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Ghimire K, Mishra SR, Neupane D, Kallestrup P, McLachlan CS. Association between Salt-Related Knowledge, Attitudes, and Behaviours and 24 h Urinary Salt Excretion in Nepal. Nutrients 2024; 16:1928. [PMID: 38931282 PMCID: PMC11206565 DOI: 10.3390/nu16121928] [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: 05/11/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
This study examined the association between salt-related knowledge, attitudes, and behaviors (KAB) and salt excretion using the 24-hour (24 h) urinary collection method. Data were utilized from the Community-Based Management of Non-Communicable Diseases in Nepal (COBIN) Salt Survey, a community-based cross-sectional study conducted among a sub-sample of COBIN cohort in Pokhara Metropolitan City, Western Nepal, from July to December 2018, among adults aged 25-70 years. A total of 451 adults participated in the study, and a single 24 h urine sample was collected from each participant. The mean [(standard deviation (SD)] age of the participants was 49.6 (9.82) years, and the majority were female (65%). The mean urinary salt excretion was 13.28 (SD: 4.72) g/day, with 98% of participants consuming ≥5 g of salt/day. Although 83% of participants knew the risks of high salt intake and 87% believed it was important to reduce their intake, only 10% reported doing so. Salt-related attitude i.e., self-perceived salt intake was significantly associated with urinary salt excretion, adding extra salt to food, consuming processed foods, and taking actions to salt control. Participants who perceived themselves as consuming high salt had higher urinary salt excretion [(14.42 g/day; 95% confidence interval (95% CI): 13.45, 15.39, p = 0.03)], were more likely to add extra [(Odds ratio (OR) = 3.59; 95% CI: 2.03, 6.33, p < 0.001)], and consume processed foods more often (OR = 1.90; 95% CI: 1.06, 3.40, p < 0.05) compared to those who self-perceived consuming a normal amount of salt. Conversely, participants who perceived themselves as consuming low salt were more likely to take actions to control salt intake (OR = 4.22; 95% CI: 1.90, 9.37, p < 0.001) compared to their counterparts who perceived consuming a normal amount of salt. There existed a gap between salt-related knowledge, attitudes, and actual behaviors, resulting in a high salt intake among the Nepalese population. Nepal urgently requires tailored national salt reduction programs that comprise both policy and community-level interventions to achieve a 30% reduction in mean population salt intake by 2025. Further validation studies are needed to assess the effectiveness of community-based intervention in Nepal.
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Affiliation(s)
- Kamal Ghimire
- Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal; (S.R.M.); (D.N.)
- School of Health, Torrens University, Sydney, NSW 2010, Australia
| | - Shiva Raj Mishra
- Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal; (S.R.M.); (D.N.)
- NHMRC Clinical Trials Centre, Faculty of Medicine and Public Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Dinesh Neupane
- Nepal Development Society, Bharatpur-10, Chitwan 44200, Nepal; (S.R.M.); (D.N.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21212, USA
| | - Per Kallestrup
- Research Unit for Global Health, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark;
| | - Craig S. McLachlan
- Centre for Healthy Futures, Torrens University, Sydney, NSW 2010, Australia;
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Liu M, Ye Z, He P, Yang S, Zhang Y, Zhou C, Zhang Y, Hou FF, Qin X. Adding salt to foods and hazards of microvascular, cerebrovascular and cardiovascular diseases. Eur J Clin Nutr 2024; 78:141-148. [PMID: 37838806 DOI: 10.1038/s41430-023-01354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND We aimed to examine the association of the frequency of adding salt to foods and the hazards of the incidence and mortality risks for a range of vascular outcomes, including microvascular, cerebrovascular, and cardiovascular diseases. METHODS 438,307 participants from the UK Biobank who completed the questionnaire on the frequency of adding salt to foods and were free of vascular disease at baseline were enrolled. Information on the frequency of adding salt to foods (do not include salt used in cooking) was collected at baseline through a touch-screen questionnaire. The primary outcomes included incident microvascular diseases, cerebrovascular diseases, and cardiovascular diseases, respectively. The secondary outcomes included: (1) each component of these vascular diseases (10 components in total), (2) first occurrence of fatal and non-fatal vascular diseases. RESULTS During a median follow-up of 12.1 years, a total of 17,169 (3.9%), 10,437 (2.4%), and 48,203 (11.0%) participants developed microvascular, cerebrovascular and cardiovascular diseases, respectively. Overall, the hazards of incident microvascular, cerebrovascular and cardiovascular diseases increased with the increasing frequency of adding salt to foods (all P for trend <0.001). Similar trends were found for the secondary outcomes. Moreover, the positive association of always adding salt to foods with hazard of cardiovascular diseases was stronger among current-smokers (P-interaction = 0.010), younger participants (P-interaction <0.001), and those with lower body mass index levels (P-interaction = 0.003). CONCLUSIONS Higher frequency of adding salt to foods was associated with higher hazards of non-fatal and fatal microvascular, cerebrovascular and cardiovascular diseases, and each component of these vascular diseases.
