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Li W, Xing A, Lamballais S, Xu W, Chen S, Zhou S, Wu S, Chen Z. Changes in Life's Essential 8 and risk of cardiovascular disease in Chinese people. Eur J Public Health 2024; 34:766-773. [PMID: 38573176 PMCID: PMC11293831 DOI: 10.1093/eurpub/ckae063] [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] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The American Heart Association recently released an updated algorithm for evaluating cardiovascular health-Life's Essential 8 (LE8). However, the associations between changes in LE8 score over time and risk of cardiovascular disease (CVD) remain unclear. METHODS We investigated associations between 6-year changes (2006-12) in LE8 score and risk of subsequent CVD events (2012-20) among 53 363 Chinese men and women from the Kailuan Study, who were free from CVD in 2012. The LE8 score was calculated based on eight components: diet quality, physical activity, smoking status, sleep health, body mass index, blood lipids, blood glucose and blood pressure. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS We documented 4281 incident CVD cases during a median of 7.7 years of follow-up. Compared with participants whose LE8 scores remained stable in a 6-year period, those with the large increases of LE8 score over the 6-year period had a lower risk of CVD, heart disease and stroke in the subsequent 8 years [HRs and 95% CIs: 0.67 (0.64, 0.70) for CVD, 0.65 (0.61, 0.69) for heart disease, 0.71 (0.67, 0.76) for stroke, all Ptrend < 0.001]. Conversely, those with the large decreases of LE8 score had 47%, 51% and 41% higher risk for CVD, heart disease and stroke, respectively. These associations were consistent across the subgroups stratified by risk factors. CONCLUSIONS Improving LE8 score in a short- and moderate-term was associated with a lower CVD risk, whereas decreased LE8 score over time was associated with a higher risk.
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Affiliation(s)
- Wenjuan Li
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Aijun Xing
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Sander Lamballais
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wenqi Xu
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Zhangling Chen
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Cardiometabolic Medicine, Changsha, Hunan, China
- FuRong Laboratory, Changsha, Hunan, China
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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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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Alhazmi A, Hawash MM, Ali H, Narapureddy BR, Aziz F. Knowledge, attitudes, and practices related to dietary salt among older adults in Abha, Saudi Arabia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:53. [PMID: 38650019 PMCID: PMC11036643 DOI: 10.1186/s41043-024-00545-z] [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: 12/18/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
The need to foster successful aging has intensified with the aging of the global population. This study aimed to assess the knowledge, attitudes, and practices (KAP) concerning dietary salt consumption and to investigate the correlations between sociodemographic variables and salt-related KAP. A structured interview was administered to a cohort of 200 older adults in Abha City, Saudi Arabia, recruited through a convenience sampling approach. The evaluation of salt-related KAP revealed widespread low knowledge (91.5%) as participants scored less than 3, negative attitudes (85.5%) scored less than 12, and predominantly unsatisfactory practices (69.5%) with scores less than 26. Noteworthy differences emerged between participants with poor overall KAP (81.5%) and those with good KAP (18.5%). Significantly weak negative correlations were found between age (r=-0.212), marital status (-0.236), and body mass index (-0.243) with overall KAP. Further examination revealed a significantly weak positive correlation between attitude and practice (r = 0.141). KAP scores show a highly significant positive correlation with overall KAP scores (r = 0.169, 0.352, 0.969). The uncovered correlations contribute to a valuable understanding of the complex dynamics surrounding salt-related KAP. This understanding guides the design of targeted interventions, such as health education programs, promoting successful aging and public health outcomes.
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Affiliation(s)
- Amani Alhazmi
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
| | - Manal Mohammed Hawash
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
- Department of Gerontological Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Haroon Ali
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Bayapa Reddy Narapureddy
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Farah Aziz
- Department of Basic Medical Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
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Bai L, Tang H, Wang M. Dietary behaviors of rural residents in northeastern China: implications for designing intervention information and targeting high-risk population. Front Public Health 2024; 12:1239449. [PMID: 38389950 PMCID: PMC10883159 DOI: 10.3389/fpubh.2024.1239449] [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: 06/13/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024] Open
Abstract
Background Dietary behavior is a pivotal modifiable determinant in reducing the occurrence of obesity/overweight and chronic non-communicable diseases. Improving the dietary behavior of rural residents in China is imminent due to the poor performance of their dietary behavior. Nutrition knowledge and health literacy are considered as elements that are linked intimately to healthy dietary behaviors but lack research in the Chinese setting. Purpose The study is designed to explore the relationship between nutritional knowledge, health literacy and dietary behaviors and to analyze the performance under different demographic characteristics. Methods A face-to-face survey of 400 rural residents on their nutrition knowledge, functional health literacy and dietary intake of five food categories consisting of 32 items was conducted based on a validated questionnaire. Descriptive analysis, difference test including ANOVA, t-test and non-parametric test, and multivariate linear regression were used for data analysis. Results The results indicate that declarative nutrition knowledge, individuals' information application capacity, and dietary behaviors, especially the intake of fruits, dairy and beans, and vegetable are not ideal and requires improvement. Male, elder, low-income, unmarried, and low-education populations performed significantly worse and were the high-risk group. Procedural nutrition knowledge, information access capacity, information understanding capacity, and information application capacity have remarkable effects on better dietary behavior. Conclusion This study provides evidence-based guidance for prioritizing information and populations for healthy dietary interventions.
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Affiliation(s)
- Li Bai
- School of Biological and Agricultural Engineering, Jilin University, Changchun, China
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
| | - Haiheng Tang
- School of Biological and Agricultural Engineering, Jilin University, Changchun, China
| | - Mingliang Wang
- School of Business and Management, Jilin University, Changchun, China
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Chan CMJ, Dickens BSL, Chong MFF. Understanding knowledge, attitudes and behaviours related to dietary sodium intake in a multi-ethnic population in Singapore. Public Health Nutr 2023; 26:2802-2814. [PMID: 37921207 PMCID: PMC10755448 DOI: 10.1017/s1368980023002422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/27/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE This study aimed to fill the current gap in the understanding of the knowledge, attitudes and behaviours (KAB) related to dietary Na among adult residents in Singapore. DESIGN A cross-sectional online survey was conducted between October and December 2020 on 955 participants selected through random sampling. SETTING The survey was conducted in Singapore. PARTICIPANTS Participants were recruited from the Singapore Population Health Study Online Panel. RESULTS Participants' mean age was 46·6 ± 14·1 years old and 58 % of them were females. Most of the participants were Chinese (82·1 %), 10·5 % were Indian and 4·5 % were Malay. Findings from the weighted data showed that most participants were aware of the health impact of high Na consumption. However, many participants were unaware of the recommended intake for salt (68%) and Na (83%), had misconceptions, and were unable to correctly use food labels to assess NA content (69%). Findings also alluded to the presence of knowledge gaps in the sources of Na in their diet. While 59 % of the participants reported to be limiting their consumption of Na, many reported facing barriers such as not knowing how to limit their Na intake. Participants also felt that there were limited options for low-Na foods when eating out and were lacking awareness of low-Na products. CONCLUSIONS Findings highlighted substantial gaps in participants' knowledge and skills in managing their Na consumption. This suggests the need for more public education and improvements in the food environment.
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Affiliation(s)
- Cindy Mei Jun Chan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549Singapore
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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Zhang P, Fan F, Li Y, Li Y, Luo R, Li L, Zhang G, Wang L, Jiao X, He FJ. Awareness and Use of Low-Sodium Salt Substitutes and Its Impact on 24-h Urinary Sodium and Potassium Excretion in China-A Cross-Sectional Study. Nutrients 2023; 15:3000. [PMID: 37447326 PMCID: PMC10346169 DOI: 10.3390/nu15133000] [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: 06/09/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The use of low-sodium salt substitute (LSSS) has the potential to reduce sodium and increase potassium intake. LSSS has been available in the Chinese market for years. However, its real-world use and impact on sodium/potassium intake is unclear. Baseline data of 4000 adult individuals who participated in three similarly designed randomized controlled trials were pooled together for this analysis. Self-reported awareness and use of LSSS were collected using a standardized questionnaire, and the participants' 24-h urinary sodium and potassium excretion was used to estimate their dietary intake. Mixed-effects models were developed to assess the relationship between LSSS and 24-h urinary sodium and potassium excretion. 32.0% of the participants reported awareness of LSSS and 11.7% reported its current use. After adjusting for location, sex, age, and education, compared with the group of participants unaware of LSSS, participants who were aware of but not using LSSS and those who were using LSSS had a lower 24-h urinary sodium excretion by -356.1 (95% CI: -503.9, -205.9) mg/d and -490.6 (95% CI: -679.2, -293.7) mg/d, respectively (p < 0.001). No significant difference was found for 24-h urinary potassium excretion or sodium-to-potassium ratio among the three groups (p > 0.05). In conclusion, the findings of low usage of LSSS and the reduced urinary sodium excretion associated with the awareness and use of LSSS provide further support for the prometon of LSSS as a key salt reduction strategy in China.
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Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health, Beijing 100600, China; (P.Z.)
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Fang Fan
- School of Public Health, Anhui Medical University, Hefei 230032, China
- Chinese Center for Health Education, Beijing 100011, China
| | - Yinghua Li
- Chinese Center for Health Education, Beijing 100011, China
| | - Yuan Li
- The George Institute for Global Health, Beijing 100600, China; (P.Z.)
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Rong Luo
- The George Institute for Global Health, Beijing 100600, China; (P.Z.)
| | - Li Li
- Chinese Center for Health Education, Beijing 100011, China
| | - Gang Zhang
- Chinese Center for Health Education, Beijing 100011, China
| | - Lanlan Wang
- Chinese Center for Health Education, Beijing 100011, China
| | - Xiaofei Jiao
- Chinese Center for Health Education, Beijing 100011, China
| | - Feng J. He
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London E1 4NS, UK;
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Tian Q, Chen S, Zhang J, Li C, Wu S, Wang Y, Wang Y. Ideal cardiovascular health metrics and life expectancy free of cardiovascular diseases: a prospective cohort study. EPMA J 2023; 14:185-199. [PMID: 37275553 PMCID: PMC10236055 DOI: 10.1007/s13167-023-00322-8] [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: 01/26/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023]
Abstract
Objectives Whether cardiovascular health (CVH) metrics impact longevity with and without cardiovascular diseases (CVDs) has not been well established. This study aimed to investigate the association between CVH metrics and life expectancy in participants free of CVD events. We hypothesized that ideal CVH status was associated with increased life expectancy and assessed the effect of CVH status as a prevention target of longevity in the framework of predictive, preventive, and personalized medicine (PPPM/3PM). Methods A total of 92,795 participants in the Kailuan study were examined and thereafter followed up until 2020. We considered three transitions (from non-CVD events to incident CVD events, from non-CVD events to mortality, and from CVD events to mortality). The multistate lifetable method was applied to estimate the life expectancy. Results During a median follow-up of 13 years, 12,541 (13.51%) deaths occurred. Compared with poor CVH, ideal CVH attenuated the risk of incident CVD events and mortality without CVD events by approximately 58% and 27%, respectively. Women with ideal CVH at age 35 had a 5.00 (3.23-6.77) year longer life expectancy free of CVD events than did women with poor CVH metrics. Among men, ideal CVH was associated with a 6.74 (5.55-7.93) year longer life expectancy free of CVD events. Conclusion An ideal CVH status is associated with a lower risk of premature mortality and a longer life expectancy, either in the general population or in CVD patients, which are cost-effective ways for personalized medicine of potential CVD patients. Our findings suggest that the promotion of a higher CVH score or ideal CVH status would result in reduced burdens of CVD events and extended disease-free life expectancy, which offered an accurate prediction for primary care following the concept of PPPM/3PM. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00322-8.
