Precision nutrition to mitigate cardiovascular risk in high-sodium, low whole-grain populations: a narrative review

High sodium intake, coupled with inadequate consumption of potassium and whole grains, represents a major global public health challenge, contributing to millions of premature deaths annually from cardiovascular, cerebrovascular, and renal diseases. Notably, elevated blood pressure, driven by excess sodium intake, is one of the leading modifiable risk factors for global mortality, accounting for an estimated 10.8 million deaths (19% of all deaths) worldwide in 2019. In parallel, widespread yet underrecognized deficiencies in essential micronutrients, particularly thiamine (vitamin B ₁ ) and riboflavin (vitamin B ₂ ), persist due to low whole-grain intake and the global shift toward refined grains and processed foods. Recent national data from China indicate that more than 80% of adults have inadequate intake of thiamine and potassium, and over 90% have insufficient riboflavin intake. Globally, up to half of the population may fail to meet recommended riboflavin requirements. Although overt thiamine deficiency has become rare, milder forms of thiamine insufficiency are common and increasingly linked to cardiometabolic dysfunction, including hypertension. While sodium reduction and increased consumption of potassium-rich and whole-grain foods remain cornerstones of healthy dietary patterns, modern eating habits characterized by processed foods, restaurant meals, and food delivery limit individuals’ ability to control sodium exposure and refined grain intake. These pervasive nutrient imbalances represent hidden but important contributors to chronic disease risk. In this narrative review, we explore the potential of targeted multi-nutrient supplementation with potassium, vitamin B ₁ , and vitamin B ₂ as a complementary and pragmatic strategy to address prevalent dietary imbalances. Drawing on molecular, nutritional, and clinical evidence, we synthesize the mechanistic rationale for this nutrient combination, highlighting their synergistic roles in cellular energy metabolism, ion transport, vascular function, and blood pressure regulation. We further discuss its potential population-level economic benefits, including genetically susceptible individuals with the methylenetetrahydrofolate reductase (MTHFR) 677TT genotype who are at high risk of hypertension and stroke. Collectively, the evidence supports targeted micronutrient supplementation as a safe, low-cost, and highly scalable public health strategy to mitigate the chronic disease burden associated with high-sodium, low whole-grain dietary patterns in modern societies.