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Affiliation(s)
- Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Sisi Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Yanjun Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
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Lv W, Ding X, Liu Y, Ma A, Yang Y, Wang Z, Gao C. Evaluating the Energy and Core Nutrients of Condiments in China. Nutrients 2023; 15:4346. [PMID: 37892422 PMCID: PMC10609505 DOI: 10.3390/nu15204346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 10/29/2023] Open
Abstract
Condiments are a significant source of sodium in the diets of Chinese residents. This study aimed to analyze the nutrient content of China's major condiments and to provide support for setting the reference intake for condiments in order to take measures on salt reduction in China. Nutrition data for condiments were collected from the Database on Nutrition Labelling of Prepackaged Foods China in 2017-2022, and by online access to food composition databases from France, the UK, Belgium, and Japan. The analyses include 1510 condiments in China and 1565 related condiments in four countries, of which the descriptive indicators were examined such as median, IQR, and range. Cross-comparisons were made in terms of the difference between the content levels in five countries and the "WHO global sodium benchmarks". The results show that among the 15 types of condiments in China, sesame/peanut butter-based products have a relatively high content of energy, fat, and protein, namely, 2580 kJ/100 g, 50 g/100 g, and 22.2 g/100 g, respectively. In addition to salt, chicken extract/chicken powder, bouillon cubes, and soy sauce are also high in sodium. Furthermore, there were significant differences in the contents of energy and core nutrients across different products when benchmarking with similar condiments in the five countries (p < 0.001). The sodium content and fat content of some condiments are excessively high. Therefore, enhancing residents' consumption awareness and reducing the amount of condiments is of great significance for reducing China's per capita salt intake and promoting good health.
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Affiliation(s)
- Wanting Lv
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (W.L.); (X.D.); (A.M.); (Y.Y.)
| | - Xin Ding
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (W.L.); (X.D.); (A.M.); (Y.Y.)
| | - Yang Liu
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China; (Y.L.); (Z.W.)
| | - Aiguo Ma
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (W.L.); (X.D.); (A.M.); (Y.Y.)
| | - Yuexin Yang
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (W.L.); (X.D.); (A.M.); (Y.Y.)
- Chinese Nutrition Society, Beijing 100053, China
| | - Zhu Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China; (Y.L.); (Z.W.)
| | - Chao Gao
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China; (Y.L.); (Z.W.)
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Li F, Chen L, Liu B, Zhong VW, Deng Y, Luo D, Gao C, Bao W, Rong S. Frequency of adding salt at the table and risk of incident cardiovascular disease and all-cause mortality: a prospective cohort study. BMC Med 2022; 20:486. [PMID: 36522670 PMCID: PMC9753015 DOI: 10.1186/s12916-022-02691-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adding salt at the table is a prevalent eating habit, but its long-term relationship with cardiovascular disease (CVD) and all-cause mortality remains unclear. We evaluated the associations of adding salt at the table with the risk of incident CVD and all-cause mortality. METHODS Among 413,109 middle- and old-aged adults without cancer or CVD, all participants reported the frequency of adding salt at the table at baseline. The associations between adding salt at the table and incident CVD (the composite endpoint of coronary heart disease, stroke, heart failure, and CVD deaths) and all-cause mortality were investigated using Cox proportional hazards models. RESULTS Of the study population, the mean age was 55.8 years and 45.5% were men; 44.4% reported adding salt at the table; 4.8% reported always adding salt at the table. During a median follow-up of 12 years, there were 37,091 incident CVD cases and 21,293 all-cause deaths. After adjustment for demographic, lifestyle, and cardiometabolic risk factors, the multivariable-adjusted hazard ratios (HRs) for participants who always added salt at the table versus never/rarely added salt at the table were 1.21 (95% confidence interval [CI]: 1.16-1.26) for CVD, 1.19 (95%CI: 1.05-1.35) for CVD mortality, and 1.22 (95%CI: 1.16-1.29) for all-cause mortality, respectively. CONCLUSIONS In this prospective cohort study, a higher frequency of adding salt at the table was associated with a greater risk of incident CVD and mortality. Our findings support the benefits of restricting the habit of adding salt at the table in promoting cardiovascular health.
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Affiliation(s)
- Fengping Li
- Department of Nutrition, School of Public Health, Wuhan University, Research Center of Public Health, Renmin Hospital of Wuhan University, No.115 Donghu Road, Wuhan, 430071, China
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Buyun Liu
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, China
| | - Victor W Zhong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Deng
- Academy of Nutrition and Health, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Dan Luo
- School of Nursing, Wuhan University, Wuhan, China
| | - Chao Gao
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Wei Bao
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026, China
| | - Shuang Rong
- Department of Nutrition, School of Public Health, Wuhan University, Research Center of Public Health, Renmin Hospital of Wuhan University, No.115 Donghu Road, Wuhan, 430071, China.
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Bhattarai S, Bista B, Yadav BK, Gynawali P, Poudyal A, Jha AK, Dhimal M. Estimation of mean population salt intakes using spot urine samples and associations with body mass index, hypertension, raised blood sugar and hypercholesterolemia: Findings from STEPS Survey 2019, Nepal. PLoS One 2022; 17:e0266662. [PMID: 35413065 PMCID: PMC9004746 DOI: 10.1371/journal.pone.0266662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background
High dietary salt intake is recognized as a risk factor for several non-communicable diseases (NCDs), in particular cardiovascular diseases (CVDs), including heart attack and stroke. Accurate measurement of population level salt intake is essential for setting targeted goals and plans for salt reduction strategies. We used a spot urine sample to estimate the mean population salt intake in Nepal and evaluated the association of salt intake with excess weight, hypertension, raised blood sugar and hypercholesterolemia, and a number of socio-demographic characteristics.
