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Wu Z, Heizhati M, Hu J, Lin M, Gan L, Li M, Yang W, Yao L, Hong J, Sun L, Li J, Li W, Li N. Lower 24-h urinary potassium excretion is associated with higher prevalent depression and anxiety status in general population. Brain Behav 2023; 13:e2842. [PMID: 36924024 PMCID: PMC10097074 DOI: 10.1002/brb3.2842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Uncertainty remains about the association of potassium (K) intake with depression and anxiety status. We explored their relationship using 24-h urinary K, reflecting K intake, in general population. METHODS We collected 24-h urine and performed self-rating depression and anxiety scales (SDS, SAS) cross-sectionally in adults selected by random sampling in China. SDS and SAS standard score ≥50 defined depression and anxiety status. Participants were divided into three groups (T1, T2, and T3) by 24-h urinary K tertile. Odds ratios (OR) and 95% confidence intervals were calculated. Sensitivity analysis was performed by excluding anti-hypertensive agent takers. RESULTS 546 participants comprised current analytical sample. First, T1 and T2 groups showed higher SDS scores (40.0 vs 40.0 vs 36.0, p = .001), prevalence (19.8 vs 15.9 vs 7.1%, p = .002), whereas increased adjusted odds for depression status only in T1 group (OR = 2.71, p = .017), compared with T3 group. Second, T1 and T2 groups showed higher SAS scores (38.0 vs 40 vs 35.0, p < .001) and prevalence (14.8 vs 21.4 vs 8.8%, p = .003), whereas increased adjusted odds for anxiety status only in T2 group (OR = 2.07, p = .042), compared with T3 groups. Third, T1 and T2 groups showed higher prevalence (10.4% vs 11.5% vs 2.7%, p = .004) and adjusted odds (OR = 3.71, p = .013; OR = 3.66, p = .014) for co-existent anxiety and depression status, compared with T3 group. Most results remained consistent in sensitivity analysis. CONCLUSIONS Lower K intake is implicated in presence of anxiety and depression status in general population; this may provide basis for programs to increase K intake and prevent disease.
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Affiliation(s)
- Zihao Wu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Mulalibieke Heizhati
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Junli Hu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Mengyue Lin
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Lin Gan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Mei Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Wenbo Yang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Ling Yao
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Jing Hong
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Le Sun
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Jing Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Wei Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, 830001, China
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Li M, Heizhati M, Wang L, Wang Z, Abudoureyimu R, Yang Z, Pan F, Sun L, Li W, Li J, Lin M, Gan L, Lu S, Li N. 24-hour urinary potassium excretion is negatively associated with self-reported sleep quality in the general population, independently of sleep-disordered breathing. J Clin Sleep Med 2022; 18:2589-2596. [PMID: 35912683 PMCID: PMC9622988 DOI: 10.5664/jcsm.10168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To investigate the association of 24-hour urinary potassium excretion with self-reported sleep quality in the general population. METHODS In this cross-sectional study, a population of patients aged 18 years or older was randomly selected from Xinjiang, China in 2019, 24-hour urine samples collected, and Pittsburgh Sleep Quality Index (PSQI) questionnaires assessed. Participants were divided into 2 groups (upper and lower median of 24-hour urinary potassium excretion). Poor sleep quality was defined as PSQI global score ≥ 6. Associations between 24-hour urinary potassium excretion and [24.8 mmol/L] sleep quality were assessed by multiple logistic regression analysis in total participants and those stratified by sex. RESULTS In total, 24-hour urine samples were collected from 1,147 participants, of whom data for those with complete urine samples and PSQI data were analyzed (n = 727; mean age = 48.7 years; percentage of women = 62%). Compared with the upper median group for 24-hour urinary potassium excretion, the lower median group showed a significantly higher PSQI global score (6 vs 5, P = .011), and prevalence of poor sleep quality (51.7% vs 42.2%, P = .011). In a fully-adjusted model of multivariate logistic regression, the lower median group showed 1.50-fold increased odds for presence of poor sleep quality (95% confidence interval: 1.01-2.24, P = .045). Sex-specific analyses translated these results to women, but not to men. CONCLUSIONS These results suggest that low potassium intake, indicated by lower potassium excretion, is associated with poor sleep quality in the general population, especially among women. Therefore, additional research is necessary to clarify the effect of increasing potassium intake to improve sleep quality. CITATION Li M, Heizhati M, Wang L, et al. 24-hour urinary potassium excretion is negatively associated with self-reported sleep quality in the general population, independently of sleep-disordered breathing. J Clin Sleep Med. 2022;18(11):2589-2596.