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Affiliation(s)
- Qiuyue Tian
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, 10 YouanmenXitoutiao, Beijing, 100069 China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, 57 Xinhua East Road, Tangshan, 063000 China
| | - Jie Zhang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, 10 YouanmenXitoutiao, Beijing, 100069 China
| | - Cancan Li
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, 10 YouanmenXitoutiao, Beijing, 100069 China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, 57 Xinhua East Road, Tangshan, 063000 China
| | - Yanxiu Wang
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, 57 Xinhua East Road, Tangshan, 063000 China
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, 10 YouanmenXitoutiao, Beijing, 100069 China
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Jiang K, He T, Ji Y, Zhu T, Jiang E. The perspective of hypertension and salt intake in Chinese population. Front Public Health 2023; 11:1125608. [PMID: 36875386 PMCID: PMC9981806 DOI: 10.3389/fpubh.2023.1125608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
Salt intake is too high nowadays. It has been widely recognized that there is a close relationship between hypertension (HTN) and dietary salt intake. Investigations reveal that long-term high salt intake, mainly sodium intake, induces a relevant increase in blood pressure in hypertensive and normotensive individuals. According to most scientific evidence, a diet with high salt intake in public increases cardiovascular risk, salted-related HTN, and other HTN-associated outcomes. Given the clinical importance, this review aims to present the prevalence of HTN and trends in salt intake in the Chinese population and will comprehensively discuss the risk factors, causes, and mechanisms of the association between salt intake and HTN. The review also highlights the education of Chinese people regarding salt intake and the cost-effectiveness of salt reduction from a global perspective. Finally, the review will emphasize the need to customize the unique Chinese practices to reduce salt intake and how awareness changes people's eating lifestyle and helps adopt diet salt reduction strategies.
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Affiliation(s)
- Kexin Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tingting He
- Department of Basic Nursing, Henan Technical Institute, Zhengzhou, China
| | - Yongzhi Ji
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tao Zhu
- Department of Geriatrics, Kaifeng Traditional Chinese Medicine Hospital, Kaifeng, China
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China.,Department of Scientific Research, Scope Research Institute of Electrophysiology, Kaifeng, China
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Salt-Related Knowledge, Attitudes, and Behaviors and Their Relationship with 24-Hour Urinary Sodium Excretion in Chinese Adults. Nutrients 2022; 14:nu14204404. [PMID: 36297088 PMCID: PMC9611823 DOI: 10.3390/nu14204404] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Salt intake in China is very high, which increases the risk of hypertension and cardiovascular disease. This study aimed to assess the levels of salt-related knowledge, attitudes, and behaviors (KABs) and the factors that influence them and to explore the relationship between the scores of salt-related KAB and 24-h urinary sodium excretion. In 2018, we collected data from 5453 individuals aged 18-75 years from six provinces in China. A face-to-face survey was carried out, focusing on the KAB related to salt reduction. All participants were asked to collect one 24-h urine sample. Of the 5453 participants, 5352 completed urine collection. The mean score for overall KAB was 31.27 (SD = 9.18), which was composed of three elements: knowledge 4.80 (SD = 5.14), attitude 9.33 (SD = 3.93), and behavior 17.14 (SD = 4.43). The average 24-h urinary sodium excretion was 187.70 (SD = 77.48) mmol, which was equivalent to a urinary sodium excretion of 4.32 (SD = 1.78) g/d. We found that salt-related knowledge, attitude, behavior, and overall KAB scores were all inversely associated with 24-h urinary sodium excretion. For every one-point increase in the KAB score, the 24-h urinary sodium excretion decreased by 0.851 mmol (95% CI: -1.095, -0.602). We also found that location (rural/urban), sex, age, and education are associated with salt-related KAB scores. These results suggest that large-scale health education is needed to reduce salt intake in the Chinese population. In particular, efforts should be focused on reaching those who live in rural areas with low educational levels and older people.
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Gupta AK, Carroll TE, Chen Y, Liang W, Cobb LK, Wang Y, Zhang J, Chen Y, Guo X, Mullin S, Murukutla N. 'Love with Less Salt': evaluation of a sodium reduction mass media campaign in China. BMJ Open 2022; 12:e056725. [PMID: 36223966 PMCID: PMC9562322 DOI: 10.1136/bmjopen-2021-056725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study examines the impact of a salt reduction campaign on knowledge, attitudes, intentions, behaviours and barriers to behaviour change relating to salt consumption in two provinces of China. METHODS In 2019, the 'Love with Less Salt' campaign ran on China Central Television and on local television channels in Shandong and Anhui provinces. Data for this study come from two representative household surveys conducted among a sample of adults aged 25-65 years in Shandong and Anhui provinces: precampaign (n=2000) and postcampaign (n=2015). Logistic regression was performed to estimate the effects of the campaign on knowledge, attitudes, intentions, behaviours and barriers to behaviour change. RESULTS Overall, 13% of postcampaign respondents recalled seeing the campaign, and reactions towards the campaign were positive. Postcampaign respondents were more likely to plan to reduce their purchase of foods high in salt than precampaign respondents (OR=1.45, p=<0.05). Campaign-aware respondents were significantly more likely than campaign-unaware respondents to report higher levels of knowledge, attitudes and behaviours regarding salt reduction. CONCLUSIONS Findings reveal that salt reduction mass media campaigns can be an effective public health tool to support efforts to reduce salt consumption in China. Continued and sustained mass media investments are likely to be effective in addressing high salt consumption nationwide.
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Affiliation(s)
| | - Tom E Carroll
- Vital Strategies, Sydney, New South Wales, Australia
| | - Yu Chen
- Vital Strategies, Beijing, China
| | | | - Laura K Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York, New York, USA
| | - Yichao Wang
- Beijing Haisi Aide Technology Co Ltd, Beijing, China
| | - Juan Zhang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yeji Chen
- Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Jinan, China
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Du X, Fang L, Xu J, Chen X, Bai Y, Wu J, Wu L, Zhong J. The association of knowledge, attitudes and behaviors related to salt with 24-h urinary sodium, potassium excretion and hypertensive status. Sci Rep 2022; 12:13901. [PMID: 35974077 PMCID: PMC9381520 DOI: 10.1038/s41598-022-18087-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/04/2022] [Indexed: 11/12/2022] Open
Abstract
To understand the association between sodium and potassium consumption levels, hypertension and knowledge, attitudes and behaviors (KAB) toward salt and the commitment to effective sodium reduction and potassium supplementation to achieve the purpose of suppressing hypertension. A stratified multistage random sampling method was used to obtain a representative provincial sample of 7512 residents aged 18-69 years through a cross-sectional survey by the Salt Reduction and Hypertension Prevention Project (SRHPP) in Zhejiang Province of China in 2017-2018. A screening including demographic, anthropometric, salt-related KAB and physical measurements was implemented, and 24-h urine of approximately 1/5 of the participants was collected and tested. The mean age was 44.8 years, 50.1% were women, 44.0% lived in urban areas, and hypertension or prehypertension accounted for approximately 35.0%. The mean 24-h urinary sodium and potassium excretion were 3848.5 (1661.1) mg/d and 1491.1 (710.9) mg/d, respectively. KAB in urban areas was generally more favorable than in rural areas, women were better than men, and the optimal blood pressure group was better than the other two groups (P < 0.05). However, the awareness and correct use rate of salt-restricted spoons, low-sodium salt and nutrition labeling were lower. A multivariable linear regression model indicated that KAB had a smaller effect on sodium (two indicators effective for promoting sodium reduction) and a greater effect on potassium (six indicators effective for promoting potassium supplementation) and mainly focused on knowledge and behavior indicators. A multivariable logistic regression model indicated that mastering more knowledge and taking active measures could effectively reduce the transition to hypertension, even if the individual was already in prehypertension. There is much room for improvement of salt-related KAB in the Chinese population. A clear association indicates that KAB can help to reduce sodium and supplement potassium, especially potassium, and help to suppress the development of hypertension. The role of beliefs in KAB should be fully valued and improved, similar to knowledge and behaviors. This study provides important evidence and insight into China's efforts to meet the targets of salt reduction and hypertension prevention.
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Affiliation(s)
- Xiaofu Du
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China
| | - Le Fang
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Xiangyu Chen
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Lin Wu
- Department of Medical College, Jinhua Polytechnic, No. 888 Haitang West Road, JinHua, 321017, China
| | - Jieming Zhong
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China.
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12
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Rusmevichientong P, Nguyen H, Morales C, Jaynes J, Wood MM. Food Choices and Hypertension Among Rural Thais: Evidence From a Discrete Choice Experiment. Int J Public Health 2022; 67:1604850. [PMID: 35910428 PMCID: PMC9335071 DOI: 10.3389/ijph.2022.1604850] [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: 02/17/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: The rural northern region of Thailand exhibits the highest rate of hypertension. This study explored hypertensive-related food choices between normotensive and hypertensive people residing in rural northern Thailand to determine which food attributes influence their choices. Methods: The study conducted a discrete choice experiment (DCE) survey among Thai adults residing in rural northern Thailand (n = 403) to estimate the relative importance of four food attributes, including food preparation, price, taste, and amount of salt. A mixed logit model was used to analyze the data from the DCE. Results: The first and second most important attributes in both hypertensive and normotensive groups were the amount of salt and food preparation at home, respectively, followed by price and taste. Specifically, the normotensive group was more attentive to the amount of salt in their food than their hypertensive counterparts. Conclusion: Intervention programs in rural communities may benefit from focusing their attention on embracing low-salt cultural foods and providing guidance on how to add flavor without additional salt or reduce high sodium seasonings without losing flavor when cooking.
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Affiliation(s)
- Pimbucha Rusmevichientong
- Department of Public Health, California State University Fullerton, Fullerton, CA, United States
- *Correspondence: Pimbucha Rusmevichientong,
| | - Helen Nguyen
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Celina Morales
- Department of Population Health and Disease Prevention, University of California Irvine, Irvine, CA, United States
| | - Jessica Jaynes
- Department of Mathematics, California State University Fullerton, Fullerton, CA, United States
| | - Michele M. Wood
- Department of Public Health, California State University Fullerton, Fullerton, CA, United States
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13
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Chan A, Chan SWC, Khanam M, Kinsman L. Factors affecting reductions in dietary salt consumption in people of Chinese descent: An integrative review. J Adv Nurs 2022; 78:1919-1937. [PMID: 35384036 PMCID: PMC9323495 DOI: 10.1111/jan.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/20/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
Aims To identify and synthesize the evidence on the perceptions of the health effects of dietary salt consumption and barriers to sustaining a salt‐reduced diet for hypertension in Chinese people. Design A systematic integrated review integrating quantitative and qualitative studies using the PRISMA guidelines. Data sources Three databases, MEDLINE, PubMed and CINAHL, were systematically searched for articles published between January 2001 and July 2020. Review methods The quality of the included studies was appraised using the Joanna Briggs Institute's critical appraisal tools for cross‐sectional and qualitative studies. Descriptive analysis and constant comparison methods were used to analyse the extracted data. Results Fourteen studies met the inclusion criteria. The synthesized results identified that (i) adequate salt‐related health education had a positive influence on dietary behaviour modifications, (ii) the level of educational exposure to the health benefits of salt reduction influenced Chinese people's perceptions of the health impact associated with high salt intake, (iii) the complexity of salt measurement was a barrier to salt reduction, (iv) salt reduction is a challenge to Chinese food culture, and (v) Chinese migrants may experience linguistic and cultural challenges when they seek appropriate dietary education and advice for hypertension management in their host countries. Conclusion There is room for improvement in recognizing and translating the knowledge of salt‐related health issues and the benefits of that knowledge about salt reduction into action. Future nursing interventions should incorporate individuals' cultural needs and the dietary culture of immediate family members. Impact This integrative review reveals that unique Chinese customs and practices reduce the effectiveness of salt reduction campaigns. The effects of education vanish without family support, resulting in suboptimal adherence to dietary salt reduction strategies.