Methods
A population-based cross-sectional study was carried out from February to May 2019 using a WHO STEPwise approach to surveillance. Spot urine was collected from 4361 participants aged 15–69 years for the analysis of salt intake. We then used the INTERSALT equation to calculate population salt intake. Student’s ‘t’ test, one-way ANOVA and multivariable linear regression were used to assess the association between salt intake and a number of factors. Statistical significance was accepted at P < .05.
Results
The average (±SD) age of participants was 40 (14.1) years. Mean salt intake, derived from spot urine samples, was estimated to be 9.1g/d. A total of 70.8% of the population consumed more than the WHO’s recommended amount of 5g salt per day, with almost one third of the population (29%) consuming more than 10g of salt per day. Higher salt intake was significantly associated with male gender (β for male = 0.98g; 95%CI:0.87,1.1) and younger age groups (β25–39 years = 0.08; 95%CI:-0.08,0.23) and higher BMI (β = 0.19; 95%CI:0.18,0.21). Participants who were hypertensive and had raised blood cholesterol consumed less salt than people who had normal blood pressure and cholesterol levels (P<0.001).
Conclusions
Salt consumption in Nepal is high, with a total of 70.8% of the population having a mean salt intake >5g/d, well above the World Health Organization recommendation. High salt intake was found to be associated with sex, age group, education, province, BMI, and raised cholesterol level of participants These findings build a strong case for action to reduce salt consumption in Nepal in order to achieve the global target of 30% reduction in population salt intake by 2025.
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Affiliation(s)
- Saroj Bhattarai
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Bihungum Bista
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Binod Kumar Yadav
- Department of Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Pradip Gynawali
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Anil Poudyal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | | | - Meghnath Dhimal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
- * E-mail: ,
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The association between dietary sodium intake, adiposity and sugar-sweetened beverages in children and adults: a systematic review and meta-analysis. Br J Nutr 2020; 126:409-427. [PMID: 33054868 DOI: 10.1017/s0007114520004122] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Higher intakes of Na may contribute to weight gain. The primary aim of this systematic review and meta-analysis was to examine the relationship between dietary Na intake and measures of adiposity in children and adults. Given the previous link between Na intake and the consumption of sugar-sweetened beverages (SSB), which are a known risk factor for obesity, a secondary aim examining the relationship between Na intake and SSB consumption was assessed. A systematic literature search identified cross-sectional and longitudinal studies and randomised controlled trials (RCT) which reduced dietary Na (≥3 months). Meta-analysis was performed for outcomes with ≥3 studies. Cross-sectionally higher Na intakes were associated with overweight/obesity in adults (five studies; n 11 067; OR 1·74; 95 % CI 1·43, 2·13) and in children (three studies; n 3625, OR 3·29; 95 % CI 2·25, 4·80), and abdominal obesity (five studies; n 19 744; OR 2·04; 95 % CI 1·72, 2·42) in adults. Overall, associations remained in sensitivity analyses which adjusted for energy. Findings from longitudinal studies were inconsistent. RCT in adults indicated a trend for lower body weight on reduced-Na compared with control diets (fifteen studies; n 5274; -0·29 kg; 95 % CI -0·59, 0·01; P = 0·06); however, it is unclear if energy intakes were also altered on reduced-Na diets. Among children higher Na intakes were associated with higher intake of SSB (four studies, n 10 329, b = 22, 16 and 26 g/d); no studies were retrieved for adults. Overall, there was a lack of high-quality studies retrieved. While cross-sectional evidence indicates Na intake was positively associated with adiposity, these findings have not been clearly confirmed by longitudinal studies or RCT.
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Santos JA, Rosewarne E, Hogendorf M, Trieu K, Pillay A, Ieremia M, Naseri LTT, Tukana I, Snowdon W, Petersen K, Webster J. Estimating mean population salt intake in Fiji and Samoa using spot urine samples. Nutr J 2019; 18:55. [PMID: 31506072 PMCID: PMC6737719 DOI: 10.1186/s12937-019-0484-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing interest in finding less costly and burdensome alternatives to measuring population-level salt intake than 24-h urine collection, such as spot urine samples. However, little is known about their usefulness in developing countries like Fiji and Samoa. The purpose of this study was to evaluate the capacity of spot urine samples to estimate mean population salt intake in Fiji and Samoa. METHODS The study involved secondary analyses of urine data from cross-sectional surveys conducted in Fiji and Samoa between 2012 and 2016. Mean salt intake was estimated from spot urine samples using six equations, and compared with the measured salt intake from 24-h urine samples. Differences and agreement between the two methods were examined through paired samples t-test, intraclass correlation coefficient analysis, and Bland-Altman plots and analyses. RESULTS A total of 414 participants from Fiji and 725 participants from Samoa were included. Unweighted mean salt intake based on 24-h urine collection was 10.58 g/day (95% CI 9.95 to 11.22) in Fiji and 7.09 g/day (95% CI 6.83 to 7.36) in Samoa. In both samples, the INTERSALT equation with potassium produced the closest salt intake estimate to the 24-h urine (difference of - 0.92 g/day, 95% CI - 1.67 to - 0.18 in the Fiji sample and + 1.53 g/day, 95% CI 1.28 to 1.77 in the Samoa sample). The presence of proportional bias was evident for all equations except for the Kawasaki equation. CONCLUSION These data suggest that additional studies where both 24-h urine and spot urine samples are collected are needed to further assess whether methods based on spot urine samples can be confidently used to estimate mean population salt intake in Fiji and Samoa.
