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Dadras O, Stanikzai MH, Jafari M, Tawfiq E. Risk factors for non-communicable diseases in Afghanistan: insights of the nationwide population-based survey in 2018. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:129. [PMID: 39175091 PMCID: PMC11342536 DOI: 10.1186/s41043-024-00625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/15/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Noncommunicable diseases (NCDs) account for a substantial number of deaths in Afghanistan. Understanding the prevalence and correlates of major NCD risk factors could provide a benchmark for future public health policies and programs to prevent and control NCDs. Therefore, this study aimed to examine the prevalence and correlates of NCD risk factors among adults aged 18-69 years in Afghanistan. METHODS We used data from the Afghanistan STEPS Survey 2018. The study population were 3650 (1896 males and 1754 females) adults aged 18-69 years sampled from all 34 provinces through a multistage cluster sampling process. Information on behavioural and biological risk factors was collected. We used STATA (version 18.0) for data analysis. RESULTS Of the total participants, 42.8% were overweight or obese, 8.6% were current smokers, 26.9% had insufficient physical activities, 82.6% had low consumption of fruits and vegetables, and only 0.5% had ever consumed alcohol. Approximately 15% of participants had a high salt intake, while 25% and 8% had elevated blood pressure and blood glucose levels, respectively. Similarly, around 18% had elevated total cholesterol. The study revealed a lower prevalence of current smoking among females [AOR = 0.17, 95%CI (0.09-0.30)] compared with males, but a higher prevalence in those who had higher education levels [1.95 (1.13-3.36)] compared with those with no formal education. Insufficient physical activity was higher in participants aged 45-69 years [1.96 (1.39-2.76)], females [4.21 (1.98-8.84)], and urban residents [2.38 (1.46-3.88)] but lower in those with higher education levels [0.60 (0.37-0.95)]. Participants in the 25th to 75th wealth percentiles had higher odds of low fruit and vegetable consumption [2.11 (1.39-3.21)], while those in the > 75th wealth percentile had lower odds of high salt intake [0.63 (0.41-0.98)]. Being overweight/obese was more prevalent in participants aged 45-69 years [1.47 (1.03-2.11)], females [1.42 (0.99-2.01)], currently married [3.56 (2.42-5.21)] or ever married [5.28 (2.76-10.11)], and urban residents [1.39 (1.04-1.86)]. Similarly, high waist circumference was more prevalent in participants aged 45-69 years [1.86 (1.21-2.86)], females [5.91 (4.36-8.00)], those being currently married [4.82 (3.12-7.46)], and those being in 25th to 75th wealth percentile [1.76 (1.27-2.43)]. A high prevalence of elevated blood pressure was observed in participants aged 45-69 years [3.60 (2.44-5.31)] and currently married [2.31 (1.24-4.31)] or ever married [6.13 (2.71-13.8)] participants. Elevated blood glucose was more prevalent in older adults ([1.92 (1.09-3.39)] for 45-69 and [3.45 (2.44-5.31)] for 30-44 years), urban residents [2.01 (1.33-3.03)], and ever-married participants [4.89 (1.48-16.2)]. A higher prevalence of elevated cholesterol was observed in females [2.68 (1.49-4.82)] and those currently married [2.57 (1.17-5.63)] or ever married [4.24 (1.31-13.73)]. CONCLUSION This study used up-to-date available data from a nationally representative sample and identified the prevalence of NCDs and associated risk factors in Afghanistan. Our findings have the potential to inform and influence health policies by identifying people at high risk of developing NCDs and can assist policymakers, health managers, and clinicians to design and implement targeted health interventions.
