Strict Versus Moderate Versus Liberal Dietary Sodium Restriction in Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 1Department of Internal Medicine, Ziv Medical Center, Safed 1310001, Israel
- 2Department of Otolaryngology, Ziv Medical Center, Safed 1310001, Israel
- 3The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
Abstract
Background: Clinical trials on dietary sodium restrictions among heart failure (HF) patients have provided inconsistent findings with limited evidence of major benefits and risks of sodium intake restrictions. This systematic review and meta-analysis compared the impact of strict versus moderate versus liberal sodium intake on all-cause mortality, HF hospitalization and composite outcomes in HF patients. Methods: A systematic search for randomized controlled trials (RCTs) was conducted across Embase, MEDLINE, and Cochrane Library databases in May 2026 and updated in June 2026. Risk of bias assessment was conducted using the Cochrane Risk of Bias (RoB 2) tool and certainty of evidence assessed using the GRADE framework. Meta-analysis using random-effects model was conducted to pool effects across included studies. Results: A total of 10 RCTs met the inclusion criteria. Strict and moderate sodium restriction strategies did not significantly reduce all-cause mortality (OR = 0.53; 95% CI: 0.10–2.69; I2 = 18.3%), HF hospitalization (RR = 0.84; 95% CI: 0.62–1.15; I2 = 0%) or composite outcome of death/HF hospitalization (OR = 0.92; 95% CI: 0.67–1.26; I2 = 0%) compared to liberal sodium restriction. However, strict to moderate sodium intake was associated with improved quality of life (QoL) (SMD = 0.33; 95% CI: 0.15–0.51; I2 = 0%), New York Heart Association (NYHA) functional class improvement (OR = 1.51; 95% CI: 1.18–1.94; I2 = 0%) and reduced BNP/NT-proBNP (ratio = 0.62; 95% CI: 0.42–0.90; I2 = 57.2%) compared to liberal intakes. Conclusions: Compared with higher sodium intake, lower sodium targets did not demonstrate significant reductions in all-cause mortality or HF hospitalization in the available RCTs. Lower sodium intake was associated with improvements in quality of life, NYHA functional class, and BNP/NT-proBNP; however, the certainty and generalizability of these findings remain limited. Current evidence is therefore insufficient to establish an optimal dietary sodium target for patients with heart failure, and adequately powered randomized trials comparing clearly defined sodium targets are warranted.
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BibTeX
@article{safiya2026strict,
title = {{Strict Versus Moderate Versus Liberal Dietary Sodium Restriction in Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials}},
author = {Rabia Safiya and Alaa Safia and Ashraf Abu Shkara},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218710},
url = {https://www.mdpi.com/2077-0383/15/21/8710},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Strict Versus Moderate Versus Liberal Dietary Sodium Restriction in Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
AU - Rabia Safiya
AU - Alaa Safia
AU - Ashraf Abu Shkara
PY - 2026
DA - 2026/11/08
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218710
UR - https://www.mdpi.com/2077-0383/15/21/8710
AB - Background: Clinical trials on dietary sodium restrictions among heart failure (HF) patients have provided inconsistent findings with limited evidence of major benefits and risks of sodium intake restrictions. This systematic review and meta-analysis compared the impact of strict versus moderate versus liberal sodium intake on all-cause mortality, HF hospitalization and composite outcomes in HF patients. Methods: A systematic search for randomized controlled trials (RCTs) was conducted across Embase, MEDLINE, and Cochrane Library databases in May 2026 and updated in June 2026. Risk of bias assessment was conducted using the Cochrane Risk of Bias (RoB 2) tool and certainty of evidence assessed using the GRADE framework. Meta-analysis using random-effects model was conducted to pool effects across included studies. Results: A total of 10 RCTs met the inclusion criteria. Strict and moderate sodium restriction strategies did not significantly reduce all-cause mortality (OR = 0.53; 95% CI: 0.10–2.69; I2 = 18.3%), HF hospitalization (RR = 0.84; 95% CI: 0.62–1.15; I2 = 0%) or composite outcome of death/HF hospitalization (OR = 0.92; 95% CI: 0.67–1.26; I2 = 0%) compared to liberal sodium restriction. However, strict to moderate sodium intake was associated with improved quality of life (QoL) (SMD = 0.33; 95% CI: 0.15–0.51; I2 = 0%), New York Heart Association (NYHA) functional class improvement (OR = 1.51; 95% CI: 1.18–1.94; I2 = 0%) and reduced BNP/NT-proBNP (ratio = 0.62; 95% CI: 0.42–0.90; I2 = 57.2%) compared to liberal intakes. Conclusions: Compared with higher sodium intake, lower sodium targets did not demonstrate significant reductions in all-cause mortality or HF hospitalization in the available RCTs. Lower sodium intake was associated with improvements in quality of life, NYHA functional class, and BNP/NT-proBNP; however, the certainty and generalizability of these findings remain limited. Current evidence is therefore insufficient to establish an optimal dietary sodium target for patients with heart failure, and adequately powered randomized trials comparing clearly defined sodium targets are warranted.
SN - 2077-0383
ER -