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Affiliation(s)
- Joseph Alvin Santos
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Martyna Hogendorf
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases, Fiji National University, Nasinu, Fiji
| | | | | | - Isimeli Tukana
- National Wellness Centre, Ministry of Health and Medical Services, Suva, Fiji
| | - Wendy Snowdon
- Global Obesity Centre, Deakin University, Geelong, 3216 Australia
| | - Kristina Petersen
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
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Ghimire K, Adhikari TB, Rijal A, Kallestrup P, Henry ME, Neupane D. Knowledge, attitudes, and practices related to salt consumption in Nepal: Findings from the community-based management of non-communicable diseases project in Nepal (COBIN). J Clin Hypertens (Greenwich) 2019; 21:739-748. [PMID: 31026125 DOI: 10.1111/jch.13544] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/22/2019] [Accepted: 04/03/2019] [Indexed: 11/29/2022]
Abstract
High salt/sodium intake is associated with an increased risk of hypertension, which is a major risk factor for cardiovascular diseases. This paper aims to examine the association between salt consumption and salt-related knowledge, attitudes, and practices (KAP) in Nepal. The cross-sectional data used in this study were collected as part of the community-based management of non-communicable diseases project (COBIN) to understand the amount and KAP related to salt consumption in Nepal. Multivariate hierarchical logistic regression was performed to assess the association of salt-related KAP and determinants of high salt consumption in Nepal. The mean per capita salt intake was 8.0 (±3.7) g/day, with 81.6% of the population reporting higher intake than the WHO recommendation of <5 g/day. People of upper castes [adjusted odds ratio (aOR) = 0.7; 95% confidence interval (CI): 0.5-0.9], people in large families (aOR = 0.6; 95% CI: 0.5-0.7), respondents who were advised to lower salt intake (aOR = 0.6; 95% CI: 0.4-0.9) and who checked salt/sodium labels in food (aOR = 0.6; 95% CI: 0.4-0.9) were less likely to consume higher amounts of salt. Similarly, people who added extra salt to their food at the table (aOR = 1.4; 95 CI: 1.1-1.9) and who reported consuming high amounts of salt (aOR = 1.5; 95% CI: 1.1-2.3) were more likely to have high salt intake. High salt intake was documented in this population. This study suggests the need for culturally tailored community-based behavior modification through health education and dietary counseling to effectively reduce salt consumption and thereby support a reduction in hypertension and cardiovascular diseases in Nepal.
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Affiliation(s)
| | - Tara Ballav Adhikari
- Nepal Development Society, Chitwan, Nepal.,Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Per Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Megan E Henry
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dinesh Neupane
- Nepal Development Society, Chitwan, Nepal.,The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Mean Dietary Salt Intake in Vanuatu: A Population Survey of 755 Participants on Efate Island. Nutrients 2019; 11:nu11040916. [PMID: 31022856 PMCID: PMC6521272 DOI: 10.3390/nu11040916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
Non-communicable diseases are responsible for 63% of global deaths, with a higher burden in low- and middle-income countries. Hypertension is the leading cause of cardiovascular-disease-related deaths worldwide, and approximately 1.7 million deaths are directly attributable to excess salt intake annually. There has been little research conducted on the level of salt consumption amongst the population of Vanuatu. Based on data from other Pacific Island countries and knowledge of changing regional diets, it was predicted that salt intake would exceed the World Health Organization’s (WHO) recommended maximum of 5 g per day. The current study aimed to provide Vanuatu with a preliminary baseline assessment of population salt intake on Efate Island. A cross-sectional survey collected demographic, clinical, and urine data from participants aged 18 to 69 years in rural and urban communities on Efate Island in October 2016 and February 2017. Mean salt intake was determined to be 7.2 (SD 2.3) g/day from spot urine samples, and 5.9 (SD 3.6) g/day from 24-h urine samples, both of which exceed the WHO recommended maximum. Based on the spot urine samples, males had significantly higher salt intake than females (7.8 g compared to 6.5 g; p < 0.001) and almost 85% of the population consumed more than the WHO recommended maximum daily amount. A coordinated government strategy is recommended to reduce salt consumption, including fiscal policies, engagement with the food industry, and education and awareness-raising to promote behavior change.
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Sparks E, Paterson K, Santos JA, Trieu K, Hinge N, Tarivonda L, Snowdon W, Johnson C, Webster J. Salt-Related Knowledge, Attitudes, and Behaviors on Efate Island, Vanuatu. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16061027. [PMID: 30901868 PMCID: PMC6466123 DOI: 10.3390/ijerph16061027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/27/2022]
Abstract
In Vanuatu, mean salt intake exceeds the recommended maximum daily intake, and contributes to the high proportion of deaths attributable to cardiovascular diseases. Understanding salt-related knowledge, attitudes, and behaviors of the Vanuatu population can inform appropriate interventions. This cross-sectional study was conducted as part of the 2016–2017 Vanuatu Salt Survey. In total, 753 participants aged between 18 and 69 years from rural and urban communities on the Island of Efate were included. Demographic and clinical data were collected and a salt-related knowledge, attitudes, and behaviors survey was administered. Knowledge relating to the need to reduce salt consumption was high, but reported behaviors did not reflect this knowledge. A total of 83% of participants agreed that too much salt could cause health problems, and 86% reported that it was “very important” to lower the amount of salt in the diet. However, more than two-thirds of the population reported always/often adding salt to food during cooking/meal preparation and at the table, and always/often consuming processed foods high in salt. Strategic, targeted, and sustained behavior change programs in parallel with interventions to change the food environment to facilitate healthier choices should be key components of a salt reduction program. Actions should implemented as part of a comprehensive strategy to prevent and control non-communicable diseases in Vanuatu.