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Affiliation(s)
- Omid Dadras
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Muhammad Haroon Stanikzai
- Department of Public Health, Faculty of Medicine, Kandahar University, District # 10, 3801, Kandahar, Afghanistan.
| | | | - Essa Tawfiq
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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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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Monower MM, Abid SUA, Abrar AK, Choudhury SR. Salt intake across the hypertension care cascade in the Bangladeshi adult population: a nationally representative cross-sectional study. BMJ Open 2024; 14:e081913. [PMID: 38580369 PMCID: PMC11002389 DOI: 10.1136/bmjopen-2023-081913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVES This study aimed to examine the distribution of daily salt intake across the hypertension care cascade and assess the proportional distribution of these care cascade categories across various salt consumption level. DESIGN A population-based national cross-sectional study. SETTINGS Data from the Bangladesh STEPS 2018 survey were used, encompassing both urban and rural strata within all eight divisions. National estimates were generated from weighted data. PARTICIPANTS A diverse population of 6754 men and women aged 18-69 years was included in the study. OUTCOME MEASURES Daily salt consumption was estimated using the spot urine sodium concentration following Tanaka equation. Distribution of salt intake among different categories of hypertension care cascade, including hypertensives, aware of hypertension status, on treatment and under control, was assessed. RESULTS Individuals with hypertension consume more salt on average (9.18 g/day, 95% CI 9.02 to 9.33) than those without hypertension (8.95 g/day, 95% CI 8.84 to 9.05) (p<0.02). No significant differences were found in salt intake when comparing aware versus unaware, treated versus untreated and controlled versus uncontrolled hypertension. In the overall population, 2.7% (95% CI 2.1% to 3.6%) of individuals without hypertension adhered to the recommended salt intake (<5 g/day) while 1.6% (95% CI 1.0% to 2.4%) with hypertension did so (p<0.03). Among individuals with hypertension, 2.4% (95% CI 1.4% to 4.0%) of those aware followed the guideline while only 0.8% (95% CI 0.4% to 1.9%) of those unaware adhered (p<0.03). Additionally, no significant differences were observed in adherence between the treated versus untreated and controlled versus uncontrolled hypertension. CONCLUSIONS Individuals with hypertension consume significantly more salt than those without, with no significant variations in salt intake based on aware, treated and controlled hypertension. Adhering to WHO salt intake guidelines aids better blood pressure management. By addressing salt consumption across hypertension care cascade, substantial progress can be made in better blood pressure control.
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Affiliation(s)
- Md Mostafa Monower
- Deaprtment of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Shehab Uddin Al Abid
- Deaprtment of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Ahmad Khairul Abrar
- Deaprtment of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Deaprtment of Epidemiology & Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
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Nie T, Huang S, Yang Y, Hu A, Wang J, Cheng Z, Liu W. A review of the world's salt reduction policies and strategies - preparing for the upcoming year 2025. Food Funct 2024; 15:2836-2859. [PMID: 38414443 DOI: 10.1039/d3fo03352j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Excessive consumption of dietary sodium is a significant contributor to non-communicable diseases, including hypertension and cardiovascular disease. There is now a global consensus that regulating salt intake is among the most cost-effective measures for enhancing public health. More than half of the countries worldwide have implemented multiple strategies to decrease salt consumption. Nevertheless, a report on sodium intake reduction published by the World Health Organization revealed that the world is off-track to meet its targeted reduction of 30% by 2025. The global situation regarding salt reduction remains concerning. This review will center on domestic and international salt reduction policies, as well as diverse strategies, given the detrimental effects of excessive dietary salt intake and the existing global salt intake scenario. Besides, we used visualization software to analyze the literature related to salt reduction research in the last five years to explore the research hotspots in this field. Our objective is to enhance public awareness regarding the imperative of reducing salt intake and promoting the active implementation of diverse salt reduction policies.
