Population: Adults in the general population, with or without hypertension. The 2012 text also applies the recommendation to pregnant and lactating women; that item belongs to the maternal atlas and is outside this context. The 2012 text excludes people with illnesses or medicines that can cause low blood sodium or sudden fluid retention, and people who need physician-supervised diets, such as people with heart failure or type 1 diabetes.; Care setting: Not stated as a care setting. The guidance covers everyday dietary sodium intake.; Geography: Global guidance. The cohort studies in the 2012 meta-analysis were conducted in Europe, Japan and the United States.; Life stage: Adult; the sources set no age bounds in the passages read; Follow-up: Not applicable to the recommendation. The cohort studies in the 2012 summary followed adults for 3.8 to 22 years. ### The WHO 2012 sodium guideline reports that, in cohort studies of adults, people who ate more sodium had more strokes than people who ate the least. The pooled risk ratio was 1.24 (95% CI 1.08 to 1.43) for stroke and 1.63 (95% CI 1.27 to 2.10) for fatal stroke. WHO rated the evidence very low quality for stroke and low quality for fatal stroke. These are observational comparisons of higher and lower intake groups. - Category: Description - Evidence stage: Evidence synthesis - Certainty: Very low certainty (method: WHO's own GRADE quality ratings, printed in the 2012 guideline: very low for the stroke result and low for the fatal stroke result. The claim takes the lower rating.) - Applies to: Recipient: Adult; Population: Adults in the general population, with or without hypertension. The 2012 text also applies the recommendation to pregnant and lactating women; that item belongs to the maternal atlas and is outside this context. The 2012 text excludes people with illnesses or medicines that can cause low blood sodium or sudden fluid retention, and people who need physician-supervised diets, such as people with heart failure or type 1 diabetes.; Care setting: Not stated as a care setting. The guidance covers everyday dietary sodium intake.; Geography: Global guidance. The cohort studies in the 2012 meta-analysis were conducted in Europe, Japan and the United States.; Life stage: Adult; the sources set no age bounds in the passages read; Follow-up: Not applicable to the recommendation. The cohort studies in the 2012 summary followed adults for 3.8 to 22 years. - Limitations: Observational cohort data with very low to low quality ratings from WHO. Groups were compared on sodium intake, not on a change in intake, and the guideline notes that some cohort studies found no link, an inverse link (higher intake with lower risk) or a J-shaped curve. Intake ranges differed widely between studies, and the lowest-intake groups in some studies ate as much as 4 g of sodium a day, so the comparison is not intake above against below the WHO limit of 2 g. Nothing here shows that cutting sodium prevents strokes; the SSaSS claim concerns a different intervention. - Last checked: Not recorded - Sources: 1. Supports: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Executive summary, Background, paragraph 1. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: WHO links high sodium intake with hypertension, cardiovascular disease and stroke. 2. Supports: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Summary of evidence, page 13, meta-analysis of cohort studies. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: Pooled risk ratio for stroke, quality very low. 3. Supports: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Summary of evidence, page 13, fatal stroke. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: Pooled risk ratio for fatal stroke, quality low. 4. Background: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Summary of evidence, page 13, cohort studies and comparison groups. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: Fifteen cohort studies in adults, reference group lowest intake, comparison group generally highest. 5. Background: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Background, page 6. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: Most cohort studies reported a direct relationship, but not all. ### WHO recommends that adults reduce sodium intake to below 2 g a day, about 5 g of salt, to lower blood pressure and the risk of heart and blood-vessel disease. WHO calls this a strong recommendation and restates it in its 2025 salt-substitute guideline. