Institute of Medicine Chief Knocks Press Coverage of Salt Report
IOM Report Supports Population-Wide Sodium Reduction Efforts
June 17, 2013
The president of the Institute of Medicine said that "some press coverage misstated" the conclusions of the organization's recent report on sodium intake and health outcomes. In an unusual letter to Secretary of Health and Human Services Kathleen Sebelius, IOM president Harvey V. Fineberg wrote that "the evidence linking sodium intake to health outcomes supports current efforts by the Centers for Disease Control and Prevention (CDC) and other authoritative bodies to reduce sodium intake in the U.S. population below the current average adult intake of 3,400 mg per day."
The IOM head did not specify which press outlets misstated the report's findings. However, the nonprofit Center for Science in the Public Interest says that the New York Times did misstate the report's findings when, in an article and an editorial, it gave readers the impression that consuming less sodium might be harmful. In fact, CSPI says, the IOM report said that evidence that very-low-sodium intakes might harm the general population was "insufficient and inconsistent." Some of the studies suggesting harm in people with congestive heart failure involved Italian patients who were being subjected to an aggressive treatment not used in the United States. And, since the publication of the IOM report, the medical journal Heart retracted a meta-analysis that included two of those Italian studies because they contained duplicated data and the researchers said they lost the raw original data.
CSPI executive director Michael F. Jacobson had earlier criticized the Times' coverage of the IOM report in a column in the Huffington Post and in a letter to Times editors signed by leading sodium experts.
"Health experts here and around the globe, including the American Heart Association, the National Institutes of Health, and the World Health Organization have urged the public to cut back on salt to reduce their risk of high blood pressure, heart attack, stroke, and other life-threatening health problems," Jacobson said. "The Times and some other media outlets undercut what should be the most important take-home message for consumers—consume less sodium."
Finebergs June 3 letter noted that the IOM committee could not find evidence to support sodium reductions to levels as low as 1,500 milligrams per day, but the committee was referring only to studies on direct effects of very low sodium intakes on the risk of strokes and heart attacks—studies that are essentially impossible to do with the current salt-laden food supply, according to Jacobson. In fact, the committee acknowledged that "blood pressure is widely recognized as a strong surrogate indicator for primary cardiovascular disease (CVD) clinical endpoints, such as myocardial infarction (MI) and stroke."
"In other words," said Jacobson, "as blood pressure rises, so does the risk of a heart attack or stroke."
"The IOM report, the CDC, and other authoritative bodies, including the American Heart Association, are congruent in supporting a population-wide reduction in current levels of sodium intake," Fineberg continued. "I hope this restatement of the report's conclusions will mitigate any misunderstanding, so that the information from the report can be constructively useful to the public and to policy-makers."
In a separate Viewpoint published in JAMA, three members of the IOM committee, including its chairman Brian Strom, made note of the retraction of the Heart meta-analysis and acknowledged that the press coverage of the report might have missed the point.
"Focusing the debate on specific targets misses the larger conclusion with which all are in agreement and may hinder implementation of important public health policy," the IOM committee members wrote. The IOM, AHA, WHO, and Dietary Guidelines for Americans all "are congruent in suggesting that excess sodium intake should be reduced, and this is likely to have significant public health effects."