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Affiliation(s)
- Ting Nie
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Siqi Huang
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Yuxin Yang
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Anna Hu
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Jianing Wang
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Zeneng Cheng
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Wenjie Liu
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
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Armas AJM, Aranda JAE, Arcos HS, Arellano FL, Arguelles CBL, Arreza AMM, Arriza MAG, Ascan CKA, Torres GCS. Assessing Dietary Salt Intake and Pilot-Testing a Home-Based Intervention to Lower Salt Intake Among Filipino College Students. J Community Health Nurs 2024; 41:57-72. [PMID: 37943282 DOI: 10.1080/07370016.2023.2277839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
PURPOSE To assess the knowledge, attitude, and behaviors related to dietary salt intake and develop a home-based intervention that helps lower salt intake among Filipino college students. DESIGN Two-phase program development study utilizing descriptive and quasi-experimental design. METHODS Phase 1 determined the knowledge, attitude, and behaviors alongside the frequency of dietary salt intake of a consecutive sample (n = 118). Phase 2 involved the development and pilot-testing of a home-based intervention wherein a random sample (n = 35) selected from Phase 1 joined for pilot-testing. The study was conducted from October - November 2021 and utilized valid and reliable measures to test the knowledge, attitude, and behavior of the participants. FINDINGS Initial assessment showed knowledge regarding health risks of high salt intake and positive attitude toward health-promoting behaviors. Post-intervention showed improvement in attitude (p = 0.0004) and behavior (p = 0.001) related to dietary salt intake alongside health literacy (p = 0.036). There was no significant change in knowledge (p = 0.054). CONCLUSION The home-based intervention involving the use of health education materials is successful in improving dietary salt intake patterns. CLINICAL EVIDENCE Community health nurses may utilize home-based interventions to help develop health-promoting behaviors among young adults.
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Muniyappa R, Narayanappa SBK. Disentangling Dual Threats: Premature Coronary Artery Disease and Early-Onset Type 2 Diabetes Mellitus in South Asians. J Endocr Soc 2023; 8:bvad167. [PMID: 38178904 PMCID: PMC10765382 DOI: 10.1210/jendso/bvad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 01/06/2024] Open
Abstract
South Asian individuals (SAs) face heightened risks of premature coronary artery disease (CAD) and early-onset type 2 diabetes mellitus (T2DM), with grave health, societal, and economic implications due to the region's dense population. Both conditions, influenced by cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity, manifest earlier and with unique thresholds in SAs. Epidemiological, demographic, nutritional, environmental, sociocultural, and economic transitions in SA have exacerbated the twin epidemic. The coupling of premature CAD and T2DM arises from increased obesity due to limited adipose storage, early-life undernutrition, distinct fat thresholds, reduced muscle mass, and a predisposition for hepatic fat accumulation from certain dietary choices cumulatively precipitating a decline in insulin sensitivity. As T2DM ensues, the β-cell adaptive responses are suboptimal, precipitating a transition from compensatory hyperinsulinemia to β-cell decompensation, underscoring a reduced functional β-cell reserve in SAs. This review delves into the interplay of these mechanisms and highlights a prediabetes endotype tied to elevated vascular risk. Deciphering these mechanistic interconnections promises to refine stratification paradigms, surpassing extant risk-prediction strategies.
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Affiliation(s)
- Ranganath Muniyappa
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Satish Babu K Narayanappa
- Department of Medicine, Sri Madhusudan Sai Institute of Medical Sciences and Research, Muddenahalli, Karnataka 562101, India
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Afroza U, Abrar AK, Nowar A, Akhtar J, Mamun MAA, Sobhan SMM, Cobb L, Ide N, Choudhury SR. Salt Intake Estimation from Urine Samples in South Asian Population: Scoping Review. Nutrients 2023; 15:4358. [PMID: 37892433 PMCID: PMC10609745 DOI: 10.3390/nu15204358] [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: 08/26/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The World Health Organization recommended reducing one's salt intake below 5 g/day to prevent disability and death from cardiovascular and other chronic diseases. This review aimed to identify salt estimation at the population level in South Asian countries, namely Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. We searched electronic databases and government websites for the literature and reports published between January 2011 and October 2021 and also consulted key informants for unpublished reports. We included studies that assessed salt intake from urinary sodium excretion, either spot urine or a 24 h urine sample, on a minimum of 100 samples in South Asian countries. We included 12 studies meeting the criteria after screening 2043 studies, out of which five followed nationally representative methods. This review revealed that salt intake in South Asian countries ranges from 6.7-13.3 g/day. The reported lowest level of salt intake was in Bangladesh and India, and the highest one was in Nepal. The estimated salt intake reported in the nationally representative studies were ranging from 8 g/day (in India) to 12.1 g/day (in Afghanistan). Salt consumption in men (8.9-12.5 g/day) was reported higher than in women (7.1-12.5 g/day). Despite the global target of population salt intake reduction, people in South Asian countries consume a much higher amount of salt than the WHO-recommended level.