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Affiliation(s)
- Alex Chan
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.,School of Nursing, University of Wollongong, Liverpool, New South Wales, Australia
| | | | - Masuma Khanam
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
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14
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Antúnez L, Vidal L, Giménez A, Curutchet MR, Ares G. Age, time orientation and risk perception are major determinants of discretionary salt usage. Appetite 2022; 171:105924. [PMID: 35031381 DOI: 10.1016/j.appet.2022.105924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/29/2021] [Accepted: 01/08/2022] [Indexed: 11/02/2022]
Abstract
The present work explored the relationship between discretionary salt usage and personal characteristics, using boosted regression trees (BRT). Specifically, the focus was on how socio-demographic characteristics and personality traits linked to risk perception and time orientation impact on discretionary salt consumption patterns. For this purpose, an online cross-sectional survey with a convenience sample of 498 Uruguayan participants was carried out. Participants completed the consideration of future consequences (CFC) scale adapted for eating behaviour, a short survey about discretionary salt consumption patterns and indicated their degree of agreement with statements measuring perceived risk of sodium consumption. Finally, socio-demographic data were collected. BRT were applied to build predictive models that related discretionary salt usage to socio-demographic characteristics, the two factors of the CFC-Food scale (consideration of the future and consideration of the immediate consequences of eating behaviour), and the two factors of the perceived risk of sodium consumption scale (severity of perceived risks and risk compensation). Age, time orientation and perceived risk were the most relevant explanatory variables for discretionary salt usage. Older people had a lower likelihood of adding salt to food, either at home or when eating out. In addition, individuals who tend to be present rather than future oriented, as well as those with low perception of risk severity and susceptibility were more likely to add salt to foods. Results from the present work suggest that communication campaigns to reduce discretionary salt intake should mainly focus on stressing the short-term health benefits of reducing sodium intake and raising perceived susceptibility.
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Affiliation(s)
- Lucía Antúnez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Canelones, Uruguay.
| | - Leticia Vidal
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Canelones, Uruguay
| | - Ana Giménez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Canelones, Uruguay
| | | | - Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Canelones, Uruguay
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15
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Yan Y, Mu J. Removing barriers to sodium reduction: Focusing on practice. J Clin Hypertens (Greenwich) 2021; 23:1862-1864. [PMID: 34343396 PMCID: PMC8678777 DOI: 10.1111/jch.14343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Yu Yan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University and Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, People's Republic of China
| | - Jianjun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University and Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, People's Republic of China
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16
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Nejad MS, Keshavarz-Mohammad N, Ramezankhani A, Zayeri F, Omidvar N, Liguori J. The Complex Role of Cognitive and Behavioral Factors in Salt Intake Levels of Women. J Lifestyle Med 2021; 11:82-89. [PMID: 34549030 PMCID: PMC8430310 DOI: 10.15280/jlm.2021.11.2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background High salt intake is responsible for some serious health consequences. This study aims to investigate the interrelationship between salt intake cognitive and behavioral factors and urinary sodium excretion levels in women. Methods A descriptive analytical cross-sectional study was conducted in two residential complexes in Ahvaz city, Iran. 260 female participants were selected using systematic random sampling. Data on salt-related cognitive factors, including knowledge, perceived susceptibility, perceived severity, attitude, intention, self-efficacy, and behavior, were collected using a validated questionnaire. To determine true salt intake, 24-hour urinary sodium excretion level was measured. Data was analyzed using Pearson correlation, one-way Anova, and linear regression tests. Results 81.2% of the participants’ salt intake was higher than the WHO recommended value (5 grams/day). A significant relationship between sodium excretion level and knowledge (r = –0.332, p < 0.001), attitude (r = –0.144, p = 0.02), behavior (r = –0.130, p = 0.036), and perceived severity (r = –0.135, p = 0.03) was found. An R2 of 0.134 demonstrates a 13.4% variation in urinary sodium excretion, associated with knowledge and perceived severity. Conclusion Future interventions should aim to improve all the salt-related cognitive factors with placing an emphasis on increasing salt-related knowledge and perceived severity.
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Affiliation(s)
| | | | - Ali Ramezankhani
- Department of Public Health, School of Public Health and Safety, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, School of Paramedical Sciences, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Julia Liguori
- London School of Hygiene and Tropical Medicine, London, England
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17
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Du X, Zhao D, Henry ME, Fang L, Xu J, Chen X, Zhang J, Bai Y, Wu J, Ma J, Zhong J, Yu M, Appel LJ. Use of Salt-Restriction Spoons and Its Associations with Urinary Sodium and Potassium in the Zhejiang Province of China: Results of a Population-Based Survey. Nutrients 2021; 13:1047. [PMID: 33804870 PMCID: PMC8063796 DOI: 10.3390/nu13041047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/02/2021] [Accepted: 03/20/2021] [Indexed: 01/31/2023] Open
Abstract
In China, a major source of sodium is salt added during cooking. In this context, use of a salt-restriction spoon (SRS) has been promoted in public health campaigns and by health care providers. To describe use of and factors associated with SRS use, knowledge of correct use, and actual correct use. This study is a population-based, representative survey of 7512 residents, aged 18 to 69 years, of China's Zhejiang Province. The survey, which was conducted in 2017 using a multistage random sampling strategy, collected demographic information, SRS use, and physical measurements; a 24-h urine collection was obtained from 1,496 of the participants. The mean age of the participants was 44.8 years, 50.1% were females, and over 1/3 (35.3%) were classified as hypertensive. Mean 24-h urinary sodium and potassium excretions were 167.3(72.2) mmol/24 h and 38.2(18.2) mmol/24 h, respectively. Only 12.0% (899/7512) of participants once used or were currently using SRS; of the 899 users, 73.4% knew how to use the SRS correctly, and just 46.5% actually used it correctly. SRS use was more commonly associated with behavioral factors rather than socio-demographic factors. Initiation of SRS use by health care providers was associated with correct technical knowledge of SRS. Lower sodium-to-potassium ratio was associated with SRS use, while SRS use was not associated with urinary sodium and potassium excretion. Use of SRS was uncommon in Zhejiang Province of China. Given that a common source of sodium in China is salt added during cooking, use of SRS is an appealing strategy, ideally as part of a multi-component campaign.
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Affiliation(s)
- Xiaofu Du
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Di Zhao
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, No. 2024 E. Monument Street, Baltimore, MD 21287, USA; (D.Z.); (M.E.H.)
| | - Megan E. Henry
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, No. 2024 E. Monument Street, Baltimore, MD 21287, USA; (D.Z.); (M.E.H.)
| | - Le Fang
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing 100050, China; (J.X.); (Y.B.); (J.W.)
| | - Xiangyu Chen
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Jie Zhang
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing 100050, China; (J.X.); (Y.B.); (J.W.)
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing 100050, China; (J.X.); (Y.B.); (J.W.)
| | - Jixiang Ma
- Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan 250014, China;
| | - Jieming Zhong
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Min Yu
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, No. 2024 E. Monument Street, Baltimore, MD 21287, USA; (D.Z.); (M.E.H.)
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18
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Du X, Fang L, Xu J, Chen X, Bai Y, Zhong J. Association between 24-h urinary sodium and potassium excretion and blood pressure among Chinese adults aged 18-69 years. Sci Rep 2021; 11:3474. [PMID: 33568767 PMCID: PMC7876040 DOI: 10.1038/s41598-021-83049-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/27/2021] [Indexed: 01/03/2023] Open
Abstract
The direction and magnitude of the association between sodium and potassium excretion and blood pressure (BP) may differ depending on the characteristics of the study participant or the intake assessment method. Our objective was to assess the relationship between BP, hypertension and 24-h urinary sodium and potassium excretion among Chinese adults. A total of 1424 provincially representative Chinese residents aged 18 to 69 years participated in a cross-sectional survey in 2017 that included demographic data, physical measurements and 24-h urine collection. In this study, the average 24-h urinary sodium and potassium excretion and sodium-to-potassium ratio were 3811.4 mg/day, 1449.3 mg/day, and 4.9, respectively. After multivariable adjustment, each 1000 mg difference in 24-h urinary sodium excretion was significantly associated with systolic BP (0.64 mm Hg; 95% confidence interval [CI] 0.05-1.24) and diastolic BP (0.45 mm Hg; 95% CI 0.08-0.81), and each 1000 mg difference in 24-h urinary potassium excretion was inversely associated with systolic BP (- 3.07 mm Hg; 95% CI - 4.57 to - 1.57) and diastolic BP (- 0.94 mm Hg; 95% CI - 1.87 to - 0.02). The sodium-to-potassium ratio was significantly associated with systolic BP (0.78 mm Hg; 95% CI 0.42-1.13) and diastolic BP (0.31 mm Hg; 95% CI 0.10-0.53) per 1-unit increase. These associations were mainly driven by the hypertensive group. Those with a sodium intake above about 4900 mg/24 h or with a potassium intake below about 1000 mg/24 h had a higher risk of hypertension. At higher but not lower levels of 24-h urinary sodium excretion, potassium can better blunt the sodium-BP relationship. The adjusted odds ratios (ORs) of hypertension in the highest quartile compared with the lowest quartile of excretion were 0.54 (95% CI 0.35-0.84) for potassium and 1.71 (95% CI 1.16-2.51) for the sodium-to-potassium ratio, while the corresponding OR for sodium was not significant (OR, 1.28; 95% CI 0.83-1.98). Our results showed that the sodium intake was significantly associated with BP among hypertensive patients and the inverse association between potassium intake and BP was stronger and involved a larger fraction of the population, especially those with a potassium intake below 1000 mg/24 h should probably increase their potassium intake.
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Affiliation(s)
- Xiaofu Du
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Le Fang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Xiangyu Chen
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Jieming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China.
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19
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Haron H, Kamal NF, Yahya HM, Shahar S. Knowledge, Attitude and Practice (KAP) of Malay Elderly on Salt Intake and Its Relationship With Blood Pressure. Front Public Health 2021; 8:559071. [PMID: 33614563 PMCID: PMC7890185 DOI: 10.3389/fpubh.2020.559071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
Hypertension is a worldwide problem and a major global health burden with high salt intake as one of the factors often related to it. Public exposure to a high salt diet has contributed to the increase in prevalence of hypertension among the Malaysian population. Improving the knowledge, attitudes and practices (KAP) related to salt intake is a key component of effective blood pressure control. Therefore, this study was aimed to determine the association of KAP of healthy salt intake toward blood pressure among the elderly residing in a semi urban area of Klang Valley Malaysia. A cross-sectional study using convenience sampling was conducted among Malay elderly, aged 60–81 years old residing in Bandar Baru Bangi. Subjects were required to answer the questionnaire via face to face interview regarding KAP of Salt Intake, together with sociodemographic and health profiles. Anthropometry parameters and blood pressure were measured. A total of 94 elderly [57.5% women with mean Body Mass Index (BMI) of 26. 46 ± 4.16, 42.5% men with mean BMI of 27.31 ± 5.19] have participated in the study. Results indicated that the overall KAP score was average (57.4%). However, majority showed a positive attitude toward reducing the salt intake. BMI was found to have significant correlation with blood pressure (r = 0.278, p < 0.05). Higher education level was significantly (p < 0.05) associated with good knowledge scores while younger subjects have a positive attitude toward healthy intake of salt (p < 0.05). Subjects with higher knowledge scores were also observed to have the more controlled blood pressure compared to those who scored less. Attitude and practices score showed no significance difference (p > 0.05) with blood pressure. Younger age, higher level of education and living partner or elderly was significantly (p < 0.05) associated with lower systolic and diastolic blood pressure. Overall, this study showed that knowledge toward healthy salt intake, BMI, education level, and living with others were significantly associated with the blood pressure among the elderly. Further education and intervention is required to improve knowledge on healthy salt intake among elderly as part of the prevention from hypertension.