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Affiliation(s)
- Mei Li
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Mulalibieke Heizhati
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Lin Wang
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Zhongrong Wang
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Reyila Abudoureyimu
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Zhikang Yang
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Fengyu Pan
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Le Sun
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Wei Li
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Jing Li
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Mengyue Lin
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Lin Gan
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Shan Lu
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
| | - Nanfang Li
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang China
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Pourkhajoei S, Yazdi‐Feyzabadi V, Amiresmaeili M, Nakhaee N, Goudarzi R. Mean population salt intake in Iran: A systematic review and meta-analysis. Health Sci Rep 2022; 5:e855. [PMID: 36226320 PMCID: PMC9531774 DOI: 10.1002/hsr2.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION High salt intake has been connected with the increase of many non-communicable diseases (NCDs) worldwide. Like other middle-income countries, Iran is experiencing a considerable increase in NCDs, necessitating attempts to reduce dietary salt intake. As in Iran there is uncertainty about the existing rate of salt intake. The present study aimed to estimate mean salt intake of Iranian population by systematically reviewing existing literature. METHODS This research is a systematic review and meta-analysis (PRISMA Protocol) of published article data, with no time constraint until the end of 2020, to estimate mean salt intake of Iranian population. A comprehensive literature search was performed on international databases of Medline, Science Direct, PubMed, Embase, Scopus, Springer, Online Library Wiley, Web of Science, Cochrane, and Google Scholar and domestic data bases of Iranmedex, Magiran, SID, and Medlib. Subgroup analysis was conducted for gender, region, measurement method, and age group. Research homogeneity was evaluated by I 2 statistic. We reviewed all studies which met inclusion criteria. STATA Ver.13.1 was used to perform meta-analysis. RESULTS Meta-analysis of data from 32 studies showed that the average salt intake in all ages was 9.674 g/day (95% CI, 9.033-10.316 g/day). The lowest estimation of salt intake was 9.33 g/day (95% CI, 7.75-10.91 g/day) which was estimated from studies which used point collection method, and the highest estimate using the food reminder questionnaire was 10.41 g/day (95% CI, 8.49-12.34 g/day). Also, the average weight salt intake for men over 18 years old in different cities was 10.39 g/day (95% CI, 9.01-11.78 g/day), for women over 18 years in different cities 9.52 g/day (95% CI, 8.42-10.62 g/day), and children and adolescents was estimated at 5.664 g/day (95% CI, 2.91-8.41 g/day). CONCLUSION The intake of salt in the Iranian population is near twice the WHO recommendation. Therefore, it is necessary to consider effective strategies and interventions to reduce dietary salt intake in Iran as a health priority.