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Affiliation(s)
- Ummay Afroza
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Ahmad Khairul Abrar
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Abira Nowar
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Jubaida Akhtar
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Mohammad Abdullah Al Mamun
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Sheikh Mohammad Mahbubus Sobhan
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Laura Cobb
- Resolve To Save Lives (RTSL), New York, NY 10004, USA; (L.C.); (N.I.)
| | - Nicole Ide
- Resolve To Save Lives (RTSL), New York, NY 10004, USA; (L.C.); (N.I.)
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
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Neyazi N, Mosadeghrad AM, Tajvar M, Safi N. Trend analysis of noncommunicable diseases and their risk factors in Afghanistan. Chronic Dis Transl Med 2023; 9:210-221. [PMID: 37711869 PMCID: PMC10497825 DOI: 10.1002/cdt3.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/09/2023] Open
Abstract
Background Afghanistan is suffering from 40-year chronic conflicts, displacement, and demolition of its infrastructure. Afghanistan mortality survey 2010 shows nearly 46% of all deaths in the country were attributed to noncommunicable diseases (NCDs). In this study, we aimed to understand the differences in mortality and premature death due to NCDs by sex and the trend for the next 8 years. Methods We applied trend analysis using the secondary data from the Institute for Health Metrics and Evaluation, Global Burden of Diseases 2019. The information on NCD mortality, NCD deaths attributed to its risk factors, NCD percent of total years lived with disability (YLDs) attribution to each risk factor extracted from this database from 2008 to 2019. We investigated the trend from 2008 to 2019 for the mentioned factors and then forecast their trends until 2030. Results Our study shows that Afghanistan has had an increasing death number due to NCDs from 2008 to 2019 (50% for both sexes) and this will reach nearly 54% by 2030. Currently, half of NCDs deaths are premature in Afghanistan. The mortality rate and prevalence of risk factors are higher among women. More than 70% of YLDs will be due to NCDs in Afghanistan till 2030. Five risk factors including high systolic blood pressure (28.3%), high body mass index (23.4%), high blood glucose (20.6%), high low-density lipoprotein cholesterol (16.3%), and smoking (12.3%) will have the highest contribution to NCDs death in 2030, respectively. Conclusions In general, our study indicates that without any specific intervention to address NCDs in Afghanistan, not only the Sustainable Development Goal target for NCDs will not be met, but an increase in almost all risk factors prevalence, as well as NCD mortality, will be seen in Afghanistan.
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Affiliation(s)
- Narges Neyazi
- International Campus, School of Public HealthTehran University of Medical SciencesTehranIran
- Department of Health System DevelopmentWorld Health OrganizationKabulAfghanistan
| | - Ali Mohammad Mosadeghrad
- Department of Health Management, Policy and Economics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Maryam Tajvar
- Department of Health Management, Policy and Economics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Najibullah Safi
- Department of Health System DevelopmentWorld Health OrganizationKabulAfghanistan
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Chan A, Wai-chi Chan S, Kinsman L. Using the health belief model to understand the factors influencing the perceptions of people of Chinese ancestry about reducing salt consumption for hypertension prevention: A cross-sectional study. PLoS One 2023; 18:e0289867. [PMID: 37585401 PMCID: PMC10431675 DOI: 10.1371/journal.pone.0289867] [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: 02/20/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND High-salt diets are linked to hypertension. Chinese people in Australia, are at increased risk of hypertension due to the combination of routine addition of high quantities of salt to food during cooking and high salt levels in processed western foods. There is a scarcity of salt-related behavioural studies on this population group. This study aimed to explore the habitual salt consumption of Chinese Australians and factors that influence their perceptions about sustaining salt-related behavioural changes for hypertension prevention. METHOD A cross-sectional descriptive study using an adapted Determinants of Salt-Restriction Behaviour Questionnaire was conducted on 188 Chinese Australians. A non-probability sampling method was used to attract participants from different parts of Australia. Statistical analyses such as descriptive analysis, t-tests and Pearson correlation tests were performed in the study. RESULTS Over 97% of participants did not measure the amount of salt added to their meals. Many participants reported that salt was added to their meals based on their experience (39.4%) and food taste (31.9%). Over 80% of participants did not know the recommended level of daily salt consumption. Although salt-related knowledge had no significant correlation with individuals' salty food taste preferences, there were significant correlations with the perceptions of the severity of disease and health benefits of reducing salt consumption (p = .001 and < .001 respectively). People with stronger salty taste preferences perceived a higher level of health threat than people with lighter salty taste preferences (p = .003). CONCLUSION Findings from this study show that knowledge about salt-reduction alone had no significant effects on salt-related behaviours. Adequate culturally relevant practice-based education in salt-reduction strategies may facilitate salt-related behavioural changes in Chinese Australians. Overall, single young Chinese Australian men with stronger salty taste preferences is the group who needs salt reduction interventions the most.
