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Findingsc

An increased Na:K ratio was significantly (p < 0.05) and independently associated with increased prevalence of renal stones

Multiple regression analysis showed that a high salt intake (> 16 g/d) was an independent predictor of risk for low BMD in stone-forming men and premenopausal women estimated by food-frequency questionnaire

persuasive evidence from large-scale observational studies has documented a direct relationship between blood pressure and the risk of cardiovascular diseases (specifically stroke and coronary heart disease) and end-stage renal disease. The relationship of blood pressure to these diseases has been characterized as “strong, continuous, graded, consistent, independent, predictive, and etiologically significant” (JNC, 1997).

Other Possible Endpoints. Other endpoints or adverse effects were considered, including clinical cardiovascular outcomes (i.e., stroke and coronary heart disease), subclinical cardiovascular outcomes (i.e., left ventricular mass), and noncardiovascular outcomes (e.g., urinary calcium excretion, osteoporosis, gastric cancer, and asthma). For left ventricular mass, cross-sectional studies consistently document an association between urinary sodium excretion and left ventricular mass, but only one small, controlled trial assessed the effects of sodium reduction on this endpoint. For urinary calcium excretion, numerous trials documented that a reduced sodium intake lowers urinary calcium excretion, but urinary calcium excretion by itself is not a well-accepted surrogate marker for bone mineral density or dietary induced osteoporosis. Evidence that links sodium intake with gastric cancer is reasonably strong, but still insufficient to establish a UL. Data on the relationship between sodium intake and asthma are sparse.

Identification of a Lowest-Observed-Adverse-Effect Level (LOAEL). In aggregate, the relationship between sodium intake and blood pres-



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