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Affiliation(s)
- Emalie Sparks
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
| | | | - Joseph Alvin Santos
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
| | - Nerida Hinge
- Vanuatu Ministry of Health, Iatika Complex, Cornwall St, Port Vila, Vanuatu.
| | - Len Tarivonda
- Vanuatu Ministry of Health, Iatika Complex, Cornwall St, Port Vila, Vanuatu.
| | - Wendy Snowdon
- Division of Pacific Technical Support, South Pacific Office, World Health Organization, Level 4, Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji.
| | - Claire Johnson
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
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11
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Abstract
OBJECTIVE Pacific Island countries are experiencing a high burden of diet-related non-communicable diseases; and consumption of fat, sugar and salt are important modifiable risk factors contributing to this. The present study systematically reviewed and summarized available literature on dietary intakes of fat, sugar and salt in the Pacific Islands. DESIGN Electronic databases (PubMed, Scopus, ScienceDirect and GlobalHealth) were searched from 2005 to January 2018. Grey literature was also searched and key stakeholders were consulted for additional information. Study eligibility was assessed by two authors and quality was evaluated using a modified tool for assessing dietary intake studies. RESULTS Thirty-one studies were included, twenty-two contained information on fat, seventeen on sugar and fourteen on salt. Dietary assessment methods varied widely and six different outcome measures for fat, sugar and salt intake - absolute intake, household expenditure, percentage contribution to energy intake, sources, availability and dietary behaviours - were used. Absolute intake of fat ranged from 25·4 g/d in Solomon Islands to 98·9 g/d in Guam, while salt intake ranged from 5·6 g/d in Kiribati to 10·3 g/d in Fiji. Only Guam reported on absolute sugar intake (47·3 g/d). Peer-reviewed research studies used higher-quality dietary assessment methods, while reports from national surveys had better participation rates but mostly utilized indirect methods to quantify intake. CONCLUSIONS Despite the established and growing crisis of diet-related diseases in the Pacific, there is inadequate evidence about what Pacific Islanders are eating. Pacific Island countries need nutrition monitoring systems to fully understand the changing diets of Pacific Islanders and inform effective policy interventions.
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12
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Linhart C, Naseri T, Lin S, Taylor R, Morrell S, McGarvey ST, Magliano DJ, Zimmet P. Continued increases in blood pressure over two decades in Samoa (1991-2013); around one-third of the increase explained by rising obesity levels. BMC Public Health 2018; 18:1122. [PMID: 30219049 PMCID: PMC6139166 DOI: 10.1186/s12889-018-6016-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To analyse trends over the period 1991-2013 in systolic blood pressure (SBP), diastolic blood pressure (DBP) and the prevalence of hypertension in adults aged 25-64 years in Samoa; and to assess the contribution of rising obesity levels to period trends. METHODS Unit record data from seven population-based surveys (n = 10,881) conducted between 1991 and 2013 were included for analysis. Surveys were adjusted to the nearest previous census to improve national representativeness. Hypertension was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg and/or on medication for hypertension. Obesity was measured by body mass index (BMI). Poisson, linear and meta-regression were used to assess period trends. RESULTS Over 1991-2013 mean SBP and DBP (mmHg), and the prevalence of hypertension (%) increased in both sexes. Increases in hypertension were: from 18.3 to 33.9% (p < 0.001) in men (mean BP from 122/74 to 132/78); and from 14.3 to 26.4% (p < 0.001) in women (mean BP from 118/73 to 126/78). The estimate of the age-adjusted mean SBP and DBP over 1991-2013, and the relative risk for hypertension in 2013 compared to 1991, were attenuated after adjusting for BMI: by 22% (men) and 32% (women) for mean SBP; 37% (men) and 32% (women) for mean DBP; and 19% in both sexes for hypertension. CONCLUSIONS Significant increases have occurred in SBP/DBP and hypertension prevalence in both sexes in Samoa during 1991-2013, which would contribute significantly to premature mortality from cardiovascular disease. Obesity accounts for around one-third of the rising trend in blood pressure in the Samoan population. Strengthening of population control of hypertension through reduction in obesity and salt intake, and case detection and treatment through primary care, is required to reduce premature mortality from cardiovascular disease in Samoa.
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Affiliation(s)
- Christine Linhart
- Public and International Health, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Sophia Lin
- Public and International Health, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Richard Taylor
- Public and International Health, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen Morrell
- Public and International Health, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen T. McGarvey
- International Health Institute, Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | | | - Paul Zimmet
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia
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13
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Abstract
Objective: Salt reduction is one of the most cost-effective interventions for the prevention of noncommunicable diseases, but there are no studies evaluating the effectiveness of national strategies in low or lower middle income countries. This study aimed to examine the effect of an 18-month nation-wide salt reduction strategy in Samoa. Methods: Two nationally representative cross-sectional surveys of adults aged 18–64 years, measuring 24-h urinary salt excretion and salt-related knowledge, attitudes and behaviours, were conducted before (2013) and after (2015) the intervention. Results: There were 234 participants at baseline (response rate 47%) and 479 at 18 months (response rate 61%). There was no change in mean population salt intake between 2013 (7.31 g/day) and 2015 (7.50 g/day) (0.19, 95% confidence interval −0.50 to 0.88; P = 0.588). There were significant changes in the proportion of the population who always or often add discretionary salt when eating (−16.2%, P = 0.002), the proportion who understood the adverse effects of salt (+9.0%, P = 0.049) and the proportion using one or more methods to control their salt intake (+20.9%, P < 0.001). A total of 73% reported that they had heard or seen the salt reduction messages. Conclusion: With widespread awareness of the salt reduction message and some improvements in salt-related knowledge and behaviours following the intervention, Samoa is now well positioned to implement much-needed structural initiatives or policies to reduce salt in the food supply.