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Affiliation(s)
- Alex Chan
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia
- School of Nursing, University of Wollongong, Wollongong, Australia
| | | | - Leigh Kinsman
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Zhang P, Zhang J, Li Y, Dong L, He FJ, Brown M, Pettigrew S, Webster J, Yamamoto R, Nishida C, Liu A, Yang X, Zhang B, Ding G, Wang H. Sodium content targets for pre-packaged foods, China: a quantitative study and proposal. Bull World Health Organ 2023; 101:453-469. [PMID: 37397173 PMCID: PMC10300770 DOI: 10.2471/blt.23.289992] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To determine the contribution of pre-packaged foods to population sodium intake in China, and to propose sodium content targets for food subcategories used for the World Health Organization's (WHO's) global sodium benchmarks. Methods The impact of four different approaches to reducing the sodium content of pre-packaged foods on population sodium intake was estimated using data from national databases covering the nutrient content and ingredients of 51 803 food products and food consumption by 15 670 Chinese adults. We recategorized food products using a food categorization framework developed for WHO's global sodium benchmarks and adapted for China-specific foods. Findings Pre-packaged foods, including condiments, contributed 1302.5 mg/day of sodium intake per adult in 2021, accounting for 30.1% of population sodium intake in China. Setting maximum sodium content levels using a 90th-percentile target would reduce sodium intake from pre-packaged foods by 96.2 mg/day, corresponding to a 1.9% reduction in population intake. Using the 75th-percentile, a fixed 20% reduction and WHO benchmark targets would further reduce intake by 262.0 mg/day (5.2% population intake), 302.8 mg/day (6.0% population intake) and 701.2 mg/day per person (13.9% population intake), respectively. Maximum sodium content levels based on revised 20% reduction targets were proposed because they should result in substantial and acceptable reductions in sodium content for most food subcategories: overall sodium intake would decline by 305.0 mg/day per person, and population intake by 6.1%. Conclusion This study provides the scientific rationale for government policy on setting targets for food sodium content in China. Simultaneous action on discretionary salt use should also be taken.
