Recommended Daily Sodium Intake
For the general adult population, limit sodium intake to less than 2,300 mg per day, with further reduction to 1,500 mg per day recommended for individuals with hypertension, diabetes, chronic kidney disease, African Americans, and adults over 51 years of age. 1, 2
General Population Recommendations
The tiered approach to sodium restriction is based on cardiovascular risk:
- Primary target: <2,300 mg/day for all adults without specific risk factors 2, 3
- Enhanced target: <1,500 mg/day provides greater blood pressure reduction and cardiovascular benefit 1, 2
- The World Health Organization recommends <2,000 mg/day (5 g salt) as an alternative general population target 2
High-Risk Populations Requiring Stricter Limits (<1,500 mg/day)
The following groups should aim for the lower 1,500 mg/day threshold 1:
- All individuals with hypertension (systolic/diastolic BP >95th percentile) 1
- All persons with diabetes mellitus 1
- All persons with chronic kidney disease 1
- All African Americans (regardless of age or comorbidities) 1
- All adults over 51 years of age 1
This high-risk group represents approximately 70% of the U.S. adult population 3, 4
Pediatric Sodium Recommendations
Age-appropriate targets based on body weight considerations 1:
- Children 1-3 years: 1,000 mg/day (adequate intake level) 1
- Children 4-8 years: 1,200 mg/day (adequate intake level) 1
- Children with CKD and hypertension: 1-2 mmol/kg/day (equivalent to 1,500-2,400 mg/day for a 60-70 kg reference) 1
Special Considerations for Diabetes and Hypertension
For individuals with both diabetes and hypertension, a sodium goal of <2,300 mg/day should be considered on an individual basis, recognizing the challenges of palatability, cost of low-sodium products, and achieving nutritional adequacy 1. While 1,500 mg/day shows greater blood pressure benefits, some studies warrant caution for universal restriction to this level in diabetic populations 1.
Evidence Supporting These Recommendations
The strength of evidence is robust:
- Blood pressure reduction: Decreasing sodium intake consistently reduces blood pressure in both general and diabetic populations 1
- Cardiovascular benefits: Reducing sodium by at least 1,000 mg/day from current levels lowers blood pressure and cardiovascular risk 2
- Potential impact: Population-wide reduction to 2,300 mg/day could prevent 11 million cases of hypertension and reduce 60,000-120,000 new coronary heart disease cases annually 3, 5
Important Caveats
Current average intake vastly exceeds recommendations: U.S. adults consume an average of 3,266-3,436 mg/day, with only 9.6% meeting their applicable recommended limit 3, 5. This gap highlights the difficulty of adherence.
Observational data suggests a J-shaped curve: Some recent prospective cohort studies indicate that very low sodium intake (<3 g/day) may paradoxically associate with higher cardiovascular risk compared to moderate intake (3-5 g/day), though these studies primarily involved high-risk populations 6. However, this does not negate guideline recommendations, as randomized controlled trials consistently show blood pressure benefits with sodium reduction 1.
Sources of dietary sodium: Approximately 75% of sodium comes from processed and restaurant foods, only 10% occurs naturally in foods, and 5-10% is added during cooking or at the table 1. This makes individual dietary modification challenging without food industry cooperation.
Practical Implementation Strategies
To achieve recommended sodium limits 1, 2:
- Replace processed and canned foods with fresh foods
- Read nutrition labels; choose products with <140 mg or <5% daily value per serving
- Use herbs, spices, and salt-free seasonings instead of salt
- Limit restaurant and fast food consumption
- Avoid salt substitutes containing potassium chloride if hyperkalemia is present 1
- Be aware that certain medications (antacids, laxatives, NSAIDs) contain significant sodium 1