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Affiliation(s)
- Sirous Pourkhajoei
- Faculty of Management and Medical Information SciencesKerman University of Medical SciencesKermanIran
| | - Vahid Yazdi‐Feyzabadi
- Social Determinants of Health Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Mohamadreza Amiresmaeili
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Nouzar Nakhaee
- Health Services Menagement Research Center, Institute for Furtures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Reza Goudarzi
- Health Services Menagement Research Center, Institute for Furtures Studies in HealthKerman University of Medical SciencesKermanIran
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Haghighatdoost F, Atefi M, Mohammadifard N, Daryabeygi-Khotbehsara R, Khosravi A, Mansourian M. The relationship between ultraprocessed food consumption and obesity indicators in Iranian adults. Nutr Metab Cardiovasc Dis 2022; 32:2074-2085. [PMID: 35843797 DOI: 10.1016/j.numecd.2022.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Food processing changes the nature of foods, and it is growing globally due to its availability and affordability and its effects on the palatability of foods. Consumption of ultraprocessed foods (UPFs) may adversely affect weight gain. The purpose of the current study is to examine the association between UPFs consumption and adiposity among Iranian adults. METHODS AND RESULTS A cross-sectional study was conducted on 1459 Iranian adults (≥19 years). Dietary intakes were assessed using a validated 136-item food frequency questionnaire (FFQ), and foods were classified based on the NOVA system. Overweight, obesity, and abdominal obesity were defined as body mass index (BMI) ≥25 and < 30, ≥30, respectively, and waist circumference (WC) ≥91 for women and WC ≥ 89 for men. The odds of general and abdominal obesity across the quartiles of UPFs were assessed by binary logistic regression. UPFs consumption contributed to 20.17% of daily energy intake. After adjustment for potential confounders, UPFs consumption was not associated with general or abdominal obesity. However, in the fully adjusted model, men in the top quartile of UPFs were twice as likely to be overweight compared with those in the bottom quartile (OR = 2.06, 95% CI: 1.03, 4.10; P = 0.047). No association was found in women or stratified analysis by age. CONCLUSION The present findings suggest a sex-specific association between UPFs consumption and overweight. UPFs consumption might be associated with an increased risk of overweight in men, but no such association was found in women. Future cohort studies are required to confirm these results.
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Affiliation(s)
- F Haghighatdoost
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Atefi
- Food and Drug Deputy, Shahroud University of Medical Sciences, Shahroud, Iran
| | - N Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | - A Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Mansourian
- Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Mohammadifard N, Grau N, Khosravi A, Esmaillzadeh A, Feizi A, Abdollahi Z, Sarrafzadegan N. Validation and reproducibility of a semi-qualitative food frequency questionnaire for assessment of sodium intake in Iranian population. Nutr J 2022; 21:9. [PMID: 35114984 PMCID: PMC8815124 DOI: 10.1186/s12937-021-00749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Few semi-quantitative food frequency questionnaires (SFFQ)s has yet been developed to assess sodium intake in Middle East region. This study was performed to validate a SFFQ for assessment of sodium consumption and food groups΄ contribution to sodium intake. Methods This study was performed on 219 healthy participants including 113 adults aged ≥19 years and 106 children aged 6–18 years in Isfahan, Iran. They were administered two SFFQ at the beginning and after 1 year to evaluate the reproducibility. The validity of SFFQ for assessment of sodium intake was compared with 24-h urine sodium and twelve 24-h dietary recalls which were completed monthly during a year as two standard methods. Results Correlation coefficient between the contribution of food groups to sodium intake based on SFFQ and 24-h dietary recalls varied from 0.04 for legumes (P = 0.667) to 0.47 for added salt (P < 0.001). There was a significant correlation between the estimated total sodium intake based on SFFQ and both standard methods (P < 0.01). Intraclass correlation coefficient (95% CI) between first and second SFFQ had a diverse range from 0.10 (-0.05, 0.17) for fats and oils to 0.49 (0.28, 0.69) for bread. According to the Bland-Altman plots, we observed an acceptable level of agreement between the two methods for sodium intake. Conclusions The SFFQ was a relatively valid and reproducible method for estimating sodium intake. Combination of this SFFQ with a valid prediction of 24-h urinary sodium excretion can be useful in achieving more accurate results. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00749-7.