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adults in the general population, with or without hypertension. The 2012 text also applies the recommendation to pregnant and lactating women; that item belongs to the maternal atlas and is outside this context. The 2012 text excludes people with illnesses or medicines that can cause low blood sodium or sudden fluid retention, and people who need physician-supervised diets, such as people with heart failure or type 1 diabetes.; Care setting: Not stated as a care setting. The guidance covers everyday dietary sodium intake.; Geography: Global guidance. The cohort studies in the 2012 meta-analysis were conducted in Europe, Japan and the United States.; Life stage: Adult; the sources set no age bounds in the passages read; Follow-up: Not applicable to the recommendation. The cohort studies in the 2012 summary followed adults for 3.8 to 22 years. - Limitations: The 2025 guideline restates the limit; the strong recommendation itself comes from the 2012 WHO guideline, which this claim cites. In its recommendation remarks that PDF rates the evidence on sodium and blood pressure as high quality, and the evidence on sodium and all-cause mortality, cardiovascular disease, stroke and coronary heart disease as lower quality. Its Annex 1 GRADE table for intake below 2 g a day against 2 g or more in adults says that no study addressed that question with cardiovascular disease or stroke as its outcome. The table rates resting systolic blood pressure at 3.47 mmHg lower from 2 studies, graded high, and has no estimate for any cardiovascular event outcome. A footnote to that table reports 5 cohort studies that compared the two intake levels, with a risk ratio of 1.30 (1.03 to 1.64) for stroke at 2 g a day or more, and the table gives that cohort result no GRADE rating. Annex 8 of the PDF describes evidence of high and moderate quality that intake below 2 g a day is beneficial for blood pressure and for the risk of cardiovascular disease, stroke and coronary heart disease in adults. It rates the cardiovascular part as moderate quality on the basis of the blood-pressure evidence, citing the well-established link between blood pressure and cardiovascular outcomes. WHO gives no single certainty rating for the 2 g limit, so the certainty stays not assessed. The 2012 text applies the limit to pregnant and lactating women too, which is outside this context. The limit is for general populations and excludes people on supervised diets or with illnesses that affect body sodium. - Last checked: Not recorded - Sources: 1. Supports: Use of lower-sodium salt substitutes: WHO guideline (Guideline, edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025.) Locator: Executive summary, aligned WHO recommendations on sodium intake, page x. Retrieved 2026-10-11T19:11:28Z. Source state: Current. Snapshot hash: e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0. How it applies: The limit as restated in 2025. 2. Supports: Use of lower-sodium salt substitutes: WHO guideline (Guideline, edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025.) Locator: Executive summary, WHO recommendation box, page ix (rationale sentence). Retrieved 2026-10-11T19:11:28Z. Source state: Current. Snapshot hash: e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0. How it applies: Why WHO recommends it: blood pressure and cardiovascular risk. 3. Background: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Executive summary, Background, paragraph 1. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: The 2012 guideline gives 2 g of sodium a day, equal to 5 g of salt. 4. Background: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Executive summary, Recommendations remarks, page 3, paragraph 1. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: Who the 2012 recommendation applies to and its exceptions. 5. Background: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Executive summary, Recommendations remarks, page 3, paragraph 4. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: WHO's statement of the quality of the evidence behind the 2012 recommendations. 6. Background: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Annex 1, GRADE table for intake below 2 g/day against 2 g/day or more in adults (PDF page 32), outcome rows and notes. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: No study had cardiovascular disease or stroke as its outcome; blood pressure rated high; a footnote reports cohort studies. 7. Background: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Summary of evidence, page 12, comparison of the lowest with the middle consumption group. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: The blood-pressure difference for below 2 g a day, with WHO's high quality rating. 8. Background: Guideline: Sodium intake for adults and children (Guideline, edition English PDF from WHO IRIS, fetched 2026-10-11. The copyright page reads 2012, reprinted 2014.) Locator: Annex 8, Quality of evidence, page 37. Retrieved 2026-10-11T19:12:45Z. Source state: Current. Snapshot hash: 1f42c807c29ae255b31554afafaed683d5598414a1e5cc2a4b89190c72e2f369. How it applies: WHO's summary of evidence quality when it set the strength of the recommendation. ## Connected pages - Observational association with stroke (WHO 2012, quality very low to low): Stroke (`core:stroke`) [a claim, not a settled fact; see claim `cardio:claim-high-sodium-raises-stroke-risk` and its context] - Discussed together in the WHO 2012 sodium guideline: Hypertension (high blood pressure) (`core:hypertension`) - Recommended for this: Salt substitution (lower-sodium, potassium-containing salt) (`cardio:salt-substitution`) [a claim, not a settled fact; see claim `cardio:claim-who-2025-lsss` and its context] - Investigated in: China Salt Substitute and Stroke Study (SSaSS) (`cardio:ssass`) ## Provenance Content hash: 28d5c3f4d3562c348a41974113320d38c1cf6e4331af59a11880360bbb34e4d2 Last substantive edit: 2026-10-11 Evidence last checked: 2026-10-11