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Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health–China, Beijing, China
| | - Jiguo Zhang
- Key Laboratory of Trace Element Nutrition of the National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
| | - Yuan Li
- The George Institute for Global Health–China, Beijing, China
| | - Le Dong
- The George Institute for Global Health–China, Beijing, China
| | - Feng J He
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Mhairi Brown
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rain Yamamoto
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Chizuru Nishida
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Aidong Liu
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Xiaoguang Yang
- Key Laboratory of Trace Element Nutrition of the National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
| | - Bing Zhang
- Key Laboratory of Trace Element Nutrition of the National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
| | - Gangqiang Ding
- Key Laboratory of Trace Element Nutrition of the National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
| | - Huijun Wang
- Key Laboratory of Trace Element Nutrition of the National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
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11
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Ghimire K, McLachlan CS, Mishra SR, Kallestrup P, Neupane D. Estimating mean population salt intake using spot urine samples in Nepal: a cross-sectional study. J Hypertens 2023; 41:711-722. [PMID: 36723497 DOI: 10.1097/hjh.0000000000003380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about the usefulness of spot urine testing compared with 24-h urine samples to estimate salt intake in low-income settings. This is given 24-h urinary collection can be costly, burdensome, and impractical in population surveys. The primary objective of the study was to compare urinary sodium levels (as an estimate of salt intake) of Nepalese population between 24-h urine and spot urine using previously established spot urine-based equations. Additionally, this study explored the 24-h prediction of creatinine and potassium excretion from spot urine samples using available prediction equations. METHODS The sample population was derived from the community-based survey conducted in Nepal in 2018. Mean salt intake was estimated from spot urine samples comparing previously published equations, and this was then contrasted with mean salt intake estimations from 24-h urine samples, using paired t test, Pearson correlation coefficient, intraclass correlation coefficient, and Bland-Altman plots. RESULTS A total of 451 participants provided both complete 24-h and morning spot urine samples. Unweighted mean (±SD) salt intake based on 24-h urine collection was 13.28 ± 4.72 g/day. The corresponding estimates were 15.44 ± 5.92 g/day for the Kawasaki, 11.06 ± 3.17 g/day for the Tanaka, 15.22 ± 16.72 g/day for the Mage, 10.66 ± 3.35 g/day for the Toft, 8.57 ± 1.72 g/day for the INTERSALT with potassium, 8.51 ± 1.73 g/day for the INTERSALT without potassium, 7.88 ± 1.94 g/day for the Whitton, 18.13 ± 19.92 g/day for the Uechi simple-mean and 12.07 ± 1.77 g/day using the Uechi regression. As compared with 24-h urine estimates, all equations showed significant mean differences (biases); the Uechi regression had the least difference with 9% underestimation (-1.21 g/day, P < 0.001).Proportional biases were evident for all equations depending on the level of salt intake in the Bland-Altman plots. CONCLUSION None of the included spot urine-based equations accurately corresponded to 24-h salt intake in the present study. These equations may be useful for longitudinal monitoring of population salt intake in Nepal, our study highlights that there are limitations on using existing equations for estimating mean salt intake in Nepali population. Further studies are warranted for accuracy and validation.
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Affiliation(s)
- Kamal Ghimire
- School of Health, Torrens University, Sydney, New South Wales, Australia
| | - Craig S McLachlan
- School of Health, Torrens University, Sydney, New South Wales, Australia
| | - Shiva R Mishra
- World Heart Federation, Salim Yusuf Emerging Leaders Programme, Geneva, Switzerland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Per Kallestrup
- Department of Public Health, Centre for Global Health, Aarhus University, Aarhus, Denmark
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Nepal Development Society, Bharatpur, Chitwan, Nepal
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12
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Vijayan M, Deshpande K, Anand S, Deshpande P. Risk Amplifiers for Vascular Disease and CKD in South Asians: When Intrinsic β-Cell Dysfunction Meets a High-Carbohydrate Diet. Clin J Am Soc Nephrol 2023; 18:681-688. [PMID: 36758530 PMCID: PMC10278793 DOI: 10.2215/cjn.0000000000000076] [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] [Indexed: 02/05/2023]
Abstract
South Asians, comprising almost one fourth of the world population, are at higher risk of type 2 diabetes mellitus, hypertension, cardiovascular disease, and CKD compared with other ethnic groups. This has major public health implications in South Asia and in other parts of the world to where South Asians have immigrated. The interplay of various modifiable and nonmodifiable risk factors confers this risk. Traditional models of cardiometabolic disease progression and CKD evaluation may not be applicable in this population with a unique genetic predisposition and phenotype. A wider understanding of dietary and lifestyle influences, genetic and metabolic risk factors, and the pitfalls of conventional equations estimating kidney function in this population are required in providing care for kidney diseases. Targeted screening of this population for metabolic and vascular risk factors and individualized management plan for disease management may be necessary. Addressing unhealthy dietary patterns, promoting physical activity, and medication management that adheres to cultural factors are crucial steps to mitigate the risk of cardiovascular disease and CKD in this population. In South Asian countries, a large rural and urban community-based multipronged approach using polypills and community health workers to decrease the incidence of these diseases may be cost-effective.
