We thank Professor Heitkamp for his valuable comments and for mentioning recent studies into reducing dietary salt intake. These support the benefit of such a measure for reducing cardiovascular diseases. His prediction of a rejection of the traffic light marking system for foods has turned out to be correct, as a result of a decision by the European Parliament in June 2010. We wish to point out that a whole range of packaged foods includes guideline daily amounts (GDAs), which show purchasers what proportion of the daily upper limit of 6 g dietary salt or 2.3 sodium they are ingesting in a portion of the respective food. However, the salt content is mostly reported as grams of sodium, which may easily lead to misinterpretation because the sodium content has to be multiplied by 2.5 in order to calculate the amount of dietary salt in grams. Clarification and standardization are required.
With regard to the recommended upper limits of daily dietary salt intake, Western countries should strive to set standard values. The current upper limits, as stipulated by the specialist societies and the World Health Organization, are between 3.8 g and 6 g of dietary salt per day. The American Heart Association demands a reduction in the daily intake of dietary salt to 5.8 g for adults, adolescents, and pregnant women, and to 3.8 g for persons older than 55, those with hypertension or renal disorders, and diabetes patients (1). The National Institute for Health and Clinical Excellence in London is targeting a reduction to 3 g/d by 2025, a target that is likely to be missed in practice and may even entail risks (2).
Prof. Dr. med. Dieter Klaus
Eh. Direktor der Med. Klinik des Klinikums Dortmund
Oskar-Schlemmer-Str. 5/182, 70191 Stuttgart, Germany
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
|1.||Appel LJ, Brands MW, Daniels SR, et al.: Dietary approaches to prevent and treat hypertension. Hypertension 2006; 47: 296–308. MEDLINE|
|2.||National Institute for Health and Clinical Excellence. NICE Public Health Guidance Nr. 25. London, June 2010.|
|3.||Klaus D, Hoyer J, Middeke M: Salt restriction for the prevention of cardiovascular disease. Dtsch Arztebl Int 2010; 107(26): 457–62. VOLLTEXT|