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Affiliation(s)
- Hasnah Haron
- Nutritional Science Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - NurAisyah Farhana Kamal
- Nutritional Science Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hanis Mastura Yahya
- Nutritional Science Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetics Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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20
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Cai F, Dong WY, Jiang JX, Chen XL, Wang Y, Deng CY, Zhang QY. Estimation of salt intake assessed by 24-h urinary sodium level among adults speaking different dialects from the Chaoshan region of southern China. Public Health Nutr 2021; 24:290-298. [PMID: 32347195 PMCID: PMC10195506 DOI: 10.1017/s136898001900507x] [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: 07/03/2019] [Revised: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Dietary salt intake may vary depending on different lifestyles. We aimed to estimate the different salt intakes and evaluate the knowledge and self-awareness about salt among people speaking the Teochew, Teochew-Hakka and Hakka dialects in the Chaoshan region of southern China. DESIGN The study followed a cluster sampling of residents in Chaoshan region. General characteristics, lifestyles, health status as well as knowledge and self-awareness related to salt intake were investigated using a questionnaire. Anthropometric variables as well as Na and K excretion in a 24-h urine collection were measured. SETTING Chaoshan region of China. PARTICIPANTS Four hundred fifteen adults who spoke only one of these three dialects. RESULTS The salt intake of adults who spoke the Teochew, Teochew-Hakka and Hakka dialects was 7·19 (interquartile range (IQR) 5·29-10·17), 9·03 (IQR 6·62-11·54) and 10·12 (IQR 7·61-12·82) g/d, respectively, with significant differences between Teochew and Teochew-Hakka speakers and between Teochew and Hakka speakers (both P < 0·05). The Na:K ratio for adults who spoke the three dialects was 3·00 (IQR 2·00-4·11), 3·50 (IQR 2·64-4·82) and 4·52 (IQR 3·35-5·97), respectively, and differed significantly among the groups (all P < 0·05). Multiple linear regression analysis showed increased Na:K ratio associated with hypertension (β = 0·71, P = 0·043) in Hakka speakers. Knowledge and self-awareness about salt intake were poor in this population. CONCLUSIONS Salt intake was closely related to lifestyles and was higher than the upper limit (5 g/d) recommended by the WHO in adults of Chaoshan, especially those speaking the Hakka dialect.
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Affiliation(s)
- Fen Cai
- Department of Nosocomial Infection Management, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Wen-Ya Dong
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Jia-Xin Jiang
- Lianshang Town Health Hospital of Chenghai District, Shantou, Guangdong, China
| | - Xiao-Li Chen
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Yue Wang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Chang-Yu Deng
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Qing-Ying Zhang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Corresponding author: Email
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Rusmevichientong P, Morales C, Castorena G, Sapbamrer R, Seesen M, Siviroj P. Dietary Salt-Related Determinants of Hypertension in Rural Northern Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020377. [PMID: 33418991 PMCID: PMC7825279 DOI: 10.3390/ijerph18020377] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 01/19/2023]
Abstract
Hypertension and its connection to high salt consumption have been observed in the Thai population. This study mainly contributed to the literature to examine the dietary-salt-related determinants associated with the risk of hypertension in rural northern Thailand, which exhibited the highest prevalence of hypertension. A total of 376 adults residing in San Pa Tong District, Chiang Mai province, were face-to-face interviewed using a structured questionnaire assessing dietary-salt-related knowledge, attitudes, consumption, sources, and habits. The subject’s blood pressure (BP) was measured twice before and after the interview. Hypertension was defined as a systolic BP ≥ 130 mmHg or a diastolic BP ≥ 80 mmHg. The dietary-salt-related knowledge, attitude, and habits toward salt reduction were positively correlated; however, knowledge and attitudes were not significantly correlated with consumption. Multivariate logistic regression results indicated subjects who frequently bought ready-to-eat food, ate out, or used bouillon cube/monosodium glutamate (MSG) during food preparation were likely to have hypertension (OR = 2.24, 95% CI: 1.36–3.69, p = 0.002). MSG was heavily consumed and used as a flavor enhancer in northern Thai cuisine; however, a few subjects realized it contains sodium due to no salty taste. The deficiency of specific dietary-salt-related knowledge illustrated the need for tailored educational intervention strategies.
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Affiliation(s)
- Pimbucha Rusmevichientong
- Department of Public Health, California State University Fullerton, Fullerton, CA 92831, USA
- Correspondence: ; Tel.: +1-657-278-7495
| | - Celina Morales
- Department of Health Sciences, California State University Northridge, Los Angeles, CA 91330, USA;
| | | | - Ratana Sapbamrer
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (R.S.); (M.S.); (P.S.)
| | - Mathuramat Seesen
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (R.S.); (M.S.); (P.S.)
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (R.S.); (M.S.); (P.S.)
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Herrera Fontana ME, Sisa I, Mosquera K, Celi ME, Teran E. Knowledge, attitudes and practices surrounding sodium intake in Ecuador: a pilot study. Rev Salud Publica (Bogota) 2021. [DOI: 10.15446/rsap.v23n1.88379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To identify the main sources of sodium in the Ecuadorian diet and determine knowledge, attitudes and practices related to the use of salt/sodium.Materials and Methods A cross-sectional study was conducted by taking a convenience sample of 177 adults. Socio-demographic, anthropometric and clinical data were collected. Frequency of consumption of food items high in sodium and knowledge, attitudes and practices regarding salt intake were evaluated.Results Meat products, sugary drinks, sausages, canned fish and seasonings are the food items with the highest consumption and sodium content. Nearly 97% of participants had a misperception about their sodium intake. While 99% know that a diet high in salt causes health problems, only 38.4% take a systematic action to regulate their salt intake.Conclusions There were a common misperception about sodium consumption. Only a small number of people take an action to reduce their consumption, although these actions was ineffective.
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23
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Webster A, Banna J, Lim E, Gibby CLK, Rose AM, Hopkins LC, Kennel JA, Orchard TS, Bomser JA, Gunther C. Knowledge, Attitudes, and Practices Regarding Dietary Sodium in College Students. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:1139-1147. [PMID: 33308515 DOI: 10.1016/j.jneb.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Test a dietary sodium survey in a US adult population of college students using a survey previously validated in a non-US adult population. METHODS Cross-sectional study of a convenience sample of college students from a Midwest (n = 168) and Pacific Island (n = 152) university. Main outcome measures were knowledge, attitudes, and practices regarding dietary sodium (38 items). Sum scores and percentages for constructs were calculated. A score <75% was considered unfavorable; t test or ANOVA were used to examine group differences. RESULTS Midwest students were primarily non-Hispanic White individuals (81%) and 65% female. Pacific Island students were predominantly Asian (51%) and 66% female. Mean ± SD construct scores (percentage) for knowledge, attitudes, and practices were 58.69 ± 10.62, 63.96 ± 16.18, 66.00 ± 12.34 (Midwest) and 57.54 ± 10.93, 64.84 ± 14.96, 64.94 ± 13.18 (Pacific Island), respectively; there were no significant differences between schools or race. CONCLUSIONS AND IMPLICATIONS College students scored low in knowledge, attitudes, and practices regarding sodium. Results from this formative study may inform assessment strategies in future dietary sodium interventions.
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Affiliation(s)
- Alison Webster
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, OH
| | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, HI
| | - Eunjung Lim
- Department of Quantitative Health Sciences, Biostatistics Core Facility, University of Hawai'i at Mānoa, Honolulu, HI
| | - Cheryl L K Gibby
- Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, HI
| | - Angela M Rose
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, OH
| | - Laura C Hopkins
- Department of Public Health and Prevention Science, Baldwin Wallace University, Berea, OH
| | - Julie A Kennel
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, OH
| | - Tonya S Orchard
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, OH
| | - Joshua A Bomser
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, OH
| | - Carolyn Gunther
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, OH.
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Dietary sodium and potassium intake: knowledge, attitude and behaviour towards dietary salt intake among adults in Addis Ababa, Ethiopia. Public Health Nutr 2020; 24:3451-3459. [PMID: 33106202 DOI: 10.1017/s1368980020003663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study aimed to estimate the consumption of Na and K and to assess salt-related knowledge, attitude and behaviour among adults in Addis Ababa, Ethiopia. DESIGN A community-based cross-sectional study was conducted. Estimates of Na and K intake were made using repeated multiple-pass 24-h dietary recall as well as using random urine. The usual intake of Na and K from the 24-h dietary recall was determined using the National Cancer Institute methodology. Estimated 24-h Na and K excretion was calculated using International Cooperative Study on Salt, Other Factors, and Blood Pressure and Tanaka formula. SETTINGS Addis Ababa, the capital city of Ethiopia. PARTICIPANTS Individuals aged 20 years and above residing in the city. RESULT The mean Na and K intake estimated using the diet recall data was 3·0 (0·9) g/d and 1·9 (0·6) g/d, respectively. Based on the urine analysis, the estimated mean Na and K intakes were 3·3 (0·7) g/d and 1·9 (0·4) g/d, respectively. Moreover, the analysis showed that the mean Na:K ratio was 2·5 (1·4). The daily intake of K was below the recommended amount for all study participants. More than 98 % and 90 % of participants had an excess intake of Na and Na:K ratio, respectively. CONCLUSION We found a high prevalence of inadequate K intake as well as excess intake of Na resulting in an increased prevalence of excess Na:K ratio. Thus, interventions targeting to decrease Na intake and to increase K intake are needed.
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Hanbazaza MA, Mumena WA. Knowledge and Practices Related to Salt Intake among Saudi Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5749. [PMID: 32784844 PMCID: PMC7459814 DOI: 10.3390/ijerph17165749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 01/13/2023]
Abstract
In Saudi Arabia, data regarding salt-related knowledge and practices are still lacking. This cross-sectional study aimed to investigate salt-related knowledge and practices and associated factors in Saudi adults. Data on the following variables were collected from 467 participants living in Madinah or Jeddah via face-to-face interviews: demographics, anthropometrics (height and weight), blood pressure (assessed using a digital sphygmomanometer), salt-related knowledge, and practices related to salt intake. Salt-related knowledge and practices were limited among the study participants; however, they were not correlated (rs = 0.10). Multiple linear regression analysis revealed that salt-related practices were negatively associated with sodium intake and positively associated with body mass index (BMI) (p < 0.001 and p = 0.001, respectively), whereas salt-related knowledge was not associated with sodium intake, blood pressure, or BMI. Salt-related knowledge is limited and not linked to practices related to salt intake in Saudi adults. Interventions are needed to increase the accessibility of low-sodium food options and improve practices limiting sodium intake to prevent the occurrence of salt-related diseases among adults in Saudi Arabia.
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Affiliation(s)
- Mahitab A. Hanbazaza
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia;
| | - Walaa A. Mumena
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah 42353, Saudi Arabia
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26
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Hou L, Guo X, Zhang J, Chen X, Yan L, Cai X, Tang J, Xu C, Wang B, Wu J, Ma J, Xu A. Associations Between Salt-Restriction Spoons and Long-Term Changes in Urinary Na +/K + Ratios and Blood Pressure: Findings From a Population-Based Cohort. J Am Heart Assoc 2020; 9:e014897. [PMID: 32674645 PMCID: PMC7660739 DOI: 10.1161/jaha.119.014897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background There have been few studies on the relationship between long-term changes in sodium intake and blood pressure. A method of reducing sodium intake in a population that is known for high-sodium intake based on homemade cooking is also needed. Methods and Results Our study was based on a baseline survey of 15 350 individuals aged 18 to 69 years with multistage random sampling and a 3-year salt-restriction campaign across Shandong Province, China. We included 339 individuals from six districts/counties in this cohort study, and the 24-hour urinary sodium-potassium ratio (Na+/K+) served as an indicator of sodium intake. The average change in ratio was 2.39 (95% CI, 2.17-2.61) from 6.81 (95% CI, 6.41-7.21) at baseline to 4.41 (95% CI, 4.18-4.64) during the resurvey. Following a reduction from low to high quartiles of urinary Na+/K+ ratio, the average increases were 10.9 (95% CI, 8.9-12.9), 9.2 (95% CI, 6.9-11.5), 6.3 (95% CI, 4.0-8.6), and 5.3 (95% CI, 2.9-7.7) mm Hg for systolic blood pressure (P for trend=0.019) and 3.8 (95% CI, 2.4-5.2), 2.9 (95% CI, 1.7-4.2), 1.6 (95% CI, 0.4-2.8), and -0.3 (95% CI, -1.4-0.8) mm Hg for diastolic blood pressure (P for trend=0.002), respectively. A reduction in salt intake was evident for people using a 2-g salt-restriction spoon for cooking (-3.49 versus -2.22; P=0.027) after adjustment of confounding factors, compared with nonusers. Similar findings were obtained for other salt-restriction spoon-based indicators. Conclusions Our study indicated that using a salt-restriction spoon for cooking was associated with reduced salt intake that led to a blunting of blood pressure deterioration. This finding further supports the salt-restriction spoon-based strategy for people whose primary salt intake is from homemade cooking.
