Oral Presentation 49th Nutrition Society of Australia Annual Scientific Meeting 2025

Salty drinking water – an overlooked health risk! (130023)

Juliette Crowther 1 , Aliyah Palu 1 , Alicia Dunning 1 2 , Loretta Weatherall 2 3 , Wendy Spencer 2 3 , Devanshi Gala 4 , Damian Maganja 1 , Katrina Kissock 1 , Kathy Trieu 1 , Sera Young 5 , Ruth McCausland 2 , Greg Leslie 6 , Jacqui Webster 7
  1. The George Institute for Global Health, Sydney, New South Wales, Australia
  2. Yuwaya Ngarra-li Partnership, University of New South Wales, Sydney, NSW, Australia
  3. Dharriwaa Elders Group, Walgett, NSW, Australia
  4. Walgett Aboriginal Medical Services Limited, Walgett, NSW, Australia
  5. Department of Anthropology, Institute for Policy Research, Center for Water Research, Northwestern University, Evanston, Illinois, USA
  6. Global Water Institute, University of New South Wales, Sydney, NSW, Australia
  7. Faculty of Health, University of Technology, Sydney, NSW, Australia

High sodium consumption increases the risk of hypertension and cardiovascular disease.(1) Although food remains the primary source of intake, elevated sodium levels in drinking water can further contribute to excessive intake, particularly in populations already exceeding recommendations.(2) A review of sodium limits in national standards for unbottled drinking water in 197 countries was conducted to inform discussion on the need for enforceable, health-based sodium limits. National standards for unbottled drinking water were identified using the WHO 2021 review of drinking water guidelines,(3) the FAOLEX country database,(4) and targeted internet and AI searches. For each country, data were extracted for the document name, year, regulatory body, regulation type, sodium limit (if stated), and rationale. Socio-geographic data were sourced from World Bank Open Data.(5) A descriptive analysis was conducted using Microsoft Excel. Drinking water standards were identified for 164 countries. Of these, 20% (n = 32), representing 30% of the global population, had no sodium limit. Of the 132 countries with a sodium limit, 92% (n = 121) adopted the WHO’s palatability-based guideline of 200 mg/L. Upper limits ranged from 50 to 400 mg/L. Only twelve countries (9%) cited health as a rationale for setting sodium limits in drinking water. Three countries—Australia, Canada, and the United States—provided a separate recommendation for at-risk populations to consume water with sodium levels below 20 mg/L. This review highlighted that globally, drinking water standards give inadequate attention to sodium’s health risks. Most standards either lack sodium limits or rely on palatability thresholds that are too high to protect health. Updating national and international standards to reflect current evidence is essential to support sodium reduction efforts. Health-based sodium limits would empower communities to better advocate for safe water. Amid rising water salinity, such reforms must form part of a broader global strategy to ensure universal and equitable access to safe, affordable drinking water as a basic human right.

 

 

  1. IHME. Global Burden of Disease Study, 2021; Seattle, USA.
  2. WHO. Sodium in Drinking-Water. WHO Guidelines Background, 2003; Geneva, Switzerland.
  3. WHO. National Drinking Water Regulations, 2nd ed., 2021; Geneva, Switzerland.
  4. FAOLEX Database. [Online: Accessed 13 Aug 2025].
  5. World Bank Open Data. [Online: Accessed 13 Aug 2025].