Estimation of salt intake, potassium intake and sodium-to-potassium ratio by 24-hour urinary excretion: an urban rural study in Sri Lanka

AbstractBackgroundSodium intakes of different populations around the world became of interest after a positive correlation was drawn between dietary sodium intake and prevalence of hypertension. Sri Lanka has adopted a salt reduction strategy to combat high blood pressure in the population with escalation of non-communicable diseases.ObjectiveTo measure intake of salt, potassium and sodium/potassium ratio of adults in urban and rural settings.DesignA community based study of 328 adults between 30-59 years, including equal numbers from urban and rural sectors. Weight, height and waist circumference were measured. Blood pressure was measured by a standardized automated measurement system and the mean of two readings was used for analysis. 24-hour urine was collected and measured for creatinine, sodium, potassium levels.ResultsMean daily salt consumption was 8.3g (95%CI:7.9,8.8), which is 1.6 times higher than WHO recommendation. Mean daily potassium intake was 1,265g (95%CI:1191.0,1339.3), which is 2.8 times lower and sodium/potassium ratio was 4.3 (95%CI:4.2,4.5), which is 7 times higher than WHO recommendation. Daily salt consumption was significantly higher in males (9.0g;95%CI:8.3,9.8) than females (7.7g;95%CI:7.2,8.2); rural (8.9g;95%CI:8.2-9.6,) than urban (7.7g;95%CI:7.2,8.3) with increasing body mass index (8.2g;95%CI:6.1,10.2 to 10.0g;95%CI:8.5,11.6). Systolic blood pressure was significantly positively correlated with high BMI and waist circumference.ConclusionsHigh salt consumption, low potassium intake and high sodium/potassium ratio was found in this population. This information can be used to set targets to reduce salt intake in the population. Need to create awareness to enhance the consumption of potassium rich food while reducing salt intake to minimize future NCD burden.

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Sodium and potassium intake, blood pressure, and cardiovascular prevention

ESC CardioMed ◽

10.1093/med/9780198784906.003.0568 ◽

2018 ◽

pp. 2431-2444

Author(s):

Francesco P. Cappuccio

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

World Health Organization ◽

Salt Intake ◽

World Health ◽

Salt Reduction ◽

Potassium Intake ◽

Salt Consumption ◽

The World ◽

Health Organization

Salt consumption is now much greater than needed for survival. High salt intake increases blood pressure in both animals and humans. Conversely, a reduction in salt intake causes a dose-dependent reduction in blood pressure in men and women of all ages and ethnic groups, and in patients already on medication. The risk of strokes and heart attacks rises with increasing blood pressure, but can be decreased by antihypertensive drugs. However, most cardiovascular disease events occur in individuals with ‘normal’ blood pressure levels. Non-pharmacological prevention is therefore the only option to reduce such events. Reduction in population salt intake reduces the number of vascular events. It is one of the most important public health measures to reduce the global cardiovascular burden. Salt reduction policies are powerful, rapid, equitable, and cost saving. The World Health Organization recommends reducing salt consumption below 5 g per day aiming at a global 30% reduction by 2025. A high potassium intake lowers blood pressure in people with and without hypertension. Its beneficial effects extend beyond blood pressure, and may include a reduction in the risk of stroke (independent of blood pressure changes). Potassium intake in the Western world is relatively low, and a lower potassium intake is associated with increased risks of cardiovascular disease, especially stroke. A moderate increase in potassium intake, either as supplement or with diet, reduces blood pressure, and the World Health Organization has issued global recommendations for a target dietary potassium intake of at least 90 mmol/day (≥3510 mg/day) for adults.

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Effect of salt reduced bread alone or with dietary counselling on 24-hour excretion of sodium, potassium and sodium/potassium ratio

Proceedings of The Nutrition Society ◽

10.1017/s0029665120001147 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Nanna Louise Riis ◽

Kirsten Bjørnsbo ◽

Anne Dahl Lassen ◽

Ellen Trolle ◽

Amalie Frederiksen ◽

...

