Nutr Res Pract.  2023 Apr;17(2):175-191. 10.4162/nrp.2023.17.2.175.

The association between dietary sodium intake and obesity in adults by sodium intake assessment methods: a review of systematic reviews and re-meta-analysis

• Lee J
• Sohn C
• Kim OY
• Lee YM
• Yoon MO
• Lee M

• KMID: 2541357
• DOI: http://doi.org/10.4162/nrp.2023.17.2.175

Abstract

BACKGROUND/OBJECTIVES
The scientific evidence of a sodium-obesity association is limited by sodium intake assessments. Our specific aim is to synthesize the association between dietary sodium intake and obesity across the sodium intake assessments as evidenced by systematic reviews in adults.
SUBJECTS/METHODS
A systematic search identified systematic reviews comparing the association of dietary sodium intakes with obesity-related outcomes such as body mass index (BMI), body weight, waist circumference, and risk of (abdominal) obesity. We searched PubMed on October 24, 2022. To assess the Risk of Bias in Systematic Reviews (ROBIS), we employed the ROBIS tool.
RESULTS
This review included 3 systematic reviews, consisting of 39 unique observational studies (35 cross-sectional studies and 4 longitudinal studies) and 15 randomized controlled trials (RCTs). We found consistently positive associations between dietary sodium intake and obesity-related outcomes in cross-sectional studies. Studies that used 24-h urine collection indicated a greater BMI for those with higher sodium intake (mean difference = 2.27 kg/m² ; 95% confidence interval [CI], 1.59–2.51; P < 0.001; I² = 77%) compared to studies that used spot urine (mean difference = 1.34 kg/m² ; 95% CI, 1.13–1.55; P < 0.001; I² = 95%) and dietary methods (mean difference = 0.85 kg/m² ; 95% CI, 0.1–1.51; P < 0.05; I² = 95%).
CONCLUSIONS
Quantitative synthesis of the systematic reviews has shown that crosssectional associations between dietary sodium intake and obesity outcomes were substantially different across the sodium intake assessments. We need more high-quality prospective cohort studies and RCTs using 24-h urine collection to examine the causal effects of sodium intake on obesity.

Keyword

Sodium; obesity; systematic review; meta-analysis; association

Figure

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  Fig. 1 Literature search and study selection process.DASH, Dietary Approaches to Stop Hypertension; SR, systematic review.

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  Fig. 2 Pooled mean difference in body mass index by sodium intake assessment.CI, confidence interval; REML, Restricted Maximum Likelihood.

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  Fig. 3 Pooled risk of overweight or obesity by sodium intake assessment.OR, odds ratio; CI, confidence interval; REML, Restricted Maximum Likelihood.

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  Fig. 4 Pooled mean difference in body weight by sodium intake assessment.CI, confidence interval; REML, Restricted Maximum Likelihood.

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  Fig. 5 Pooled mean difference in waist circumference by sodium intake assessment.CI, confidence interval; REML, Restricted Maximum Likelihood.

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  Fig. 6 Pooled risk of abdominal obesity by sodium intake assessment.OR, odds ratio; CI, confidence interval; REML, Restricted Maximum Likelihood.

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