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Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds.

Rating

5 Star

Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds.

Our Review Summary

Two stories we reviewed on this study about salt intake showed how two well meaning journalists could come to very different conclusions about how to present this information. The New York Times story took the most cautious approach, weighing the preponderance of evidence linking salt to heart disease against this single study with several limitations and giving more weight to the preponderance of evidence. The USA Today story decided to give both the critics of the study and the study itself equal weight and took the odd step of bringing in the salt industry. This is not “fair and balanced” journalism. This is he said/she said that lacks critical analysis and leaves readers frustrated and confused.

 

Why This Matters

For years, high salt intake has been suggested as a cause of heart disease and early death. Researching the impact of salt, or any dietary factor, on health can be tricky, as both of these stories explain, and this study attempted to provide a deeper look at the connection between salt and health. But, as the authors themselves acknowledge in the paper, there are significant limitations to this study that should have given reporters more pause when reporting the findings. The biggest one was acknowledged by the New York Times in saying, “was observational, considered at best suggestive and not conclusive.” USA Today missed this point.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Applicable
As with availability, the cost of salt is not really applicable in this context.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory
The harms and benefits are intertwined here, given that the study found a benefit to eating more salt and harm from eating too little. As mentioned above, these were adequately quantified.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The focus of this story was avoiding harm by eating too much (or too little) salt. “The investigators found that the less salt people ate, the more likely they were to die of heart disease — 50 people in the lowest third of salt consumption (2.5 grams of sodium per day) died during the study as compared with 24 in the medium group (3.9 grams of sodium per day) and 10 in the highest salt consumption group (6.0 grams of sodium per day). And while those eating the most salt had, on average, a slight increase in systolic blood pressure — a 1.71-millimeter increase in pressure for each 2.5-gram increase in sodium per day — they were no more likely to develop hypertension.” It does a great job presenting the numbers in absolute terms.

Does the story seem to grasp the quality of the evidence?

Satisfactory

This story did readers a great service by showing in the lead that this study had problems. It said at the top, “A new study found that low-salt diets increase the risk of death from heart attacks and strokes and do not prevent high blood pressure, but the research’s limitations mean the debate over the effects of salt in the diet is far from over. In fact, officials at the Centers for Disease Control and Prevention felt so strongly that the study was flawed that they criticized it in an interview, something they normally do not do.” The story then went on to discuss many of the study’s positives and negatives. The study, for example, only tested people’s sodium intake twice, over a period as long as 7.9 years. As the story says, “The researchers assessed the participants’ sodium consumption at the study’s start and at its conclusion by measuring the amount of sodium excreted in urine over a 24-hour period.” The conclusions drawn by the study are fairly significant given that they are based on only two tests taken over nearly 8 years in a total of 74 people who died over the course of the study. The USA Today story, by contrast, presented the evidence as worthy of equal consideration with the much larger body of evidence showing that salt does have harmful health effects in high quantities.

Does the story commit disease-mongering?

Satisfactory
This story definitely did not engage in disease-mongering. Contrary to the USA Today story, which may lead people to believe that they can avoid a heart attack by eating more salt, this story said up high that the study was not strong enough to support any change in diet. It said, for example, “that its subjects were relatively young, with an average age of 40 at the start; and that with few cardiovascular events, it was hard to draw conclusions. And the study, Dr. Briss and others say, flies in the face of a body of evidence indicating that higher sodium consumption can increase the risk of cardiovascular disease.”

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story did a better job than USA Today finding experts who could give readers a broad context for the findings. We also appreciated how it noted that one of the experts had worked for the Salt Institute, which is the leading advocacy organization for more salt consumption.

[Addendum on May 6: It’s very difficult to find an “independent” expert to comment on the evidence base on salt. Dr. Alderman, who is quoted in the Times story and frequently weighs in on this controversy, has an asterisk next to his name (appropriately so) because of his previous ties to the salt industry. But it’s worth noting that the independent experts in this field, such as Dr. Appel and Dr. Sacks (who are also quoted in the Times story), are closely affiliated with NHLBI which funds much of the research on sodium. And as Gary Taubes posited many years ago in Science magazine, the NHLBI may not be a dispassionate arbiter of the evidence. (The full text of his story can be accessed at the National Association of Science Writers website: http://www.nasw.org/1999-science-society-awards.) ]

Does the story compare the new approach with existing alternatives?

Not Applicable

This criterion does not apply with this story.

Does the story establish the availability of the treatment/test/product/procedure?

Not Applicable
Not applicable.  The availability of salt is not in question.

Does the story establish the true novelty of the approach?

Satisfactory
The study’s findings do, as the story says, fly “in the face of a body of evidence indicating that higher sodium consumption can increase the risk of cardiovascular disease.” The story makes that clear.

Does the story appear to rely solely or largely on a news release?

Satisfactory
The story did not rely on a press release.

Total Score: 7 of 7 Satisfactory

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