Keyword(s):

Risk Factor ◽

Salt Intake ◽

Salt Content ◽

Dietary Sodium ◽

Wheat Bread ◽

Control Group ◽

Sodium Potassium ◽

Salt Reduction ◽

Potassium Intake ◽

Dietary Counselling

AbstractExcess dietary sodium plays an important role in hypertension, a leading risk factor for cardiovascular disease (CVD). To counteract some of the negative effects of sodium, an increased intake of potassium has shown beneficial effects on blood pressure. In fact, the sodium to potassium ratio might be a stronger risk factor for CVD than either sodium or potassium alone. The objective of the present study was to estimate the effect of A) a salt reduction strategy (providing salt reduced bread) and B) a salt reduction and potassium promoting strategy (providing salt reduced bread combined with dietary counselling), on intake of sodium, potassium and the sodium/potassium ratio. The study is a 4-month cluster randomized controlled trial with families randomly assigned to either intervention A, intervention B or control. Participants in intervention A received bread gradually reduced in salt content from 1.2 g salt/100 g to 0.6 g salt/100 g in ryebread and 0.4 g salt/100 g in wheat bread. Participants in intervention B received the same salt reduced bread and in addition dietary counselling on how to eat food with less salt and more potassium. The control group received standard bread (1.2 g salt/100g). Sodium and potassium intake were measured through three consecutive 24-hour urine measurements in adults and one in children at baseline and follow-up. Changes in outcomes were assessed using linear mixed models. Eighty-nine families, including 155 adults (46.5 % men) and 156 children (51.9 % boys), from the suburb of Copenhagen, Denmark, participated in the study. The sodium/potassium ratio was significantly reduced by -0.57 ± 0.19 mmol/L (P = 0.003) in intervention B compared to control group, resulting from a non-significant lower sodium and increased potassium intake. No significant differences were found between intervention A and control group (preliminary results). These findings support future actions to reduce salt intake, focusing on a combination of structural and educational strategies.

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Reducing the population's sodium intake: the UK Food Standards Agency's salt reduction programme

Public Health Nutrition ◽

10.1017/s1368980011000966 ◽

2011 ◽

Vol 15 (2) ◽

pp. 254-261 ◽

Cited By ~ 141

Author(s):

Laura A Wyness ◽

Judith L Butriss ◽

Sara A Stanner

Keyword(s):

Blood Pressure ◽

Salt Intake ◽

Sodium Intake ◽

Salt Reduction ◽

Campaign Evaluation ◽

Food Standards ◽

Reporting Framework ◽

Population Average ◽

Scientific Papers ◽

The Uk

AbstractObjectiveTo describe the UK Food Standards Agency's (FSA) salt reduction programme undertaken between 2003 and 2010 and to discuss its effectiveness.DesignRelevant scientific papers, campaign materials and evaluations and consultation responses to the FSA's salt reduction programme were used.SettingAdult salt intakes, monitored using urinary Na data collected from UK-wide surveys, indicate a statistically significant reduction in the population's average salt intake from 9·5 g/d in 2000–2001 to 8·6 g/d in 2008, which is likely to have health benefits.SubjectsReducing salt intake will have an impact on blood pressure; an estimated 6 % of deaths from CHD in the UK can be avoided if the number of people with high blood pressure is reduced by 50 %.ResultsSalt levels in food, monitored using commercial label data and information collected through an industry self-reporting framework, indicated that substantial reductions of up to 70 % in some foods had been achieved. The FSA's consumer campaign evaluation showed increased awareness of the benefits of reducing salt intake on health, with 43 % of adults in 2009 claiming to have made a special effort to reduce salt in their diet compared with 34 % of adults in 2004, before the campaign commenced.ConclusionsThe UK's salt reduction programme successfully reduced the average salt intake of the population and increased consumers’ awareness. Significant challenges remain in achieving the population average salt intake of 6 g/d recommended by the UK's Scientific Advisory Committee on Nutrition. However, the UK has demonstrated the success of its programme and this approach is now being implemented elsewhere in the world.