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Affiliation(s)
- Madhusudan Vijayan
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
- Institute for Critical Care Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kavita Deshpande
- Department of Family Medicine, La Maestra Community Health Centers, San Diego, California
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Priya Deshpande
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
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Zhang P, Sun J, Li Y, Li Y, Sun Y, Luo R, Nie X, Li L, Liu Y, He FJ. An mHealth-based school health education system designed to scale up salt reduction in China (EduSaltS): A development and preliminary implementation study. Front Nutr 2023; 10:1161282. [PMID: 37139455 PMCID: PMC10149706 DOI: 10.3389/fnut.2023.1161282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background High-salt diet is an important risk factor for several non-communicable diseases. School-based health education has been found effective in reducing salt intake among children and their families in China. However, no such interventions have been scaled up in the real world. For this purpose, a study was launched to support the development and scale-up of an mHealth-based system (EduSaltS) that integrated routine health education and salt reduction and was delivered through primary schools. This study aims to elaborate the framework, development process, features, and preliminary scaling-up of the EduSaltS system. Methods The EduSaltS system evolved from previously successfully tested interventions to reduce family salt intake by empowering schoolchildren through school health education. EduSaltS was designed by following the WHO's conceptual framework for developing a scaling-up strategy which accounted for the nature of the innovation, the capacity of the implementing organizations, the characteristics of the environment, the resources available, and type of scaling up. The system was then developed step by step from determination of online platform architecture, definition of component interventions and activities, development of specific educational materials and tools, to the development of the online/offline hybridized system. The system was tested and refined by a pilot in two schools and a preliminary scale-up in two cities in China. Results EduSaltS was developed as an innovative health education system, including an online WeChat-based education platform, a set of offline activities, and an actual administrative website showing the progress and setting the system. The WeChat platform could be installed on users' smartphones to automatically deliver 20 sessions of five-minute well-structured cartoon video classes, followed by other online interactive activities. It also helps support project implementation and real-time performance evaluation. As a first-stage roll-out, a one-year course has been successfully implemented among 54,538 children and their families from 209 schools in two cities, and the average course completion rate was 89.1%. Conclusion As an innovative mHealth-based health education system, EduSaltS was developed based on successfully tested interventions and an appropriate framework for scaling up. The early-stage roll-out has shown its preliminary scalability, and further evaluation is ongoing.
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Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health, Beijing, China
| | - Jingwen Sun
- The George Institute for Global Health, Beijing, China
| | - Yinghua Li
- Chinese Center for Health Education, Beijing, China
| | - Yuan Li
- The George Institute for Global Health, Beijing, China
| | - Yuewen Sun
- The George Institute for Global Health, Beijing, China
| | - Rong Luo
- The George Institute for Global Health, Beijing, China
| | - Xueqiong Nie
- Chinese Center for Health Education, Beijing, China
| | - Li Li
- Chinese Center for Health Education, Beijing, China
| | - Yu Liu
- School of Computing Science and Engineering, Beihang University, Beijing, China
| | - Feng J He
- Barts and The London School of Medicine and Dentistry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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14
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Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, Alsaid J, Neupane D, Kario K, Beheiry H, Brouwers S, Burger D, Charchar FJ, Cho MC, Guzik TJ, Haji Al-Saedi GF, Ishaq M, Itoh H, Jones ESW, Khan T, Kokubo Y, Kotruchin P, Muxfeldt E, Odili A, Patil M, Ralapanawa U, Romero CA, Schlaich MP, Shehab A, Mooi CS, Steckelings UM, Stergiou G, Touyz RM, Unger T, Wainford RD, Wang JG, Williams B, Wynne BM, Tomaszewski M. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res 2023; 119:381-409. [PMID: 36219457 PMCID: PMC9619669 DOI: 10.1093/cvr/cvac130] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
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Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease; North-West University, Hoffman Street, Potchefstroom 2520, South Africa
- SAMRC Development Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Jafar Alsaid
- Ochsner Health System, New Orleans, Louisiana, USA