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Affiliation(s)
- Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Grau
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Awat Feizi
- Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Abdollahi
- Nutrition Department, The Ministry of Health and Medical Education, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Azadnajafabad S, Ebrahimi N, Mohammadi E, Ghasemi E, Saeedi Moghaddam S, Aminorroaya A, Rezaei N, Ghanbari A, Masinaei M, Mohammadi Fateh S, Haghshenas R, Gorgani F, Kazemi A, Dilmaghani-Marand A, Farzadfar F. Disparities and spatial variations of high salt intake in Iran: a subnational study of districts based on the small area estimation method. Public Health Nutr 2021; 24:6281-6291. [PMID: 34261565 PMCID: PMC11148577 DOI: 10.1017/s1368980021002986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High salt intake is one of the leading diet-related risk factors for several non-communicable diseases. We aimed to estimate the prevalence of high salt intake in Iran. DESIGN A modelling study by the small area estimation method, based on a nationwide cross-sectional survey, Iran STEPwise approach to risk factor Surveillance (STEPS) 2016. The modelling estimated the prevalence of high salt intake, defined as a daily salt intake ≥ 5 g in all districts of Iran based on data from available districts. The modelling results were provided in different geographical and socio-economic scales to make the comparison possible across the country. SETTING 429 districts of all provinces of Iran, 2016. PARTICIPANTS 18 635 salt intake measurements from individuals 25 years old and above who participated in the Iran STEPS 2016 survey. RESULTS All districts in Iran had a high prevalence of high salt intake. The estimated prevalence of high salt intake among females of all districts ranged between 72·68 % (95 % UI 58·48, 84·81) and 95·04 % (95 % UI 87·10, 100). Estimated prevalence for males ranged between 88·44 % (95 % UI 80·29, 96·15) and 98·64 % (95 % UI 94·97, 100). In all categorisations, males had a significantly higher prevalence of high salt intake. Among females, the population with the lower economic status had a higher salt consumption than the participants with higher economic status by investigating the concentration index. CONCLUSIONS Findings of this study highlight the high salt intake as a prominent risk factor in all Iran regions, despite some variations in different scales. More suitable population-wide policies are warranted to handle this public health issue in Iran.
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Affiliation(s)
- Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arya Aminorroaya
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Gorgani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Al-Jawaldeh A, Taktouk M, Chatila A, Naalbandian S, Al-Thani AAM, Alkhalaf MM, Almamary S, Barham R, Baqadir NM, Binsunaid FF, Fouad G, Nasreddine L. Salt Reduction Initiatives in the Eastern Mediterranean Region and Evaluation of Progress towards the 2025 Global Target: A Systematic Review. Nutrients 2021; 13:2676. [PMID: 34444836 PMCID: PMC8399509 DOI: 10.3390/nu13082676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and classified according to a pre-defined framework: salt intake assessments; leadership and strategic approach; implementation strategies; monitoring and evaluation of program impact. Salt intake levels were estimated in 15 out of the 22 countries (68%), while national salt reduction initiatives were identified in 13 (59%). The majority of countries were found to implement multifaceted reduction interventions, characterized by a combination of two or more implementation strategies. The least common implementation strategy was taxation, while the most common was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%). Monitoring activities were conducted by few countries (27%), while impact evaluations were lacking. Despite the ongoing salt reduction efforts in several countries of the region, more action is needed to initiate reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluations of ongoing programs. Such efforts are vital for the achievement of the targeted 30% reduction in salt intake.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo 11435, Egypt;
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (M.T.); (A.C.)
| | - Aya Chatila
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (M.T.); (A.C.)
| | - Sally Naalbandian
- Science and Agriculture Library, American University of Beirut, Beirut 11-0236, Lebanon;
| | | | - Majid M. Alkhalaf
- National Nutrition Committee, Saudi Food and Drug Authority, Riyadh 13312-6288, Saudi Arabia; (M.M.A.); (N.M.B.)
| | | | - Rawhieh Barham
- Nutrition Department, Ministry of Health, Amman 11118, Jordan;
| | - Nimah M. Baqadir
- National Nutrition Committee, Saudi Food and Drug Authority, Riyadh 13312-6288, Saudi Arabia; (M.M.A.); (N.M.B.)
| | - Faisal F. Binsunaid
- Healthy Food Department, Saudi Food and Drug Authority, Riyadh 13312-6288, Saudi Arabia;
| | - Gihan Fouad
- National Nutrition Institute, Cairo 11435, Egypt;
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (M.T.); (A.C.)