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Affiliation(s)
- Lei Hou
- National Center for Chronic and Noncommunicable Disease Control and Prevention Chinese Center for Disease Control and Prevention Beijing China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention Jinan China
| | - Jiyu Zhang
- Shandong Center for Disease Control and Prevention Jinan China
| | - Xi Chen
- Shandong Center for Disease Control and Prevention Jinan China
| | - Liuxia Yan
- National Center for Chronic and Noncommunicable Disease Control and Prevention Chinese Center for Disease Control and Prevention Beijing China
| | - Xiaoning Cai
- National Center for Chronic and Noncommunicable Disease Control and Prevention Chinese Center for Disease Control and Prevention Beijing China
| | - Junli Tang
- Shandong Center for Disease Control and Prevention Jinan China
| | - Chunxiao Xu
- Shandong Center for Disease Control and Prevention Jinan China
| | - Baohua Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention Chinese Center for Disease Control and Prevention Beijing China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention Chinese Center for Disease Control and Prevention Beijing China
| | - Jixiang Ma
- Division of Non-communicable Disease Control and Community Health Chinese Center for Disease Control and Prevention Beijing China
| | - Aiqiang Xu
- Shandong Center for Disease Control and Prevention Jinan China
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27
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Xu A, Ma J, Guo X, Wang L, Wu J, Zhang J, Bai Y, Xu J, Lu Z, Xu Z, Zhang X, Ding G, Hong Y, Du F, Wu Y, Yan L, Tang J, Cai X, Dong J, Xu C, Ren J, Chen X, Gao C, Zhang B, Yang Q, Moolenaar R, Cai Y, Jackson SL, Xie G, Yu S, Cui J, Wang Z, Zhao L, Ju L, Shen D, Yun S, Liang X, Bi Z, Wang Y. Association of a Province-Wide Intervention With Salt Intake and Hypertension in Shandong Province, China, 2011-2016. JAMA Intern Med 2020; 180:877-886. [PMID: 32338717 PMCID: PMC7186913 DOI: 10.1001/jamainternmed.2020.0904] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE High salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease. OBJECTIVE To assess the association of a government-led, multisectoral, and population-based intervention with reduced salt intake and blood pressure in Shandong Province, China. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) program, a 5-year intervention to reduce sodium consumption in Shandong Province, China. Two representative samples of adults (aged 18-69 years) were surveyed in 2011 (15 350 preintervention participants) and 2016 (16 490 postintervention participants) to examine changes in blood pressure, and knowledge, attitudes, and behaviors related to sodium intake. Urine samples were collected from random subsamples (2024 preintervention participants and 1675 postintervention participants) for measuring sodium and potassium excretion. Data were analyzed from January 20, 2017, to April 9, 2019. INTERVENTIONS Media campaigns, distribution of scaled salt spoons, promotion of low-sodium products in markets and restaurants, and activities to support household sodium reduction and school-based sodium reduction education. MAIN OUTCOMES AND MEASURES The primary outcome was change in urinary sodium excretion. Secondary outcomes were changes in potassium excretion, blood pressure, and knowledge, attitudes, and behaviors. Outcomes were adjusted for likely confounders. Means (95% CIs) and percentages were weighted. RESULTS Among 15 350 participants in 2011, 7683 (50.4%) were men and the mean age was 40.7 years (95% CI, 40.2-41.2 years); among 16 490 participants in 2016, 8077 (50.7%) were men and the mean age was 42.8 years (95% CI, 42.5-43.1 years). Among participants with 24-hour urine samples, 1060 (51.8%) were men and the mean age was 40.9 years (95% CI, 40.5-41.3 years) in 2011 and 836 (50.7%) were men and the mean age was 40.7 years (95% CI, 40.1-41.4 years) in 2016. The 24-hour urinary sodium excretion decreased 25% from 5338 mg per day (95% CI, 5065-5612 mg per day) in 2011 to 4013 mg per day (95% CI, 3837-4190 mg per day) in 2016 (P < .001), and potassium excretion increased 15% from 1607 mg per day (95% CI, 1511-1704 mg per day) to 1850 mg per day (95% CI, 1771-1929 mg per day) (P < .001). Adjusted mean systolic blood pressure among all participants decreased from 131.8 mm Hg (95% CI, 129.8-133.8 mm Hg) to 130.0 mm Hg (95% CI, 127.7-132.4 mm Hg) (P = .04), and diastolic blood pressure decreased from 83.9 mm Hg (95% CI, 82.6-85.1 mm Hg) to 80.8 mm Hg (95% CI, 79.4-82.1 mm Hg) (P < .001). Knowledge, attitudes, and behaviors associated with dietary sodium reduction and hypertension improved significantly. CONCLUSIONS AND RELEVANCE The findings suggest that a government-led and population-based intervention in Shandong, China, was associated with significant decreases in dietary sodium intake and a modest reduction in blood pressure. The results of SMASH may have implications for sodium reduction and blood pressure control in other regions of China and worldwide.
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Affiliation(s)
- Aiqiang Xu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Jixiang Ma
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiyu Zhang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zilong Lu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Zhongji Xu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaochang Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fengjun Du
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
| | - Liuxia Yan
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Junli Tang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Xiaoning Cai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Dong
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Chunxiao Xu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Jie Ren
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Xi Chen
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Congcong Gao
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Bingyin Zhang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ronald Moolenaar
- Division of Global Health Protection Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ying Cai
- Division of Global Health Protection Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gaoqiang Xie
- Peking University Clinical Research Institute, Beijing, China
| | - Shicheng Yu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Cui
- China National Salt Industry Company Limited, Beijing, China
| | - Zengwu Wang
- Division of Preventive and Community Health, National Center for Cardiovascular Disease, The State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lahong Ju
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Danyang Shen
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shumei Yun
- Missouri Department of Mental Health, Jefferson City
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenqiang Bi
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Yu Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
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The Predictors of High Dietary Salt Intake among Hypertensive Patients in Iran. Int J Hypertens 2020; 2020:6748696. [PMID: 32328301 PMCID: PMC7168708 DOI: 10.1155/2020/6748696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/03/2020] [Accepted: 03/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background Hypertension and its complications are among the major health problems all over the world, particularly in developing countries. The aims of this study were to show that, weather the hypertensive patients follow the expertise recommendations and differences between men and women in their levels of knowledge and behavior in salt taking. Methods The present cross-sectional study was conducted among all hypertensive patients in rural health centers of Tabriz, Iran, in Feb-May; 2016. Data were collected by an interviewer-administrated questionnaire, along with anthropometric, blood pressure, and 24-hour urinary sodium excretion measurements. Multivariate logistic regression analysis was used to compute adjusted odds ratio (OR). Results In all 205 patients, 62.9% female, 40.5% aged over 60 years, and 53.7% with low or moderate socioeconomic status, 49.3% body mass index (BMI) 30 kg/m2 and above, 10.2% of the patients had systolic/diastolic equal and above (≥) 40/90 mmHg, participated in the study. In total, 16.6% were aware of the daily salt allowance for healthy people with sex difference (P < 0.001). Significant predictors of adding salt beyond the dietary recommendations in food preparation were occupation (unemployed) (OR = 4.05, 95% CI = 1.041-15.78, (P = 0.044)) and blood pressure level (systolic/diastolic ≥140/90) (OR = 2.76, 95% CI = 1.28-5.96 (P = 0.010)), while adding salt at the table correlated with sex (men) (OR = 4.47, 95% CI = 1.21-16.57 (P = 0.025)), age (54-59) (OR = 0.05 95% CI = 0.01-0.39, (P = 0.005)), and knowledge (general) (OR = 1.06, 95% CI = 0.99-1.13 (P = 0.05)). Conclusion The different pattern of salt intake was observed between men and women. In general, the amount of salt taken by hypertensive patients is higher than recommended allowances. Both men and women add extra amount of salt to food, women when preparing food and men at the table. Salt intake level both during preparing and eating food may be associated with occupation (unemployed), blood pressure level (systolic/diastolic ≥140/90), sex (men), age (54-59), and also patient knowledge (general).
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Xian J, Zeng M, Zhu R, Cai Z, Shi Z, Abdullah AS, Zhao Y. Design and implementation of an intelligent monitoring system for household added salt consumption in China based on a real-world study: a randomized controlled trial. Trials 2020; 21:349. [PMID: 32317000 PMCID: PMC7171770 DOI: 10.1186/s13063-020-04295-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high intake of salt is a major risk factor for cardiovascular diseases. Despite decades of effort to reduce salt consumption, the salt intake in China is still considerably above the recommended level. Thus, this study aims to design and implement an intelligent household added salt monitoring system (SALTCHECKER) to monitor and control added salt consumption in Chinese households. METHODS A randomized controlled trial will be conducted among households to test the effect of a SALTCHECKER in Chongqing, China. The test modalities are the SALTCHECKER (with a smart salt checker and a salt-limiting WeChat mini programme) compared to a salt checker (with only a weighing function). The effectiveness of the system will be investigated by assessing the daily added salt intake of each household member and the salt consumption-related knowledge, attitude and practice (KAP) of the household's main cook. Assessments will be performed at baseline and at 3 and 6 months. DISCUSSION This study will be the first to explore the effect of the household added salt monitoring system on the reduction in salt intake in households. If the intelligent monitoring system is found to be effective in limiting household added salt consumption, it could provide scientific evidence on reducing salt consumption and preventing salt-related chronic diseases. TRIAL REGISTRATION Chinese clinical trial registry (Primary registry in the World Health Organization registry network): ChiCTR1800018586. Date of registration: September 25, 2018.