- Queensland University, Brisbane, Queensland, Australia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hind Beheiry
- International University of Africa, Khartoum, Sudan
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
- Department of Physiology and Anatomy, University of Melbourne, Melbourne, Victoria, Australia
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth Muxfeldt
- University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
| | - Augustine Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - Cesar A Romero
- Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Perth, Western Australia, Australia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ching Siew Mooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - U Muscha Steckelings
- Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Thomas Unger
- CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - Brandi M Wynne
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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15
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Liu Y, Chen J, Zou B, Sun Y, Zhao Y, Duan M, Wang Y, Dai R, Li X, Jia F. Evaluation of the quality and flavor of salted duck eggs with partial replacement of NaCl by non-sodium metal salts. Lebensm Wiss Technol 2022. [DOI: 10.1016/j.lwt.2022.114206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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16
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Gupta K, Al Rifai M, Hussain A, Minhas AMK, Patel J, Kalra D, Samad Z, Virani SS. South Asian ethnicity: What can we do to make this risk enhancer a risk equivalent? Prog Cardiovasc Dis 2022; 75:21-32. [PMID: 36279943 DOI: 10.1016/j.pcad.2022.10.001] [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: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
South Asians account for around 25% of the global population and are the fastest-growing ethnicity in the US. This population has an increasing burden of atherosclerotic cardiovascular disease (ASCVD) which is also seen in the diaspora. Current risk prediction equations underestimate this risk and consider the South Asian ethnicity as a risk-enhancer among those with borderline-intermediate risk. In this review, we discuss why the South Asian population is at a higher risk of ASCVD and strategies to mitigate this increased risk.
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Affiliation(s)
- Kartik Gupta
- Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Mahmoud Al Rifai
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Aliza Hussain
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Jaideep Patel
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Dinesh Kalra
- Rudd Heart & Lung Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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17
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Koh J, Ang G, Tan KB, Chen C. The social cost of high sodium diet in Singapore. Br J Nutr 2022; 129:1-9. [PMID: 35614498 DOI: 10.1017/s0007114522001568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High sodium (Na) diet is one of the leading behavioural risks of disease identified in the Singapore Burden of Disease Study. We aim to estimate the cost attributable to a high Na diet in Singapore in 2019 from a societal perspective by employing a prevalence-based approach in cost-of-illness studies. We extracted national-level healthcare data and population attributable fractions by sex and age. Costs included direct and indirect costs from inpatient treatment and productivity losses. In 2019, the annual societal cost attributable to a high Na diet was conservatively estimated to be USA$262 million (95 % uncertainty interval (UI) 218, 359 million). At least USA$67·8 million (95 % UI 48·4, 120 million) and USA$194 million (95 % UI 153, 274 million) could be saved on healthcare and indirect costs, respectively, if the daily Na intake of Singaporeans was reduced to an average of 3 g. Overall, males had higher costs compared with females at USA$221 million (95 % UI 174, 312 million) and USA$41·1 million (95 % UI 33·5, 61·7 million), respectively. Productivity loss from foregone wages due to premature mortality had the largest cost at USA$191 million (95 % UI 150, 271 million). CVD had the largest healthcare expenditure at USA$61·4 million (95 % UI 41·6, 113 million), driven by ischaemic heart disease at USA$41·0 million (95 % UI 21·4, 88·9 million). Our study found that reducing Na intake could reduce future healthcare expenditures and productivity losses. This result is vital for policy evaluation in a rapidly ageing society like Singapore, where the burden of diseases associated with high Na diet is expected to increase.
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Affiliation(s)
- Jemima Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Gregory Ang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Kelvin-Bryan Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Ministry of Health, Singapore, Singapore
- Centre for Regulatory Excellence, Duke-NUS Medical School, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, UK
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