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8
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Association between 24-h urinary sodium to potassium ratio and mild cognitive impairment in community-based general population. Public Health Nutr 2021; 24:5795-5804. [PMID: 33821782 DOI: 10.1017/s1368980021001452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore the relationship between parameters of Na and K excretion using 24-h urine sample and mild cognitive impairment (MCI) in general population. DESIGN This is a cross-sectional study. SETTING Community-based general population in Emin China. PARTICIPANTS Totally, 1147 subjects aged ≥18 years were selected to complete the study, with a multistage proportional random sampling method. Cognitive status was assessed with Mini Mental State Examination (MMSE) questionnaire and timed 24-h urine specimens were collected. Finally, 561 participants aged ≥35 years with complete urine sample and MMSE data were included for the current analysis and divided into groups by tertiles of 24-h urinary sodium to potassium ratio (24-h UNa/K) as lowest (T1), middle (T2) and highest (T3) groups. RESULTS The MMSE score was significantly lower in T3, compared with the T1 group (26·0 v. 25·0, P = 0·002), and the prevalent MCI was significantly higher in T3 than in T1 group (11·7 % v. 25·8 %, P < 0·001). In multiple linear regression, 24-UNa/K (β: -0·184, 95 % CI -0·319, -0·050, P = 0·007) was negatively associated with MMSE score. In multivariable logistic regression, compared with T1 group, 24-h UNa/K in the T2 and T3 groups showed 2·01 (95 % CI 1·03, 3·93, P = 0·041) and 3·38 (95 % CI 1·77, 6·44, P < 0·001) fold odds for presence of MCI, even after adjustment for confounders. More augmented results were demonstrated in sensitivity analysis by excluding individuals taking anti-hypertensive agents. CONCLUSIONS Higher 24-h UNa/K is in an independent association with prevalent MCI.
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9
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Donfrancesco C, Lo Noce C, Russo O, Minutoli D, Di Lonardo A, Profumo E, Buttari B, Iacone R, Vespasiano F, Vannucchi S, Onder G, Galletti F, Galeone D, Bellisario P, Gulizia MM, Giampaoli S, Palmieri L, Strazzullo P. Trend of salt intake measured by 24-h urine collection in the Italian adult population between the 2008 and 2018 CUORE project surveys. Nutr Metab Cardiovasc Dis 2021; 31:802-813. [PMID: 33546949 DOI: 10.1016/j.numecd.2020.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The WHO Global Action Plan for the Prevention of non-communicable diseases (NCDs) recommends a 30% relative reduction in mean population salt/sodium intake. The study assessed the trend in the habitual salt intake of the Italian adult population from 2008 to 2012 to 2018-2019 based on 24-h urinary sodium excretion, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU' SALUTE national surveys. METHODS AND RESULTS Data were from cross-sectional surveys of randomly selected age and sex-stratified samples of resident persons aged 35-74 years in 10 (out of 20) Italian Regions distributed in North, Centre and South of the Country. Urinary sodium and creatinine measurements were carried out in a central laboratory. The analyses included 942 men and 916 women examined in 2008-2012, and 967 men and 1010 women examined in 2018-2019. The age-standardized mean daily population salt (sodium chloride) intake was 10.8 g (95% CI 10.5-11.1) in men and 8.3 g (8.1-8.5) in women in 2008-2012 and respectively 9.5 g (9.3-9.8) and 7.2 g (7.0-7.4) in 2018-2019. A statistically significant (p<0.0001) salt intake reduction was thus observed over 10 years for both genders, and all age, body mass index (BMI) and educational classes. CONCLUSIONS The average daily salt intake of the Italian general adult population remains higher than the WHO recommended level, but a significant reduction of 12% in men and 13% in women has occurred in the past ten years. These results encourage the initiatives undertaken by the Italian Ministry of Health aimed at the reduction of salt intake at the population level.
