The Prevalence of High Sodium Intake among Maehongson Population, Thailand
Keywords:
high sodium intake, sodium, potassium, hypertension, cardiovascular diseasesAbstract
Discretionary and non-discretionary salt are the two-sources of sodium that humans consume. High dietary sodium intake has been associated with the increased incidence of hypertension as well as the increased risk of cardiovascular disease (CVD) that contribute to a prominent health problem and public health challenges worldwide. There was no current study to find the prevalence of high salt intake by using 24-hour urine collection method at the population level in Maehongson Province. The objective of this study was to determine the prevalence of high sodium intake and estimated dietary sodium and potassium intake in the population of Maehongson. Data were collected from a cross-sectional survey conducted among 869 Maehongson population of aged 18 years and over from June 2020 to June 2021. The basic general characteristics were recorded as follows: age, sex, body mass index, waist circumference, blood pressure, underlying disease, educational level, occupation and monthly income, etc. Dietary sodium and potassium intake were assessed by a single 24-hour urine collection. The estimated sodium intake measured >100 mmol/day was above WHO recommendation. The estimated potassium intake measured <90 mmol/day (3,510 mg) represented inadequate intake for potassium. There were 820 participants included in the analysis (response rate of 82.0%). The mean age was 50.7±12.3 years, 34.9% were male. The proportion of high sodium intake was 79%. The 24-hour urine collection estimating the mean total sodium intake was 162.1±81.1 mmol/day, equivalent to 3728.6±1866.0 mg or 9.5±4.7 g of salt. The mean estimated potassium intake was 47.6±20.4 mmol (1861.7±795.6 mg) and Na/K (mg/mg) was 2.2±1.1. This study showed that obesity and overweight (BMI >25 kg/m2 ) found to be associated with a higher prevalence of high sodium intake than normal weight population, 87.1% and 74.3%, respectively (p<0.05). In conclusion, the majority among Maehongson population consumed excess sodium intake. Estimated sodium intake was around twice the recommended maximum level of intake, and potassium intake was low. Thus, sodium reduction and increasing potassium intake should be considered as an essential public health effort to prevent hypertension and CVD.
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References
Bhave G, Neilson EG. Body fluid dynamics: back to the future. J Am Soc Nephrol 2011;22(12):2166-81.
Edelman IS, Leibman J. Anatomy of body water and electrolytes. Am J Med 1959;27:256-77.
Bie P. Mechanisms of sodium balance: total body sodium, surrogate variables, and renal sodium excretion. Am J Physiol Regul Integr Comp Physiol 2018;315(5): R945-R62.
Strazzullo P, Leclercq C. Sodium. Adv Nutr 2014; 5(2):188-90.
Bhat S, Marklund M, Henry ME, Appel LJ, Croft KD, Neal B, et al. A Systematic Review of the Sources of Dietary Salt Around the World. Adv Nutr 2020; 11(3):677-86.
Dahl LK. Salt and hypertension. Am J Clin Nutr 1972;25(2):231-44.
Qian Q. Salt, water and nephron: Mechanisms of action and link to hypertension and chronic kidney disease. Nephrology 2018;23(Suppl 4):S44-9.
Collaborators GBDCoD. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1736-88.
INTERSALT Study - an international co-operative study on the relation of blood pressure to electrolyte excretion in populations. I. Design and methods. The INTERSALT Co-operative Research Group. J Hypertens 1986;4(6): 781-7.
Mente A, O’Donnell M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, et al. Urinary sodium excretionblood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study. Lancet 2018;392(10146):496-506.
Collaborators GBDD. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019;393(10184):1958-72.
Cook NR, Appel LJ, Whelton PK. Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention. J Am Coll Cardio 2016; 68(15):1609-17.
World Health Organization. Guideline: potassium intake for adults and children. Geneva: World Health Organization; 2012.
O’Donnell M, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med 2014;371(7):612-23.
Thi Minh Nguyen T, Miura K, Tanaka-Mizuno S, Tanaka T, Nakamura Y, Fujiyoshi A, et al. Association of blood pressure with estimates of 24-h urinary sodium and potassium excretion from repeated single-spot urine samples. Hypertens Res 2019;42(3):411-8.
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(1):3474.
World Health Organization. Guideline: Sodium Intake for Adults and Children. Geneva: World Health Organization; 2012.