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Dietary Sodium, Potassium, and Sodium to Potassium Ratio in Patients With Systemic Lupus Erythematosus

Biological Research For Nursing ◽

10.1177/10998004211065491 ◽

2022 ◽

pp. 109980042110654

Author(s):

María Correa-Rodríguez ◽

Sara DelOlmo-Romero ◽

Gabriela Pocovi-Gerardino ◽

José-Luis Callejas-Rubio ◽

Raquel Ríos-Fernández ◽

...

Keyword(s):

Disease Activity ◽

Sodium Intake ◽

Dietary Sodium ◽

Complement C3 ◽

Systemic Lupus ◽

Sodium Potassium ◽

Complement C4 ◽

Potassium Intake ◽

Dietary Potassium ◽

Sodium And Potassium

Purpose: The aim of this study was to investigate the association between dietary sodium, potassium, and sodium:potassium ratio and clinical disease activity parameters, damage accrual, and cardiovascular disease risk factors in a population of patients with systemic lupus erythematous (SLE). Research design and study sample: A cross-sectional study including a total of 280 patients was conducted (90.4% females; mean age 46.9 ± 12.85 years). Data collection: The SLE Disease Activity Index (SLEDAI-2K) and the SDI Damage Index were used to assess disease activity and disease-related damage, respectively. A 24-hour diet recall was used to estimate dietary intake of sodium and potassium. Results: Dietary sodium intake was significantly associated with anti-dsDNA ( β = −.005; 95% CI [.002 .008]; p = .001) and complement C4 level ( β = −.002; 95% CI [−.003, .000]; p = .039). Dietary potassium intake was also significantly associated with complement C3 level ( β = −.004; 95% CI [−.007, −.001]; p = .021). Multiple logistic regression models revealed a positive association between dietary sodium intake and the risk of having hsCRP > 3 ( p = .005) and an inverse association between dietary potassium intake and the risk of having hsCRP > 3 ( p = .004). Conclusions: SLE patients with higher dietary sodium and lower dietary potassium intakes had an increased risk of higher hsCRP. Dietary sodium intake was significantly associated with anti-dsDNA and complement C4 level, while dietary potassium intake was associated with complement C3 level, supporting that dietary sodium and potassium intakes might play a key role in markers related to disease activity in SLE patients.

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Sodium Intake and Hypertension

Nutrients ◽

10.3390/nu11091970 ◽

2019 ◽

Vol 11 (9) ◽

pp. 1970 ◽

Cited By ~ 28

Author(s):

Grillo ◽

Salvi ◽

Coruzzi ◽

Salvi ◽

Parati

Keyword(s):

Blood Pressure ◽

Salt Intake ◽

Sodium Intake ◽

Peripheral Resistance ◽

Dietary Sodium ◽

Dietary Salt ◽

High Sodium ◽

Close Relationship ◽

And Function ◽

Modest Reduction

The close relationship between hypertension and dietary sodium intake is widely recognized and supported by several studies. A reduction in dietary sodium not only decreases the blood pressure and the incidence of hypertension, but is also associated with a reduction in morbidity and mortality from cardiovascular diseases. Prolonged modest reduction in salt intake induces a relevant fall in blood pressure in both hypertensive and normotensive individuals, irrespective of sex and ethnic group, with larger falls in systolic blood pressure for larger reductions in dietary salt. The high sodium intake and the increase in blood pressure levels are related to water retention, increase in systemic peripheral resistance, alterations in the endothelial function, changes in the structure and function of large elastic arteries, modification in sympathetic activity, and in the autonomic neuronal modulation of the cardiovascular system. In this review, we have focused on the effects of sodium intake on vascular hemodynamics and their implication in the pathogenesis of hypertension.