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Affiliation(s)
| | | | - Ornella Russo
- Federico II University of Naples Medical School, Naples, Italy
| | | | | | | | | | - Roberto Iacone
- Federico II University of Naples Medical School, Naples, Italy
| | | | | | | | | | | | | | - Michele M Gulizia
- National Hospital of High Relevance and Specialization "Garibaldi", Catania, Italy; Heart Care Foundation, Florence, Italy
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10
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Emamian MH, Ebrahimi H, Hashemi H, Fotouhi A. Salt intake and blood pressure in Iranian children and adolescents: a population-based study. BMC Cardiovasc Disord 2021; 21:62. [PMID: 33530964 PMCID: PMC7851910 DOI: 10.1186/s12872-021-01876-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/18/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Previous studies have reported a high prevalence of hypertension in Iranian students, especially in rural areas. The aim of this study was to investigate the daily intake of salt in students and its association with high blood pressure. METHODS A random sub-sample was selected from the participants of the second phase of Shahroud schoolchildren eye cohort study and then a random urine sample was tested for sodium, potassium and creatinine. Urine electrolyte esexcretion and daily salt intake were calculated by Tanaka et al.'s formula. RESULTS Among 1455 participants (including 230 participants from rural area and 472 girls), the mean age was 12.9 ± 1.7 year and the mean daily salt intake was 9.7 ± 2.6 g (95% CI 9.5-9.8). The mean salt consumption in rural areas [10.8 (95% CI 10.4-11.2)] was higher than urban areas [9.4 (95% CI 9.3-9.6)], in people with hypertension [10.8 (95% CI 10.3-11.3)] was more than people with normal blood pressure [9.4 (95% CI 9.3-9.6)], and in boys [9.8 (95% CI 9.7-10.0)] was more than girls [9.3 (95% CI 9.1-9.6)]. Higher age, BMI z-score, male sex and rural life, were associated with increased daily salt intake. Increased salt intake was associated with increased systolic and diastolic blood pressure. CONCLUSION Daily salt intake in Iranian adolescents was about 2 times the recommended amount of the World Health Organization, was higher in rural areas and was associated with blood pressure. Reducing salt intake should be considered as an important intervention, especially in rural areas.
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Affiliation(s)
- Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hossein Ebrahimi
- Randomized Controlled Trial Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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11
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Layeghiasl M, Malekzadeh J, Shams M, Maleki M. Using Social Marketing to Reduce Salt Intake in Iran. Front Public Health 2020; 8:207. [PMID: 32582611 PMCID: PMC7289950 DOI: 10.3389/fpubh.2020.00207] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/05/2020] [Indexed: 01/21/2023] Open
Abstract
Objectives: WHO has recommended that the average salt intake must be <5 grams per day. However, people consume salt much more in many countries. In this study, we design and implement an intervention based on social marketing model to reduce salt consumption in Yasuj, Iran. Materials and Methods: This study employed a quasi-experimental pretest-posttest with control group design which consisted of a formative research (qualitative-quantitative) and an interventional phase. To collect the qualitative data, six focus group discussions by participating of 66 people were established. The qualitative data were analyzed manually using directed content analysis. In quantitative study, 166 people aged 25-50 years completed a KAP questionnaire, and their average salt intake was determined through measuring sodium in their urine sample. By analyzing the data, marketing mix components were determined for designing an intervention. An educational package (including posters for installing in the kitchen, pamphlets, phone counseling, four educational classes, and brief interventions done by physicians and other health personnel) focused on reducing salt intake and using alternatives was developed. For one month, program was implemented for intervention group. Two months later, KAP survey and measuring the urine sodium were repeated for intervention and control groups. The data was compared for two groups, before and after the intervention by using independent t-test, paired t-tests and repeated measures ANOVA. Results: The qualitative findings showed that most participants agreed that the salt intake was high in Iran. Most of them recommended home-based and family-driven strategies to reduce salt intake, offered using healthier alternatives for salt, and recognized physicians and health care providers in healthcare facilities as the most important to encourage people to reduce salt intake. After the intervention, the mean and standard deviation of KAP were improved significantly in intervention group. The mean salt intake decreased significantly by 3.01 ± 2.38 in the intervention group and repeated measures ANOVA showed significant change over time (P < 0.001) and a significant difference between two groups (P = 0.04). Also, the interaction between time and group was significant (P = 0.001). Conclusion: The mean salt intake among the study population was approximately three times more than the level recommended by the WHO. The social marketing-based intervention succeeded in reducing the salt intake of the study subjects by ~3 grams on average.
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Affiliation(s)
- Mehdi Layeghiasl
- Department of Health Education and Promotion, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Janmohamad Malekzadeh
- Department of Nutrition, Yasuj University of Medical Sciences, Yasuj, Iran.,Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohsen Shams
- Department of Health Education and Promotion, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran.,Iranian Social Marketing Association, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mostafa Maleki
- Iranian Social Marketing Association, Yasuj University of Medical Sciences, Yasuj, Iran.,Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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