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Affiliation(s)
- Jinli Xian
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China.,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Mao Zeng
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China.,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Rui Zhu
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China.,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Zhengjie Cai
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China.,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Kunshan, 215347, Jiangsu Province, China.,Duke Global Health Institute, Duke University, Durham, NC, 27710, USA.,School of Medicine, Department of General Internal Medicine, Boston University Medical Center, Boston, MA, 02118, USA
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China. .,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China. .,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China. .,Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
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Badrasawi MMH, Hijjeh NH, Amer RS, Allan RM, Altamimi M. Nutrition Awareness and Oral Health among Dental Patients in Palestine: A Cross-Sectional Study. Int J Dent 2020; 2020:3472753. [PMID: 32184828 PMCID: PMC7061134 DOI: 10.1155/2020/3472753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/07/2022] Open
Abstract
Nutrition plays a key role in oral and dental health. Similarly, oral health affects nutrition status and diet intake. Consumption of much cariogenic nutrients such as sugar affects dental and gum health. The awareness of dietary practices that affect the oral health is an essential component in the dental care system. The knowledge of the dietary factors that affect the oral health is a major component in the treatment plan. In this vein, this study was conducted to determine the level of awareness of nutrition information affecting oral health among dental patients who visit the private and university dental clinics in West Bank, Palestine. A total of 169 patients were invited to join the study and signed the consent form. A pretested questionnaire was used to collect the required data which included patients' sociodemographics, medical history, oral care practices, dietary practices, and oral health-related nutritional awareness. Face and content validity were verified, followed by a pilot study to determine the questionnaire reliability alpha, and the data were collected from October to November 2018. The Construct Validation was done using the Rasch measurement model, and the descriptive statistical analysis was done to determine the level of awareness and the difference among the groups using SPSS version 21. The total mean score of the nutrition awareness was (9.3 ± 2.8), with higher level of nutrition awareness among females, and the highest score was 16 out of 17. The good oral health condition was reported among 44%, fair 32%, poor 16%, and bad 10% while excellent oral health was reported among only 5% of the participants. There was no significant relationship between level of nutritional awareness with economic status, level of education, or area of living. For oral health, females showed significantly better oral and gum health levels (p < 0.05). The overall level of nutrition knowledge among the participants is insufficient. These results point to the need for oral health and nutrition educational courses and programs to improve oral and nutritional awareness and knowledge among Palestinian people and dental patients in particular. Improving the dietary habits and oral practices with lifestyle changes should also be encouraged.
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Affiliation(s)
- Manal M. H. Badrasawi
- Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus 30500, State of Palestine
| | - Nour H. Hijjeh
- Healthy and Therapeutic Nutrition Program, Faculty of Applied Sciences, Palestine Polytechnic University, Hebron 30500, State of Palestine
| | - Rana S. Amer
- Healthy and Therapeutic Nutrition Program, Faculty of Applied Sciences, Palestine Polytechnic University, Hebron 30500, State of Palestine
| | - Reema M. Allan
- Healthy and Therapeutic Nutrition Program, Faculty of Applied Sciences, Palestine Polytechnic University, Hebron 30500, State of Palestine
| | - Mohammad Altamimi
- Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus 30500, State of Palestine
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Aburto TC, Gordon‐Larsen P, Poti JM, Howard AG, Adair LS, Avery CL, Popkin BM. Is a Hypertension Diagnosis Associated With Improved Dietary Outcomes Within 2 to 4 Years? A Fixed-Effects Analysis From the China Health and Nutrition Survey. J Am Heart Assoc 2019; 8:e012703. [PMID: 31657282 PMCID: PMC6898848 DOI: 10.1161/jaha.119.012703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022]
Abstract
Background Evidence shows that dietary factors play an important role in blood pressure. However, there is no clear understanding of whether hypertension diagnosis is associated with dietary modifications. The aim of this study is to estimate the longitudinal association between hypertension diagnosis and subsequent changes (within 2-4 years) in dietary sodium, potassium, and sodium-potassium (Na/K) ratio. Methods and Results We included adults (18-75 years, n=16 264) from up to 9 waves (1991-2015) of the China Health and Nutrition Survey. Diet data were collected using three 24-hour dietary recalls and a household food inventory. We used fixed-effects models to estimate the association between newly self-reported diagnosed hypertension and subsequent within-individual changes in sodium, potassium, and Na/K ratio. We also examined changes among couples and at the household level. Results suggest that on average, men who were diagnosed with hypertension decreased their sodium intake by 251 mg/d and their Na/K ratio by 0.19 within 2 to 4 years after diagnosis (P<0.005). Among spouse pairs, sodium intake and Na/K ratio of women decreased when their husbands were diagnosed (P<0.05). Household average sodium density and Na/K ratio decreased, and household average potassium density increased after a man was diagnosed. In contrast, changes were not statistically significant when women were diagnosed. Conclusions Our findings suggest that hypertension diagnosis for a man may result in modest dietary improvements for him, his wife, and other household members. Yet, diagnosis for a woman does not seem to result in dietary changes for her or her household members.
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Affiliation(s)
- Tania C. Aburto
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Penny Gordon‐Larsen
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
| | - Jennifer M. Poti
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Annie G. Howard
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Linda S. Adair
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
| | - Christy L. Avery
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Barry M. Popkin
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
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Morowatisharifabad MA, Salehi-Abargouei A, Mirzaei M, Rahimdel T. Behavioral beliefs of reducing salt intake from the perspective of people at risk of hypertension: An exploratory study. ARYA ATHEROSCLEROSIS 2019; 15:59-66. [PMID: 31440287 PMCID: PMC6679659 DOI: 10.22122/arya.v15i2.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The average salt intake in Iran is 12 g per day and it is reported to be about 10 g per day in Yazd City, Iran. This study was conducted to explain the behavioral beliefs toward salt intake reduction in people at risk of hypertension (HTN) based on Theory of Planned Behavior (TPB) guideline. METHODS This study was a TPB-based exploratory research. The participants were 25 married individuals at risk of developing HTN, with a mean age of 42.9 ± 7.2 years. They were selected by purposive maximum variation sampling continued until data saturation. The data collection method was a semi-structured interview. Study lasted from January 2017 to April 2017. RESULTS Concerning the advantages and disadvantages of reducing daily salt intake, data analysis yielded 52 primary codes, 19 subcategories, and 5 categories. Advantages in two categories included disease prevention and misconceptions about the benefits, and disadvantages in three categories included physical health disorder, difficulty following a low-salt diet, and false beliefs about the disadvantages of salt intake reduction. CONCLUSION According to the findings of this study, prevention of high blood pressure and cardiovascular diseases (CVDs) was among the most important advantages of reducing salt intake, and undesirable taste of low-salt foods and family members' disagreement were among the most important disadvantages of reducing salt intake. The misconceptions of our participants included blood lipids reduction and creation of difficulty contracting the muscles. It is recommended to correct misconceptions and strengthen behavioral beliefs to promote salt intake reduction behavior in educational interventions.
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Affiliation(s)
| | - Amin Salehi-Abargouei
- Assistant Professor, Nutrition and Food Security Research Center AND Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Mirzaei
- Professor, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Tahereh Rahimdel
- PhD Candidate, Department of Health Education and Health Promotion, International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Wu S, An S, Li W, Lichtenstein AH, Gao J, Kris-Etherton PM, Wu Y, Jin C, Huang S, Hu FB, Gao X. Association of Trajectory of Cardiovascular Health Score and Incident Cardiovascular Disease. JAMA Netw Open 2019; 2:e194758. [PMID: 31150075 PMCID: PMC6547110 DOI: 10.1001/jamanetworkopen.2019.4758] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
Importance The American Heart Association 2020 Strategic Impact Goals target an improvement in overall cardiovascular health, as assessed by 7 health metrics (smoking, body weight, physical activity, diet, plasma glucose level, plasma cholesterol level, and blood pressure). Objective To examine whether trajectories of overall cardiovascular health over time, as assessed by the cardiovascular health score (CHS) in 2006, 2008, and 2010, are associated with subsequent risk of CVD. Design, Setting, and Participants The Kailuan study is a prospective, population-based study that began in 2006. The cohort included 74 701 Chinese adults free of myocardial infarction, stroke, and cancer in or before 2010. In the present study, CHS trajectories were developed from 2006 to 2010 to predict CVD risk from 2010 to 2015. Data analysis was performed from January 1, 2006, to December 31, 2015. Exposures The CHS trajectories during 2006-2010 were identified using latent mixture models. Main Outcomes and Measures Incident CVD events (myocardial infarction and stroke) during 2010-2015 were confirmed by review of medical records. The CHS trajectories were determined using 7 cardiovascular health metrics scored as poor (0 points), intermediate (1 point), and ideal (2 points); total score ranges from 0 (worst) to 14 (best). Based on the baseline CHS and patterns over time, 5 trajectories were categorized (low-stable, moderate-increasing, moderate-decreasing, high-stable I, and high-stable II). Results Of the 74 701 adults included in the study (mean [SD] age at baseline, 49.6 [11.8] years), 58 216 (77.9%) were men and 16 485 (22.1%) were women. Five CHS trajectories were identified from 2006 to 2010: low-stable (n = 4393; range, 4.6-5.2), moderate-increasing (n = 4643; mean increase from 5.4 to 7.8), moderate-decreasing (n = 14 853; mean decrease from 7.4 to 6.3), high-stable I (n = 36 352; range, 8.8-9.0), and high-stable II (n = 14 461; range, 10.9-11.0). During 5 years of follow-up, 1852 incident CVD cases were identified. Relative to the low-stable trajectory, the high-stable II trajectory was associated with a lower subsequent risk of CVD (adjusted hazard ratio, 0.21; 95% CI, 0.16-0.26, after adjusting for age, sex, educational level, income, occupation, alcohol intake, and serum high-sensitivity C-reactive protein concentration at baseline). Conclusions and Relevance Cardiovascular health trajectories may be associated with subsequent CVD risk.
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Affiliation(s)
- Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, People’s Republic of China
| | - Shasha An
- Department of Emergency, HanDan Central Hospital, HanDan, People's Republic of China
| | - Weijuan Li
- Vanderbilt University Medical Center/Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
| | - Alice H. Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Jingsheng Gao
- Department of Cardiology, Kailuan General Hospital, Tangshan, People’s Republic of China
| | | | - Yuntao Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, People’s Republic of China
| | - Cheng Jin
- Department of Cardiology, Kailuan General Hospital, Tangshan, People’s Republic of China
- Department of Nutritional Sciences, Pennsylvania State University, State College
| | - Shue Huang
- Department of Nutritional Sciences, Pennsylvania State University, State College
| | - Frank B. Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, State College
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Knowledge and Attitudes Are Related to Selected Salt-Specific Behaviours among Australian Parents. Nutrients 2018; 10:nu10060720. [PMID: 29867025 PMCID: PMC6024726 DOI: 10.3390/nu10060720] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 11/25/2022] Open
Abstract
Salt intake in adults and children exceeds recommended levels. Salt-related knowledge, attitudes, and behaviours (KABs) may influence the amount of salt consumed. The aims of this study were to assess salt-related KABs among parents, and investigate whether salt-related knowledge and attitudes are associated with salt-specific behaviours. Parents with children <18 years were recruited from four shopping centers across Victoria, Australia; Facebook; and an online consumer research panel; they then completed an online questionnaire assessing salt-related KABs and salt use in children. Eight hundred and thirty-seven parents (mean age 41.0 (10.0) (SD) years) provided valid responses. Most (77%) parents were aware that eating too much salt damages children’s health and that reducing the amount of salt in their children’s diet was important (70%), and 46% reported adding salt to food prepared for their children. Parents who were aware that eating too much salt damages children’s health were less likely to report that their child added salt at the table (OR = 0.51, p < 0.001), and that they added salt to food prepared for the child (OR = 0.46, p < 0.001). Educational messages that highlight the adverse health effects of salt during childhood are likely to be useful in reducing discretionary salt use in the home environment.
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Salt Use Behaviours of Ghanaians and South Africans: A Comparative Study of Knowledge, Attitudes and Practices. Nutrients 2017; 9:nu9090939. [PMID: 28846641 PMCID: PMC5622699 DOI: 10.3390/nu9090939] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/30/2022] Open
Abstract
Salt consumption is high in Africa and the continent also shares the greatest burden of hypertension. This study examines salt-related knowledge, attitude and self-reported behaviours (KAB) amongst adults from two African countries—Ghana and South Africa—which have distributed different public health messages related to salt. KAB was assessed in the multinational longitudinal World Health Organisation (WHO) study on global AGEing and adult health (WHO-SAGE) Wave 2 (2014–2015). Respondents were randomly selected across both countries—Ghana (n = 6746; mean age 58 years old; SD 17; 41% men; 31% hypertensive) and South Africa (n = 3776, mean age 54 years old; SD 17; 32% men; 45% hypertensive). South Africans were more likely than Ghanaians to add salt to food at the table (OR 4.80, CI 4.071–5.611, p < 0.001) but less likely to add salt to food during cooking (OR 0.16, CI 0.130–0.197, p < 0.001). South Africans were also less likely to take action to control their salt intake (OR 0.436, CI 0.379–0.488, p < 0.001). Considering the various salt reduction initiatives of South Africa that have been largely absent in Ghana, this study supports additional efforts to raise consumer awareness on discretionary salt use and behaviour change in both countries.
