Adverse health outcomes associated with drinking highly saline water: a systematic review
File(s)
Published online version
Author(s)
Type
Journal Article
Abstract
In climate change-affected coastal areas, sea level rise, storm surges, droughts and altered rainfalls are significantly increasing salinity levels in drinking water sources. This is a major public health problem that affects many millions of people. We systematically reviewed and assessed the strength and quality of the evidence on the relationship between drinking water with high sodium levels (> 200 mgNa/l) and adverse cardiovascular, renal, and pregnancy-related health outcomes, following the PRISMA guidelines, the ROBINS-E Cochrane tool and the Navigation Guide. From five bibliographic databases, we identified 22 relevant studies, some of which assessed more than one health domain. The evidence was of moderate quality and strength. 14 analyses from eight studies at low risk of bias and four studies at moderate risk of bias, linked drinking high-salinity water to adverse health outcomes including hypertension and cardiovascular disease, impaired renal function, gestational hypertension and preeclampsia, and higher infant mortality. Eight studies were inconclusive. Three analyses, of which two at low risk of bias, associated drinking high-salinity water to improved health outcomes. Overall, our findings suggest that salinisation of drinking water sources is likely to increase adverse cardiovascular, renal, and pregnancy-related health outcomes. This conclusion highlights the importance of effective and timely adaptation at scale, and calls for a revision of the WHO guidelines for the intake of salt from water. The latest WHO guidelines (2022) do not set any health-based standard for sodium levels in drinking water, a problem that affects millions of people and will worsen with climate change.
Date Issued
2025-11-01
Date Acceptance
2025-09-02
Citation
European Journal of Epidemiology, 2025, 40 (11), pp.1307-1322
ISSN
0393-2990
Publisher
Springer Science and Business Media LLC
Start Page
1307
End Page
1322
Journal / Book Title
European Journal of Epidemiology
Volume
40
Issue
11
Copyright Statement
© Springer Nature B.V. 2025 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41021114
PII: 10.1007/s10654-025-01307-9
Subjects
Cardiovascular health
Climate change
Drinking water
Maternal and infant health.
Renal health
Salinity
Publication Status
Published
Coverage Spatial
Netherlands
Date Publish Online
2025-09-29