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Salt and potassium intake among adult Ghanaians: WHO-SAGE Ghana Wave 3

BMC Nutrition ◽

10.1186/s40795-020-00379-y ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Elias K. Menyanu ◽

Barbara Corso ◽

Nadia Minicuci ◽

Ilaria Rocco ◽

Joanna Russell ◽

...

Keyword(s):

Salt Intake ◽

Population Based ◽

Dietary Sodium ◽

World Health ◽

Adult Health ◽

Salt Reduction ◽

Hypertension Prevalence ◽

Salt Consumption ◽

Consumption Data

Abstract Though Ghana has high hypertension prevalence, the country lacks current national salt consumption data required to build and enhance advocacy for salt reduction. We explored the characteristics of a randomly selected sub sample that had valid urine collection, along with matched survey, anthropometric and BP data (n = 839, mean age = 60y), from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE), Ghana Wave 3, n = 3053). We also investigated the relationship between salt intake and blood pressure (BP) among the cohort. BP was measured in triplicate and 24 h urine was collected for the determination of urinary sodium (Na), potassium (K), creatinine (Cr) and iodine levels. Hypertension prevalence was 44.3%. Median salt intake was 8.3 g/day, higher in women compared to men (8.6, interquartile range (IQR) 7.5 g/day vs 7.5, IQR 7.4 g/day, p < 0.01), younger participants (18–49 y) compared to older ones (50+ y) (9.7, IQR 7.9 g/day vs 8.1, IQR 7.1 g/day, p < 0.01) and those with higher Body Mass Index (BMI) (> 30 kg/m2) compared to a healthy BMI (18.5–24.9 kg/m2) (10.04, IQR 5.1 g/day vs 6.2, IQR 5.6 g/day, p < 0.01). More than three quarters (77%, n = 647) of participants had salt intakes above the WHO maximum recommendation of 5 g/d, and nearly two thirds (65%, n = 548) had daily K intakes below the recommended level of 90 mmol. Dietary sodium to potassium (Na: K) ratios above 2 mmol/mmol were positively associated with increasing BP with age. Population-based interventions to reduce salt intake and increase K consumption are needed.

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Effects of AT1A receptor deletion on blood pressure and sodium excretion during altered dietary salt intake

AJP Renal Physiology ◽

10.1152/ajprenal.00259.2001 ◽

2002 ◽

Vol 283 (3) ◽

pp. F447-F453 ◽

Cited By ~ 31

Author(s):

Amy J. Mangrum ◽

R. Ariel Gomez ◽

Victoria F. Norwood

Keyword(s):

Blood Pressure ◽

Salt Intake ◽

Sodium Intake ◽

Dietary Sodium ◽

Sodium Balance ◽

Wild Type ◽

Compensatory Mechanisms ◽

Wide Range ◽

Blood Pressures ◽

Pressure Natriuresis

The present study was performed to investigate the role of type 1A ANG II (AT1A) receptors in regulating sodium balance and blood pressure maintenance during chronic dietary sodium variations in AT1A receptor-deficient (−/−) mice. Groups of AT1A (−/−) and wild-type mice were placed on a low (LS)-, normal (NS)-, or high-salt (HS) diet for 3 wk. AT1A(−/−) mice on an LS diet had high urinary volume and low blood pressure despite increased renin and aldosterone levels. On an HS diet, (−/−) mice demonstrated significant diuresis, yet blood pressure increased to levels greater than control littermates. There was no effect of dietary sodium intake on systolic blood pressures in wild-type animals. The pressure-natriuresis relationship in AT1A (−/−) mice demonstrated a shift to the left and a decreased slope compared with wild-type littermates. These studies demonstrate that mice lacking the AT1A receptor have blood pressures sensitive to changes in dietary sodium, marked alterations of the pressure-natriuresis relationship, and compensatory mechanisms capable of maintaining normal sodium balance across a wide range of sodium intakes.