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Stages of Behavioral Change for Reducing Sodium Intake in Korean Consumers: Comparison of Characteristics Based on Social Cognitive Theory. Nutrients 2017; 9:nu9080808. [PMID: 28749441 PMCID: PMC5579602 DOI: 10.3390/nu9080808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 11/17/2022] Open
Abstract
High sodium intake increases the risk of cardiovascular disease. Given the importance of behavioral changes to reducing sodium intake, this study aims to investigate the stages of change and the differences in cognitive and behavioral characteristics by stage in Korean consumers. Adult participants (N = 3892) completed a questionnaire on the stages of behavioral change, recognition of social efforts, outcome expectancy, barriers to practice, nutrition knowledge and dietary behaviors, and self-efficiency related to reduced sodium intake. The numbers of participants in each stage of behavioral change for reducing sodium intake was 29.5% in the maintenance stage, 19.5% in the action stage, and 51.0% in the preaction stage that included the precontemplation, contemplation, and preparation stages. Multiple logistic regression showed that the factors differentiating the three stages were recognizing a supportive social environment, perceived barriers to the practice of reducing sodium intake, and self-efficacy to be conscious of sodium content and to request less salt when eating out. Purchasing experience of sodium-reduced products for salty foods, knowledge of the recommended intake of salt and the difference between sodium and salt, and improving dietary habits of eating salted fish, processed food, and salty snacks were factors for being in the action stage versus the preaction stage. These findings suggest that tailored intervention according to the characteristics of each stage is helpful in reducing sodium intake.
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Lee J, Cui W, Jin M. Barriers, Attitudes, and Dietary Behaviors Regarding Sodium Reduction in the Elderly Korean-Chinese Population in Yanbian, China. Osong Public Health Res Perspect 2017; 8:185-194. [PMID: 28781941 PMCID: PMC5525563 DOI: 10.24171/j.phrp.2017.8.3.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/17/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives This research investigated the barriers, attitudes, and dietary behaviors related to sodium reduction among the elderly Korean–Chinese population in Yanbian, China. Methods We conducted this pilot study using both descriptive research and a focus group interview at the elderly community center in Yanbian. Results In total, 21 elderly Korean–Chinese (average age, 71 years) were examined. The findings showed that the top three barriers to sodium reduction were 1) the difficulties associated with having meals with others, 2) a preference for liquid based-dishes, and 3) the lack of taste in low-sodium dishes. Although the participants strongly believed that a reduced-sodium diet would improve their health, they were poorly aware of the amount of sodium in various foods and dishes. In particular, the focus group interviews with eight participants (mean age, 67 years) revealed that salt-preserved foods (e.g., Korean pickled cabbage called ‘kimchi’ and soybean paste) were frequently consumed as part of their food culture, and that very salty dishes were served at restaurants, both of which lead to a high sodium intake. Conclusion This study provides useful preliminary data to help design a nutrition intervention program for sodium reduction that targets the elderly Korean–Chinese population in China.
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Affiliation(s)
- Jounghee Lee
- Department of Nutrition Education, Graduate School of Education, Kyonggi University, Suwon, Korea
| | - Wenying Cui
- Department of Nursing Science, Yanbian University of Science & Technology, Yanji, China
| | - Meixiang Jin
- Department of Nursing Science, Yanbian University of Science & Technology, Yanji, China
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Relationship between urinary sodium with blood pressure and hypertension among a Kazakh community population in Xinjiang, China. J Hum Hypertens 2017; 31:333-340. [PMID: 28054572 DOI: 10.1038/jhh.2016.83] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/02/2016] [Accepted: 10/21/2016] [Indexed: 01/11/2023]
Abstract
Urinary sodium levels are reported to be associated with blood pressure in clinical trials and epidemiology studies. Nevertheless, the public health message of reducing sodium intake in free-living community populations remains under debate. Based on an ongoing prospective study initiated in 2012 with a community-based design in Xinjiang, China, 1668 adults (⩾30 years old) were assessed in the current study for associations between urinary sodium and blood pressure and hypertension in a free-living population of Kazakh people. After excluding 223 people on antihypertensive medication, 1445 participants were analyzed. Second urine samples after waking were used to estimate 24-h urinary sodium excretion, which is a marker for sodium intake. Following analyses, we found that the distribution of systolic and diastolic blood pressures moved upward with increasing quartiles of urinary sodium. After adjusting for age, differences in median systolic blood pressure were 8.5 mm Hg for men and 8.0 mm Hg for women between the top and bottom urinary sodium quartiles, and differences for diastolic blood pressure were 4.7 mm Hg for men and 4.3 mm Hg for women. A significant increased risk for hypertension was observed for the top quartile of urinary sodium after adjusting for age, body mass index, smoking, alcohol consumption, fruit and vegetable consumption, with corresponding odds ratios being 1.61 (95% confidence interval (CI): 1.02-2.54) for men and 1.92 (95% CI: 1.13-3.27) for women. Improving education about reducing salt intake is of particular public importance to reduce blood pressure and the risk for hypertension among the Kazakh people.
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Implantation and pregnancy outcome of Sprague–Dawley rats fed with low and high salt diet. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kaddumukasa MN, Katabira E, Sajatovic M, Pundik S, Kaddumukasa M, Goldstein LB. Influence of sodium consumption and associated knowledge on poststroke hypertension in Uganda. Neurology 2016; 87:1198-205. [PMID: 27558374 DOI: 10.1212/wnl.0000000000003117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/04/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed 24-hour urine sodium levels as an index of dietary salt consumption and its association with dietary salt knowledge and hypertension among poststroke patients with and without a history of hypertension in Uganda. METHODS A case-control study in which poststroke patients with a history of hypertension (cases, n = 123) were compared to poststroke patients without known hypertension (controls, n = 112). Dietary salt intake was assessed by 24-hour urine sodium, a valid measure of dietary salt consumption. Dietary salt knowledge was determined by questionnaire. The independent relationships among salt knowledge, 24-hour urine sodium, and blood pressure control were assessed using multiple regression analysis. RESULTS High 24-hour urine sodium (≥8.5 g/d) was 2 times more prevalent among hypertensive poststroke patients than controls (p = 0.002). Patients with minimal poststroke disability who had a choice in determining their diets had higher urine sodium than their more disabled counterparts. Only 43% of the study population had basic dietary salt knowledge, 39% had adequate diet-disease-related knowledge, and 37% had procedural knowledge (report of specific steps being taken to reduce salt consumption). Dietary salt knowledge was similarly poor among cases and controls (p = 0.488) and was not related to education level (p = 0.205). CONCLUSIONS High urine sodium and high salt-diet preferences were more frequent among poststroke hypertensive patients in Uganda than in their nonhypertensive counterparts. There was, however, no difference in dietary salt knowledge between these groups. The development of educational strategies that include salt-diet preferences may lead to better blood pressure control in this high-risk population.
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Affiliation(s)
- Martin N Kaddumukasa
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington.
| | - Elly Katabira
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
| | - Martha Sajatovic
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
| | - Svetlana Pundik
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
| | - Mark Kaddumukasa
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
| | - Larry B Goldstein
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
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Seo S, Kim OY, Ahn J. Healthy Eating Exploratory Program for the Elderly: Low Salt Intake in Congregate Meal Service. J Nutr Health Aging 2016; 20:316-24. [PMID: 26892581 DOI: 10.1007/s12603-015-0622-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study reported on an exploratory program to help the low income elderly improve healthy eating behavior, specifically by reducing salt intake. DESIGN We conducted an exploratory program for 4 weeks for this study. The exploratory program involved offering menus with reduced salt and providing education on healthy eating. After the exploratory program, a survey of the elderly and in-depth interviews allowed us to evaluate the program for foodservice providers (dietitian, social workers, and volunteer workers). This study included both foodservice workers and elderly who actually used the foodservice in a congregate meal service system. This is a unique approach. SETTING A congregate meal service center in Seoul, Korea. PARTICIPANTS Seventy four elderly in a congregate meal service center. MEASUREMENTS Demographics were collected, and the healthy eating program and healthy eating education for elderly respondents were evaluated. RESULTS The elderly showed high satisfaction with the exploratory program for healthy eating. We found no significant differences in satisfaction with the program between the elderly who attended education sessions and those who did not, but more of the elderly from the education sessions showed positive behavioral change intentions. CONCLUSION The exploratory program influenced to reduce the salt intake of the elderly in congregate meal service. This study suggests cooperation of foodservice providers and the support of administrators is critical to the success of such programs.
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Affiliation(s)
- S Seo
- Sunhee Seo, Ewha Womans University, Seoul, Republic of Korea,
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Dong B, Wang Z, Ma J. Urban-rural disparity in blood pressure among Chinese children: 1985-2010. Eur J Public Health 2015; 26:569-75. [PMID: 26715473 DOI: 10.1093/eurpub/ckv239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Understanding the urban-rural gap in childhood blood pressure (BP) is crucial to alleviate the urban-rural disparity in burden of hypertension in the future. This study investigated trends in urban-rural BP disparity and the influence of body mass index among Chinese children between 1985 and 2010. METHODS Data included 1 010 153 children aged 8-17 years enrolled in the Chinese National Survey on Students' Constitution and Health, a successive national cross-sectional survey. High BP was defined according to age-sex- and height-specific 95th percentile. Multi-variable linear and logistic regression models were used to assess the urban-rural BP differentials. RESULTS Although urban children had greater prevalence of overweight and obesity than rural counterparts, rural children revealed higher levels of BP across the consecutive 25-year periods. The urban-rural disparity in prevalence of high systolic BP decreased from 2.3 (95% confidence interval: 2.3, 2.6) % to 0.2 (-0.1, 0.4) % in boys and 3.7 (3.5, 4.0) % to 0.6 (0.3, 0.8) % in girls between 1985 and 2010 after adjusting for confounding factors. Further adjustment of body mass index did not change the urban-rural disparity and its trend. The similar results were also observed for diastolic BP. CONCLUSIONS Despite the urban-rural disparity in BP decreased between 1985 and 2010, rural children constantly showed higher BP levels than their urban counterparts. Since these differentials in BP cannot be explained by obesity, study of other potential factors could provide further opportunity to bridge this gap.
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Affiliation(s)
- Bin Dong
- 1 Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China 2 Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Zhiqiang Wang
- 1 Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China 2 Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jun Ma
- 1 Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China
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Kamran A, Azadbakht L, Sharifirad G, Mahaki B, Mohebi S. The relationship between blood pressure and the structures of Pender's health promotion model in rural hypertensive patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2015; 4:29. [PMID: 25883999 PMCID: PMC4392569 DOI: 10.4103/2277-9531.154124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION AND OBJECTIVE Perception is the most important predictor of behavior and there is a strong relation and correlation between behavior and believes. Thus, to improve self-care behaviors of patients, it is required to fully understand their perceptions about behavior. This paper aimed to assess the prediction power of health promotion model of systolic blood pressure (SBP) as the result of self-care behavior in rural hypertensive. METHODS This cross-sectional study has been carried out through random multistage sampling on 671 rural patients under the coverage of health center of Ardebil city in 2013. Data were collected through reliable and valid questionnaire based on the health promotion model in eight sectors. For data analysis, Pearson correlation statistical tests, multivariate linear regression, ANOVA and independent t-test were used and for confirmatory factor analysis, SPSS 18 and AMOS 18 (SPSS Inc., Chicago, IL, USA) were used. RESULTS The results showed significant negative correlation between self-efficacy, perceived benefits, situational influences, affects related to behavior and commitment to action structures with SBP and showed a positive significant correlation between perceived barriers and SBP. Furthermore, age and body mass had direct significant relation with SBP. The age of patients showed inverse significant correlation with self-efficacy, perceived benefits, affects related to behavior, interpersonal influences and commitment and showed a direct significant correlation with perceived barriers, means that by increase of age, the perceived barriers also increased. The structures of health promotion model have in overall the prediction power of 71.4% of SBP changes. CONCLUSION The diet perceptions of patients, the same as health promotion model, has good predictive power of SBP, especially the structures of perceived benefits and self-efficacy have inverse meaningful relation with systole blood pressure and predicted a higher percentage of this variable.
