The role of dietary salt in metabolism and energy balance: Insights beyond cardiovascular disease

• Published in: Diabetes, obesity & metabolism Vol. 25; no. 5; pp. 1147 - 1161
• Main Authors: Wu, Qi, Burley, George, Li, Li‐Cheng, Lin, Shu, Shi, Yan‐Chuan
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2023; Wiley Subscription Services, Inc
• Subjects: Body temperature; Cardiovascular disease; cardiovascular disease (CVD); Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Clinical trials; Diet; dietary salt (NaCl); Energy balance; Energy expenditure; Energy Metabolism; Ghrelin; Homeostasis; Humans; Insulin; Insulin resistance; Leptin; Metabolic disorders; Metabolic syndrome; Metabolism; Obesity; Obesity - metabolism; Review; Reviews; Salt; salt reduction; salt substitution; Sodium chloride; Sodium Chloride, Dietary - adverse effects; sodium intake; Thermogenesis; dietary salt (NaCl); metabolic syndrome; thermogenesis; sodium intake; salt substitution; energy balance; metabolism; cardiovascular disease (CVD); obesity; salt reduction
• ISSN: 1462-8902; 1463-1326; 1463-1326
• DOI: 10.1111/dom.14980

Dietary salt (NaCl) is essential to an organism's survival. However, today's diets are dominated by excessive salt intake, which significantly impacts individual and population health. High salt intake is closely linked to cardiovascular disease (CVD), especially hypertension, through a number of well‐studied mechanisms. Emerging evidence indicates that salt overconsumption may also be associated with metabolic disorders. In this review, we first summarize recent updates on the mechanisms of salt‐induced CVD, the effects of salt reduction and the use of salt substitution as a therapy. Next, we focus on how high salt intake can impact metabolism and energy balance, describing the mechanisms through which this occurs, including leptin resistance, the overproduction of fructose and ghrelin, insulin resistance and altered hormonal factors. A further influence on metabolism worth noting is the reported role of salt in inducing thermogenesis and increasing body temperature, leading to an increase in energy expenditure. While this result could be viewed as a positive metabolic effect because it promotes a negative energy balance to combat obesity, caution must be taken with this frame of thinking given the deleterious consequences of chronic high salt intake on cardiovascular health. Nevertheless, this review highlights the importance of salt as a noncaloric nutrient in regulating whole‐body energy homeostasis. Through this review, we hope to provide a scientific framework for future studies to systematically address the metabolic impacts of dietary salt and salt replacement treatments. In addition, we hope to form a foundation for future clinical trials to explore how these salt‐induced metabolic changes impact obesity development and progression, and to elucidate the regulatory mechanisms that drive these changes, with the aim of developing novel therapeutics for obesity and CVD.