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Asupan kalium-natrium dan status obesitas sebagai faktor risiko kejadian hipertensi pasien rawat jalan di RS Panembahan Senopati Bantul Yogyakarta

Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetics) ◽

10.21927/ijnd.2016.4(1).41-48 ◽

2016 ◽

Vol 4 (1) ◽

pp. 41

Author(s):

Effatul Afifah

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Food Frequency Questionnaire ◽

Sodium Intake ◽

T Test ◽

Research Association ◽

Chi Square ◽

Sodium Potassium ◽

Food Frequency ◽

Potassium Intake

ABSTRACTBackground: Hypertension is one of the problems in the medical and public health area. Based on National Health Research Association in 2013, hypertension is the third leading cause of death of all ages patterns, after stroke and TB, with the proportion of deaths was 6.8%. The prevalence of hypertension in DIY was 25.7%. The risk factors of diet containing high fat, high sodium, and low potassium to elevate blood pressure.Objectives: To know the effect of the intake of sodium-potassium and the status of obesity as a risk factor for hypertension.Methods: This study used analytic observational study design with control-case design. Samples were 104 and divided into 52 cases and 52 controls. Data were collected using a questionnaire include: name, age, gender, address, education level, the type of work, and form of food frequency questionnaire (FFQ) to inquire patterns of food intake (intake of sodium-potassium) for 3 months with food models. Obesity status was measured using body mass index (BMI), and merqurial sphygmomanometer hypertension was used to measure blood pressure. Analysis of data used statistical test independent t-test, chi-square.Results: No significant correlation between age and the incidence of hypertension (OR=2.448), neither did sodium intake with hypertension, potassium intake with hypertension, and nutritional status (obesity) associated with the incidence of hypertension.Conclusions: Age was the risk factor for hypertension, while the intake of sodium-potassium and status of obesity were not.KEYWORDS: hypertension, sodium intake, potassium intake, obesity ABSTRAKLatar belakang: Hipertensi merupakan salah satu masalah dalam dunia medis dan kesehatan masyarakat. Dalam riset kesehatan dasar nasional tahun 2013, hipertensi merupakan penyebab kematian semua umur yang ketiga, setelah stroke dan tuberculosis (TB), dengan proporsi kematian sebesar 6,8%. Prevalensi hipertensi untuk wilayah DIY 25,7% termasuk angka yang tinggi. Faktor risiko pola makan yang mengandung tinggi lemak, tinggi natrium dan rendah kalium memiliki kontribusi terhadap peningkatan tekanan darah.Tujuan: Untuk mengetahui pengaruh asupan natrium, kalium, dan status obesitas sebagai faktor risiko hipertensi.Metode: Penelitian ini menggunakan desain studi observasional analitik dengan rancangan kasus kontrol dengan jumlah total sampel 104 yang terbagi dalam 52 kasus dan 52 kontrol. Pengumpulan data menggunakan kuesioner meliputi: nama, umur, jenis kelamin, alamat, tingkat pendidikan, dan jenis pekerjaan dan formulir food frequency questionnaire (FFQ) untuk menanyakan pola asupan makanan (asupan natrium, kalium) selama 3 bulan menggunakan food model. Status obesitas diukur dengan menggunakan indek massa tubuh (IMT) dan hipertensi diukur menggunakan merqurial sphygmomanometer. Analisis data menggunakan uji statistik independent t-test, chi-square.Hasil: Ada hubungan yang signifikan antara usia dengan kejadian hipertensi (OR=2,448). Asupan natrium tidak berhubungan signifi kan dengan hipertensi. Tidak ada hubungan yang signifikan antara asupan kalium dengan hipertensi dan status gizi (obesitas) tidak berhubungan secara signifikan dengan kejadian hipertensi.Kesimpulan: Usia merupakan faktor risiko kejadian hipertensi, sedangkan asupan natrium, kalium, dan status obesitas bukan merupakan faktor risiko hipertensi.KATA KUNCI: hipertensi, asupan natrium, asupan kalium, obesitas

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Salt intake was higher among males and those with high BMI and waist circumference: introduction to the Malaysian Community Salt Survey (MyCoSS), a population-based salt intake survey in Malaysia

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00229-y ◽

2021 ◽

Vol 40 (S1) ◽

Author(s):

Rashidah Ambak ◽

Feng J He ◽

Fatimah Othman ◽

Viola Michael ◽

Muhammad Fadhli Mohd Yusoff ◽

...