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Affiliation(s)
- Aziz Kamran
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Leila Azadbakht
- Food Security Research Center, Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Sharifirad
- Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran
| | - Behzad Mahaki
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Siamak Mohebi
- Health Policy and Promotion Research Center, Qom University of Medical Sciences, Qom, Iran
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Sarmugam R, Worsley A. Current levels of salt knowledge: a review of the literature. Nutrients 2014; 6:5534-59. [PMID: 25470377 PMCID: PMC4276982 DOI: 10.3390/nu6125534] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/03/2014] [Accepted: 11/06/2014] [Indexed: 11/29/2022] Open
Abstract
High salt intake increases the risk of hypertension and cardiovascular diseases. Given the role of knowledge as a determinant of food intake, this paper aims to review the current levels of salt knowledge and the association between salt knowledge and dietary salt intake and salt-related dietary practices in the general population. Twenty two studies were included in the review. In general, the studies showed consumers were able to identify the health risks associated with high salt intake. However, knowledge of recommended daily intakes, understanding of the relationships between salt and sodium and foods that contribute most salt to the diet were poor. Four of the five studies which examined the relationships between salt knowledge and salt-related dietary practices reported significant associations. Two important gaps in the current literature were identified. First, there is a need for a robustly validated tool to examine salt knowledge and its impact on salt intake. Second, a comprehensive salt knowledge assessment should include assessment of procedural, as well as declarative, knowledge.
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Affiliation(s)
- Rani Sarmugam
- Health Promotion Board, 168937 Singapore, Singapore.
| | - Anthony Worsley
- School of Exercise and Nutrition Sciences, Deakin University, Burwood VIC 3125, Australia.
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Nasreddine L, Akl C, Al-Shaar L, Almedawar MM, Isma’eel H. Consumer knowledge, attitudes and salt-related behavior in the Middle-East: the case of Lebanon. Nutrients 2014; 6:5079-102. [PMID: 25401502 PMCID: PMC4245581 DOI: 10.3390/nu6115079] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/01/2014] [Accepted: 10/28/2014] [Indexed: 01/19/2023] Open
Abstract
Sodium intake is high in Lebanon, a country of the Middle East region where rates of cardiovascular diseases are amongst the highest in the world. This study examines salt-related knowledge, attitude and self-reported behaviors amongst adult Lebanese consumers and investigates the association of socio-demographic factors, knowledge and attitudes with salt-related behaviors. Using a multicomponent questionnaire, a cross-sectional study was conducted in nine supermarkets in Beirut, based on systematic random sampling (n = 442). Factors associated with salt-related behaviors were examined by multivariate regression analysis. Specific knowledge and attitude gaps were documented with only 22.6% of participants identifying processed foods as the main source of salt, 55.6% discerning the relationship between salt and sodium, 32.4% recognizing the daily limit of salt intake and 44.7% reporting being concerned about the amount of salt in their diet. The majority of participants reported behavioral practices that increase salt intake with only 38.3% checking for salt label content, 43.7% reporting that their food purchases are influenced by salt content and 38.6% trying to buy low-salt foods. Knowledge, attitudes and older age were found to significantly predict salt-related behaviors. Findings offer valuable insight on salt-related knowledge, attitude and behaviors in a sample of Lebanese consumers and provide key information that could spur the development of evidence-based salt-reduction interventions specific to the Middle East.
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Affiliation(s)
- Lara Nasreddine
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; E-Mails: (L.N.); (C.A.)
- Vascular Medicine Program, American University of Beirut Medical Center, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; E-Mails: (L.A.-S.); (M.M.A.)
| | - Christelle Akl
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; E-Mails: (L.N.); (C.A.)
| | - Laila Al-Shaar
- Vascular Medicine Program, American University of Beirut Medical Center, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; E-Mails: (L.A.-S.); (M.M.A.)
| | - Mohamad M. Almedawar
- Vascular Medicine Program, American University of Beirut Medical Center, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; E-Mails: (L.A.-S.); (M.M.A.)
| | - Hussain Isma’eel
- Vascular Medicine Program, American University of Beirut Medical Center, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; E-Mails: (L.A.-S.); (M.M.A.)
- Division of Cardiology, Department of Internal Medicine, American University of Beirut, 11-0236 Riad El Solh, 1107-2020 Beirut, Lebanon; E-Mail:
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Multilevel evaluation of 'China Healthy Lifestyles for All', a nationwide initiative to promote lower intakes of salt and edible oil. Prev Med 2014; 67:210-5. [PMID: 25088409 DOI: 10.1016/j.ypmed.2014.07.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/08/2014] [Accepted: 07/11/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the impact of 'China Healthy Lifestyle for All' on levels of knowledge, taste and intentions to modify future consumption of salt and edible oil. METHODS Between May and August 2012, a face-to-face survey carried out in all 31 provinces, autonomous regions, and municipalities in mainland China, achieved a 98.1% response. Intention-To-Treat analysis via multilevel logistic regression was used to examine differences in outcomes between 31,396 non-institutionalised individuals aged > 18 years from 31 'intervention' (i.e. participating) and 26 'control' (i.e. non-participating) counties respectively. RESULTS Adjusting for socioeconomic confounders, participants in 'intervention' counties were more likely to know the limit of salt (Odds Ratio 3.14, 95% Confidence Interval (95% CI) 1.98, 4.96) and oil consumption (3.67, 95% CI 2.31, 5.82), and were more intent to modify their consumption (salt 1.98, 95% CI 1.41, 2.76; oil OR 1.99, 95% CI 1.41, 2.81) and to report a change in taste (salt 1.90, 95% CI 1.31, 2.75; oil 2.07, 95% CI 1.38, 3.10). 'Intervention' effects were consistent regardless of income or education, but women and older participants benefited disproportionately. Outcomes were 2.8 and 4.7 times more likely among those with better recall. CONCLUSION Place-based health promotion interventions have an important role to play in addressing non-communicable disease in China.
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Teh JKL, Tey NP, Ng ST. Ethnic and gender differentials in non-communicable diseases and self-rated health in Malaysia. PLoS One 2014; 9:e91328. [PMID: 24603609 PMCID: PMC3946348 DOI: 10.1371/journal.pone.0091328] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/10/2014] [Indexed: 12/14/2022] Open
Abstract
Objectives This paper examines the ethnic and gender differentials in high blood pressure (HBP), diabetes, coronary heart disease (CHD), arthritis and asthma among older people in Malaysia, and how these diseases along with other factors affect self-rated health. Differentials in the prevalence of non-communicable diseases among older people are examined in the context of socio-cultural perspectives in multi-ethnic Malaysia. Methods Data for this paper are obtained from the 2004 Malaysian Population and Family Survey. The survey covered a nationally representative sample of 3,406 persons aged 50 and over, comprising three main ethnic groups (Malays, Chinese and Indians) and all other indigenous groups. Bivariate analyses and hierarchical logistic regression were used in the analyses. Results Arthritis was the most common non-communicable disease (NCD), followed by HBP, diabetes, asthma and CHD. Older females were more likely than males to have arthritis and HBP, but males were more likely to have asthma. Diabetes and CHD were most prevalent among Indians, while arthritis and HBP were most prevalent among the Indigenous groups. Older people were more likely to report poor health if they suffered from NCD, especially CHD. Controlling for socio-economic, health and lifestyle factors, Chinese were least likely to report poor health, whereas Indians and Indigenous people were more likely to do so. Chinese that had HBP were more likely to report poor health compared to other ethnic groups with the same disease. Among those with arthritis, Indians were more likely to report poor health. Conclusion Perceived health status and prevalence of arthritis, HBP, diabetes, asthma and CHD varied widely across ethnic groups. Promotion of healthy lifestyle, early detection and timely intervention of NCDs affecting different ethnic groups and gender with socio-cultural orientations would go a long way in alleviating the debilitating effects of the common NCDs among older people.
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Affiliation(s)
- Jane K. L. Teh
- Population Studies Unit, Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Nai Peng Tey
- Population Studies Unit, Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Malaysia
| | - Sor Tho Ng
- Population Studies Unit, Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Malaysia
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Sodium intake, dietary knowledge, and illness perceptions of controlled and uncontrolled rural hypertensive patients. Int J Hypertens 2014; 2014:245480. [PMID: 24678414 PMCID: PMC3941601 DOI: 10.1155/2014/245480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/03/2013] [Accepted: 12/17/2013] [Indexed: 02/07/2023] Open
Abstract
Introduction and Objectives. Nutritional knowledge of the patients is important in dietary adherence. This study aimed to determine the relationship between illness perceptions and nutritional knowledge with the amounts of sodium intake among rural hypertensive patients. Methods. In a cross-sectional study, 671 hypertensive patients were selected in a multistage random sampling from the rural areas of Ardabil city, Iran, in 2013. Data were collected using a questionnaire consisting of four sections and were analyzed using Pearson correlation and multiple linear regressions by SPSS-18. Results. The mean of sodium intake in the uncontrolled hypertensive patients was 3599 ± 258 mg/day and significantly greater than controlled group (2654 ± 540 mg/day) (P < 0.001). Knowledge and illness perceptions could predict 47.2% of the variation in sodium intake of uncontrolled group. A significant negative relationship was found between knowledge and illness perceptions of uncontrolled hypertensive patients with dietary sodium intake (r = −0.66, P < 0.001 and r = −0.65, P < 0.001, resp.). Conclusion. Considering the fact that patients' nutritional knowledge and illness perceptions could highly predict their sodium intake, the importance of paying more attention to improve patients' information and perceptions about hypertension is undeniable, especially among the uncontrolled hypertensive patients.
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Huang S, Chen Y, Zhou J, Wang J. Use of family member-based supervision in the management of patients with hypertension in rural China. Patient Prefer Adherence 2014; 8:1035-42. [PMID: 25114514 PMCID: PMC4125371 DOI: 10.2147/ppa.s66777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Medication nonadherence is a major problem in the management of hypertension. The aim of this study was to develop a family member-based supportive therapy for patients with hypertension to provide an affordable way to access essential health services and to ensure adequate control of blood pressure. This study applied a mixed methods approach using qualitative and quantitative study designs in Yangzhong County, a rural area in the People's Republic of China. Findings from indepth interviews demonstrated that the limited effects of traditional health education, a lack of professional advice regarding antihypertensive treatment, and age were related to a patient's adherence with regular blood pressure measurement and taking medication. We also performed a quantitative study, selecting two villages in Yangzhong County as study sites. A total of 188 patients with hypertension were invited to participate in a 6-month family member-based intervention trial. The primary outcomes were the acceptability and feasibility of the intervention strategy. Secondary outcomes included medication adherence and changes in blood pressure. More than 75% of patients expressed a wish for external reminders, and 93.5% responded that they would accept the family member-based supervision. The patients preferred their spouse or a child as the supervisor. After the 6-month intervention, the proportion of patients with uncontrolled blood pressure decreased from 87.2% to 45.7%. This pilot study shows that external supervision by family members is acceptable and feasible for patients with hypertension; it also shows favorable effects with regard to improved treatment adherence and blood pressure control. Future randomized controlled trials with modified intervention measures are needed to validate this finding.
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Affiliation(s)
- Susan Huang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Ye Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jing Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jianming Wang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
- Correspondence: Jianming Wang, Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, People’s Republic of China, Email
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