Science 1998; 281(14): 898-907. “The (Political) Science of Salt”

The (political) science of salt
Gary Taubes. Science. Washington: Aug 14, 1998. Vol. 281, Iss. 5379; pg. 898, 9 pgs

Abstract (Summary)

Taubes discusses the debate over the benefits of salt reduction, which shows how the demands of good science clash with the pressures of public health policy.

Quotes from the full article:

The last 5 years have also seen two studies published-the latest this past March in The Lancet-suggesting that low-salt diets can increase mortality. Both studies were done by Michael Alderman, a hypertension specialist at New York City’s Albert Einstein College of Medicine and president of the American Society of Hypertension. Epidemiologists-and Alderman himself-caution against putting too much stock in the studies. “They are yet more association studies,” says Swales. “Any insult you make of Intersalt you can make of those as well.” But Alderman also notes that only a handful of such studies comparing salt intake to mortality have ever been done, and none have come out definitively negative. “People just rely upon statements that [salt reduction] can’t really do any harm,” says Swales. “It may or may not be true. Individual harmful effects can be as small as beneficial effects, and you can’t detect those in clinical trials either.”

After publication of his second study, Alderman recruited past and present presidents of hypertension societies and the American Heart Association and wrote to Lenfant at the NHLBI “urging prompt appointment of an independent panel of qualified medical and public health scientists to review existing recommendations [on salt consumption] in light of all available data.” In April Lenfant told Science that he had agreed to proceed with the review. If such a panel should convene, Hennekens has one observation worth keeping in mind: “The problem with this field is that people have chosen sides,” he says. “What we ought to do is let the science drive the system rather than the opinions.”

[Sidebar]
TOUCHSTONES OF THE SALT DEBATE
[Sidebar]

Dahl et aL, 1972. Clinical, ecological, and rat studies supporting salt-blood pressure link.
Gleibermann et aL, 1973. Review of 27 ecologic studies suggests a direct linear relationship between salt and blood pressure. Cooper et at, 1979. Intrapopulation study of several hundred schoolchildren suggests “not wholly negative” relationship between salt and blood pressure.
McCarron et al, 1984. Analysis of the National Health and Nutrition Examination Survey database suggests that salt is harmless and that calcium and potassium protect against hypertension.
Smith et al., 1988 (Scottish Heart Health Study). Study of 7300 Scottish men finds no relationship between salt intake and blood pressure.

[Sidebar]
Intersalt, 1988. Study of 52 200-person populations shows weak or no relationship between salt and blood pressure but infers a relationship between salt and the rise in blood pressure with age.
Intersalt Revisited, 1996. Statistical reanalysis of the original Intersalt data now finds strong, consistent positive association between salt and blood pressure.
Cutler et aL, 1991. Meta-analysis of 27 clinical trials finds that salt reduction lowers blood pressure in both hypertensives and normotensives.
Law et al., 1991. Review of 24 ecologic studies, 14 intrapopulation studies, and 78 clinical trials finds that salt-blood pressure link is “substantially larger” than generally appreciated and increases with age.

[Sidebar]
Midgley et al., 1996. Meta-analysis of 56 clinical trials concludes that benefit from salt reduction is small and does not support current dietary recommendations.
Cutler et al. 1997. Meta-analysis of 32 clinical trials concludes that benefit of salt reduction is larger and does support current dietary recommendations.
Trials of Hypertension Prevention Colaborative Research Group,1997 (TOHP II). CLinical trial in 2400 subjects indicates that Long-term reductions in salt intake are hard to maintain and result in little or no reduction in blood pressure.
Appel et al.,1997 (DASH). Clinical trial of 459 people shows that dietary factors other than sodium have a much greater effect on blood pressure.
Graudal et al., 1998. Meta-analysis of 114 clinical trials does not support a general recommendation to reduce salt intake.

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Indexing (document details)

Subjects: Salt,  Public health,  Public policy,  Medical research,  Scientists
MeSH subjects: Blood Pressure — drug effects,  Diet, Sodium-Restricted,  Sodium Chloride — adverse effects,  Sodium Chloride — pharmacology
Author(s): Gary Taubes
Document types: Feature,  NEWS,  News
Publication title: Science. Washington: Aug 14, 1998. Vol. 281, Iss. 5379;  pg. 898, 9 pgs
Source type: Periodical
ISSN: 00368075
ProQuest document ID: 33238653
Text Word Count 9115
Document URL: http://proquest.umi.com/pqdweb?did=33238653&sid=1&Fmt=2&clientId=24448&RQT=309&VName=PQD

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One Response to “Science 1998; 281(14): 898-907. “The (Political) Science of Salt””

  1. pharmacy tech Says:

    Terrific work! This is the type of information that should be shared around the web. Shame on the search engines for not positioning this post higher!

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