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14
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McKenzie B, Santos JA, Trieu K, Thout SR, Johnson C, Arcand J, Webster J, McLean R. The Science of Salt: A focused review on salt-related knowledge, attitudes and behaviors, and gender differences. J Clin Hypertens (Greenwich) 2018; 20:850-866. [PMID: 29722131 PMCID: PMC8031068 DOI: 10.1111/jch.13289] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/21/2018] [Indexed: 12/20/2022]
Abstract
The aim of the current review was to examine the scope of studies published in the Science of Salt Weekly that contained a measure of self-reported knowledge, attitudes, and behavior (KAB) concerning salt. Specific objectives were to examine how KAB measures are used to evaluate salt reduction intervention studies, the questionnaires used, and whether any gender differences exist in self-reported KAB. Studies were reviewed from the commencement of Science of Salt Weekly, June 2013 to the end of August 2017. Seventy-five studies had relevant measures of KAB and were included in this review, 13 of these were salt-reduction intervention-evaluation studies, with the remainder (62) being descriptive KAB studies. The KAB questionnaires used were specific to the populations studied, without evidence of a best practice measure. 40% of studies used KAB alone as the primary outcome measure; the remaining studies used more quantitative measures of salt intake such as 24-hour urine. Only half of the descriptive studies showed KAB outcomes disaggregated by gender, and of those, 73% showed women had more favorable KAB related to salt. None of the salt intervention-evaluation studies showed disaggregated KAB data. Therefore, it is likely important that evaluation studies disaggregate, and are appropriately powered to disaggregate all outcomes by gender to address potential disparities.
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Affiliation(s)
- Briar McKenzie
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Sudhir Raj Thout
- The George Institute for Global Health India, Unit No. 301, Hyderabad, Telangana, India
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael McLean
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
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15
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Webster J, Pillay A, Suku A, Gohil P, Santos JA, Schultz J, Wate J, Trieu K, Hope S, Snowdon W, Moodie M, Jan S, Bell C. Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji. Nutrients 2018; 10:nu10020155. [PMID: 29385758 PMCID: PMC5852731 DOI: 10.3390/nu10020155] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 01/08/2023] Open
Abstract
This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.
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MESH Headings
- Costs and Cost Analysis
- Cyclonic Storms
- Diet, Healthy/economics
- Diet, Healthy/ethnology
- Diet, Sodium-Restricted/economics
- Diet, Sodium-Restricted/ethnology
- Fast Foods/adverse effects
- Fast Foods/analysis
- Fast Foods/economics
- Fiji
- Focus Groups
- Food Industry/economics
- Food, Preserved/adverse effects
- Food, Preserved/analysis
- Food, Preserved/economics
- Health Knowledge, Attitudes, Practice/ethnology
- Health Plan Implementation/economics
- Health Promotion/economics
- Humans
- Hypertension/economics
- Hypertension/ethnology
- Hypertension/etiology
- Hypertension/prevention & control
- Information Dissemination
- Nutrition Surveys/economics
- Patient Compliance/ethnology
- Program Evaluation
- Public-Private Sector Partnerships/economics
- Sodium Chloride, Dietary/adverse effects
- Sodium Chloride, Dietary/analysis
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Affiliation(s)
- Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Arleen Suku
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Paayal Gohil
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | | | - Jillian Wate
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | - Silvia Hope
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia.
| | - Wendy Snowdon
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia.
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Colin Bell
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
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16
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Assessment of a Salt Reduction Intervention on Adult Population Salt Intake in Fiji. Nutrients 2017; 9:nu9121350. [PMID: 29231897 PMCID: PMC5748800 DOI: 10.3390/nu9121350] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/15/2017] [Accepted: 12/07/2017] [Indexed: 11/17/2022] Open
Abstract
Reducing population salt intake is a global public health priority due to the potential to save lives and reduce the burden on the healthcare system through decreased blood pressure. This implementation science research project set out to measure salt consumption patterns and to assess the impact of a complex, multi-faceted intervention to reduce population salt intake in Fiji between 2012 and 2016. The intervention combined initiatives to engage food businesses to reduce salt in foods and meals with targeted consumer behavior change programs. There were 169 participants at baseline (response rate 28.2%) and 272 at 20 months (response rate 22.4%). The mean salt intake from 24-h urine samples was estimated to be 11.7 grams per day (g/d) at baseline and 10.3 g/d after 20 months (difference: -1.4 g/day, 95% CI -3.1 to 0.3, p = 0.115). Sub-analysis showed a statistically significant reduction in female salt intake in the Central Division but no differential impact in relation to age or ethnicity. Whilst the low response rate means it is not possible to draw firm conclusions about these changes, the population salt intake in Fiji, at 10.3 g/day, is still twice the World Health Organization's (WHO) recommended maximum intake. This project also assessed iodine intake levels in women of child-bearing age and found that they were within recommended guidelines. Existing policies and programs to reduce salt intake and prevent iodine deficiency need to be maintained or strengthened. Monitoring to assess changes in salt intake and to ensure that iodine levels remain adequate should be built into future surveys.