Keyword(s):

Blood Pressure ◽

Waist Circumference ◽

Sample Size ◽

Salt Intake ◽

Daily Intake ◽

Successful Implementation ◽

Dietary Salt ◽

Ministry Of Health ◽

Salt Reduction ◽

Dietary Salt Intake

Abstract Background Recognising that excessive dietary salt intake is associated with high blood pressure and adverse cardiovascular health, the Ministry of Health Malaysia conducted the Malaysian Community Salt Survey (MyCoSS) among Malaysian adults. This paper introduced MyCoSS projects and presented findings on the salt intake of the Malaysian adult population. Methods MyCoSS was a nationally representative survey, designed to provide valuable data on dietary salt intake, sources of salt in the diet, and knowledge, perception, and practice about salt among Malaysian adults. It was a cross-sectional household survey, covering Malaysian citizens of 18 years old and above. Multi-stage-stratified sampling was used to warrant national representativeness. Sample size was calculated on all objectives studied, and the biggest sample size was derived from the knowledge on the effect of high salt on health (1300 participants). Salt intake was estimated using a single 24-h urine collection and its sources from a food frequency questionnaire. Knowledge, attitude, and practice were determined from a pre-tested questionnaire. All questionnaires were fully administered by trained interviewers using mobile devices. Anthropometric indices (weight, height, and waist circumference) and blood pressure were measured using a standardised protocol. Ethical approvals were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia, and Queen Mary University of London prior to conducting the survey. Results Findings showed that the average sodium intake of Malaysian adults (3167 mg/day) was higher than the WHO recommendation of 2000 mg/day. Daily intake was significantly higher among males and individuals with higher BMI and higher waist circumference. Conclusion Salt intake in the Malaysian population was higher than the WHO recommendation. MyCoSS’s findings will be used for the development and implementation of national salt reduction policy. A successful implementation of a national salt reduction programme in Malaysia will benefit the whole population.

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Core Strategies to Increase the Uptake and Use of Potassium-Enriched Low-Sodium Salt

Nutrients ◽

10.3390/nu13093203 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3203

Author(s):

Adefunke Ajenikoko ◽

Nicole Ide ◽

Roopa Shivashankar ◽

Zeng Ge ◽

Matti Marklund ◽

...

Keyword(s):

Blood Pressure ◽

Sodium Salt ◽

Program Implementation ◽

Sodium Intake ◽

Scale Up ◽

Population Level ◽

Reduce Blood Pressure ◽

Dietary Sodium ◽

Potassium Intake ◽

Low Sodium

Excess sodium consumption and insufficient potassium intake contribute to high blood pressure and thus increase the risk of heart disease and stroke. In low-sodium salt, a portion of the sodium in salt (the amount varies, typically ranging from 10 to 50%) is replaced with minerals such as potassium chloride. Low-sodium salt may be an effective, scalable, and sustainable approach to reduce sodium and therefore reduce blood pressure and cardiovascular disease at the population level. Low-sodium salt programs have not been widely scaled up, although they have the potential to both reduce dietary sodium intake and increase dietary potassium intake. This article proposes a framework for a successful scale-up of low-sodium salt use in the home through four core strategies: availability, awareness and promotion, affordability, and advocacy. This framework identifies challenges and potential solutions within the core strategies to begin to understand the pathway to successful program implementation and evaluation of low-sodium salt use.

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