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17
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Santos JA, Trieu K, Raj TS, Arcand J, Johnson C, Webster J, McLean R. The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March-August 2016). J Clin Hypertens (Greenwich) 2017; 19:439-451. [PMID: 28247592 PMCID: PMC8031001 DOI: 10.1111/jch.12971] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/03/2016] [Indexed: 11/10/2023]
Abstract
This review aims to identify, summarize, and appraise studies reporting on the implementation of salt reduction interventions that were published between March and August 2016. Overall, 40 studies were included: four studies evaluated the impact of salt reduction interventions, while 36 studies were identified as relevant to the design, assessment, and implementation of salt reduction strategies. Detailed appraisal and commentary were undertaken on the four studies that measured the impact of the interventions. Among them, different evaluation approaches were adopted; however, all demonstrated positive health outcomes relating to dietary salt reduction. Three of the four studies measured sodium in breads and provided consistent evidence that sodium reduction in breads is feasible and different intervention options are available. None of the studies were conducted in low- or lower middle-income countries, which stresses the need for more resources and research support for the implementation of salt reduction interventions in these countries.
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Affiliation(s)
- Joseph Alvin Santos
- The George Institute for Global HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Kathy Trieu
- The George Institute for Global HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | | | - JoAnne Arcand
- Faculty of Health SciencesUniversity of Ontario Institute of TechnologyOshawa OntarioCanada
| | - Claire Johnson
- The George Institute for Global HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Jacqui Webster
- The George Institute for Global HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Rachael McLean
- Departments of Preventive & Social Medicine/Human NutritionUniversity of OtagoDunedinNew Zealand
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18
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Hope SF, Webster J, Trieu K, Pillay A, Ieremia M, Bell C, Snowdon W, Neal B, Moodie M. A systematic review of economic evaluations of population-based sodium reduction interventions. PLoS One 2017; 12:e0173600. [PMID: 28355231 PMCID: PMC5371286 DOI: 10.1371/journal.pone.0173600] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/23/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To summarise evidence describing the cost-effectiveness of population-based interventions targeting sodium reduction. Methods A systematic search of published and grey literature databases and websites was conducted using specified key words. Characteristics of identified economic evaluations were recorded, and included studies were appraised for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results Twenty studies met the study inclusion criteria and received a full paper review. Fourteen studies were identified as full economic evaluations in that they included both costs and benefits associated with an intervention measured against a comparator. Most studies were modelling exercises based on scenarios for achieving salt reduction and assumed effects on health outcomes. All 14 studies concluded that their specified intervention(s) targeting reductions in population sodium consumption were cost-effective, and in the majority of cases, were cost saving. Just over half the studies (8/14) were assessed as being of ‘excellent’ reporting quality, five studies fell into the ‘very good’ quality category and one into the ‘good’ category. All of the identified evaluations were based on modelling, whereby inputs for all the key parameters including the effect size were either drawn from published datasets, existing literature or based on expert advice. Conclusion Despite a clear increase in evaluations of salt reduction programs in recent years, this review identified relatively few economic evaluations of population salt reduction interventions. None of the studies were based on actual implementation of intervention(s) and the associated collection of new empirical data. The studies universally showed that population-based salt reduction strategies are likely to be cost effective or cost saving. However, given the reliance on modelling, there is a need for the effectiveness of new interventions to be evaluated in the field using strong study designs and parallel economic evaluations.
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Affiliation(s)
- Silvia F. Hope
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Jacqui Webster
- The George Institute for Global Health, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, Sydney, Australia
| | - Arti Pillay
- Pacific Research Centre for Prevention of Obesity and Non Communicable Diseases (C-POND)/ Fiji National University, Suva, Fiji
| | | | - Colin Bell
- Global Obesity Centre, Faculty of Health, Deakin University, Melbourne, Australia
| | - Wendy Snowdon
- Global Obesity Centre, Faculty of Health, Deakin University, Melbourne, Australia
| | - Bruce Neal
- The George Institute for Global Health, Sydney, Australia
- The Charles Perkins Centre, University of Sydney, Sydney, Australia
- Division of Epidemiology and Biostatistics, Imperial College, London, United Kingdom
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Global Obesity Centre, Faculty of Health, Deakin University, Melbourne, Australia
- * E-mail:
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19
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Johnson C, Mohan S, Rogers K, Shivashankar R, Thout SR, Gupta P, He FJ, MacGregor GA, Webster J, Krishnan A, Maulik PK, Reddy KS, Prabhakaran D, Neal B. The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India. Nutrients 2017; 9:E144. [PMID: 28212309 PMCID: PMC5331575 DOI: 10.3390/nu9020144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 11/16/2022] Open
Abstract
Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants' physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87-9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake-less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55-9.87 g/day) versus less-educated (9.34, 8.57-10.12 g/day) individuals (p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt.
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Affiliation(s)
- Claire Johnson
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Sailesh Mohan
- Public Health Foundation of India, New Delhi 110070, India.
| | - Kris Rogers
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
| | - Roopa Shivashankar
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | | | - Priti Gupta
- Public Health Foundation of India, New Delhi 110070, India.
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Jacqui Webster
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Pallab K Maulik
- George Institute for Global Health, Hyderabad 500034, India.
- George Institute for Global Health, University of Oxford, Oxford OX1 3PA, UK.
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | - Bruce Neal
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
- Charles Perkins Centre, University of Sydney, Sydney 2050, Australia.
- School of Public Health, Imperial College, London SW7 2AZ, UK.
- Royal Prince Alfred Hospital, Sydney 2050, Australia.
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20
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Vedanthan R, Bernabe-Ortiz A, Herasme OI, Joshi R, Lopez-Jaramillo P, Thrift AG, Webster J, Webster R, Yeates K, Gyamfi J, Ieremia M, Johnson C, Kamano JH, Lazo-Porras M, Limbani F, Liu P, McCready T, Miranda JJ, Mohan S, Ogedegbe O, Oldenburg B, Ovbiagele B, Owolabi M, Peiris D, Ponce-Lucero V, Praveen D, Pillay A, Schwalm JD, Tobe SW, Trieu K, Yusoff K, Fuster V. Innovative Approaches to Hypertension Control in Low- and Middle-Income Countries. Cardiol Clin 2017; 35:99-115. [PMID: 27886793 PMCID: PMC5131527 DOI: 10.1016/j.ccl.2016.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Elevated blood pressure, a major risk factor for ischemic heart disease, heart failure, and stroke, is the leading global risk for mortality. Treatment and control rates are very low in low- and middle-income countries. There is an urgent need to address this problem. The Global Alliance for Chronic Diseases sponsored research projects focus on controlling hypertension, including community engagement, salt reduction, salt substitution, task redistribution, mHealth, and fixed-dose combination therapies. This paper reviews the rationale for each approach and summarizes the experience of some of the research teams. The studies demonstrate innovative and practical methods for improving hypertension control.
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Affiliation(s)
- Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Omarys I Herasme
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Rohina Joshi
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | | | - Amanda G Thrift
- School of Clinical Sciences at Monash Health, Monash University, Wellington Road and Blackburn Road, Clayton, VIC 3800, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Ruth Webster
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Karen Yeates
- School of Medicine, Queens University, 15 Arch Street, Kingston, ON K7L 3N6, Canada
| | - Joyce Gyamfi
- School of Medicine, New York University, 550 1st Avenue, New York, NY 10016, USA
| | - Merina Ieremia
- Samoan Ministry of Health, Motootua, Ifiifi street, Apia, Samoa
| | - Claire Johnson
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Jemima H Kamano
- College of Health Sciences, School of Medicine, Moi University, PO Box 3900, Eldoret 30100, Kenya
| | - Maria Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Felix Limbani
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg 2000, South Africa
| | - Peter Liu
- University of Ottawa, 75 Laurier Avenue East, Ottawa, ON K1N 6N5, Canada
| | - Tara McCready
- Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Sailesh Mohan
- Public Health Foundation of India, Plot No. 47, Sector 44, New Delhi, India
| | - Olugbenga Ogedegbe
- School of Medicine, New York University, 550 1st Avenue, New York, NY 10016, USA
| | - Brian Oldenburg
- School of Population and Global Health, University of Melbourne, Parkville, VC 3010, Australia
| | - Bruce Ovbiagele
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | | | - David Peiris
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Vilarmina Ponce-Lucero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Devarsetty Praveen
- The George Institute for Global Health, 301 ANR Centre, Road No 1, Banjara Hills, Hyderabad 500034, India
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, Fiji National University, Suva, Fiji
| | - Jon-David Schwalm
- Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Sheldon W Tobe
- University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A1, Canada
| | - Kathy Trieu
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selangor and UCSI University, Kuala Lumpur, Malaysia
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
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21
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Do HTP, Santos JA, Trieu K, Petersen K, Le MB, Lai DT, Bauman A, Webster J. Effectiveness of a Communication for Behavioral Impact (COMBI) Intervention to Reduce Salt Intake in a Vietnamese Province Based on Estimations From Spot Urine Samples. J Clin Hypertens (Greenwich) 2016; 18:1135-1142. [PMID: 27458104 PMCID: PMC5129579 DOI: 10.1111/jch.12884] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/14/2016] [Accepted: 04/29/2016] [Indexed: 12/01/2022]
Abstract
This study evaluated the effectiveness of the Communication for Behavioral Impact (COMBI)–Eat Less Salt intervention conducted in Viet Tri, Vietnam. The behavior change intervention was implemented in four wards and four communes for one year, which included mass media communication, school interventions, community programs, and focus on high‐risk groups. Mean sodium excretion was estimated from spot urine samples using different equations. A subsample provided 24‐hour urine to validate estimates from spot urine. Information about salt‐related knowledge and behaviors was also collected. There were 513 participants at both baseline and follow‐up. Mean sodium excretion estimated from spot urines fell significantly from 8.48 g/d at baseline to 8.05 g/d at follow‐up (P=.001). All spot equations demonstrated a significant reduction in sodium levels; however, the change was smaller than the measured 24‐hour urine. Participants showed improved knowledge and behaviors following the intervention. The COMBI intervention was effective in lowering average population salt intake and improving knowledge and behaviors.
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Affiliation(s)
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of Sydney, NSW, Australia
| | - Kristina Petersen
- The George Institute for Global Health, University of Sydney, NSW, Australia
| | - Mai Bach Le
- National Institute of Nutrition, Hanoi, Vietnam
| | | | | | - Jacqui Webster
- The George Institute for Global Health, University of Sydney, NSW, Australia.
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