World Health Organization. Diet, nutrition and the prevention of chronic diseases. World Health Organ Tech Rep Ser 2003;916(i-viii):1-149.
Jackson SL, King SM, Zhao L, Cogswell ME. Prevalence of Excess Sodium Intake in the United States - NHANES, 2009-2012. MMWR 2016;64(52):1393-7.
Buranakitjaroen P, Phoojaroenchanachai M. The prevalence of high sodium intake among hypertensive patients at hypertension clinic, Siriraj Hospital. J Med Assoc Thai 2013;96(Suppl 2):S1-8.
Corder CJ, Rathi BM, Sharif S, Leslie SW. 24-hour urine collection. Treasure Island, FL: Stat Pearls; 2021.
Kampmann JP, Siersbaek-Nielsen K, Kristensen M, Hansen JM. [Variations in urinary creatinine and endogenous creatinine clearance due to age]. Ugeskr Laeger 1971;133(48):2369-72.
Walser M. Creatinine excretion as a measure of protein nutrition in adults of varying age. JPEN J Parenter Enteral Nutr 1987;11(Suppl 5):S73-8.
Oterdoom LH, Gansevoort RT, Schouten JP, de Jong PE, Gans RO, Bakker SJ. Urinary creatinine excretion, an indirect measure of muscle mass, is an independent predictor of cardiovascular disease and mortality in the general population. Atherosclerosis 2009;207(2):534- 40.
Khaw KT, Bingham S, Welch A, Luben R, O’Brien E, Wareham N, et al. Blood pressure and urinary sodium in men and women: the Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). Am J Clin Nutr 2004;80(5):1397-403.
Chailimpamontree W, Kantachuvesiri S, Aekplakorn W, Lappichetpaiboon R, Sripaiboonkij Thokanit N, Vathesatogkit P, et al. Estimated dietary sodium intake in Thailand: A nationwide population survey with 24-hour urine collections. J Clin Hypertens 2021;23(4):744-54.
Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol 2009;38(3):791-813.
Land MA, Webster J, Christoforou A, Johnson C, Trevena H, Hodgins F, et al. The association of knowledge, attitudes and behaviours related to salt with 24-hour urinary sodium excretion. Int J Behav Nutr Phys Act 2014;11(1):47.
He FJ, Marrero NM, MacGregor GA. Salt intake is related to soft drink consumption in children and adolescents: a link to obesity? Hypertension 2008;51(3):629- 34.
Grimes CA, Riddell LJ, Campbell KJ, Nowson CA. Dietary salt intake, sugar-sweetened beverage consumption, and obesity risk. Pediatrics 2013;131(1):14-21.
Romani JD, Albeaux-Fernet M. [Study of Water-Sodium Metabolism in Obesity]. Sem Hop 1965;41:829-33.
Ma Y, He FJ, MacGregor GA. High salt intake: independent risk factor for obesity? Hypertension 2015; 66(4):843-9.
Lee M, Sorn SR, Lee Y, Kang I. Salt Induces Adipogenesis/Lipogenesis and Inflammatory Adipocytokines Secretion in Adipocytes. Int J Mol Sci 2019;20(1):1- 13.
Oh SW, Koo HS, Han KH, Han SY, Chin HJ. Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age. PLoS One 2017; 12(12):e0188770.
La Sala L, Pontiroli AE. Prevention of diabetes and cardiovascular disease in obesity. Int J Mol Sci 2020; 21(21):1-17.
Grillo A, Salvi L, Coruzzi P, Salvi P, Parati G. Sodium intake and hypertension. Nutrients 2019;11(9):1-16.
Rossitto G, Maiolino G, Lerco S, Ceolotto G, Blackburn G, Mary S, et al. High sodium intake, glomerular hyperfiltration, and protein catabolism in patients with essential hypertension. Cardiovasc Res 2021;117(5): 1372-81.
Lee HK. Success of 2013-2020 World Health Organization action plan to control non-communicable diseases would require pollutants control. J Diabetes Investig 2014;5(6):621-2.
Oberleithner H, Callies C, Kusche-Vihrog K, Schillers H, Shahin V, Riethmuller C, et al. Potassium softens vascular endothelium and increases nitric oxide release. Proc Natl Acad Sci 2009;106(8):2829-34.
Norlander AE, Madhur MS, Harrison DG. The immunology of hypertension. J Exp Med 2018;215(1):21- 33.
Iwahori T, Miura K, Ueshima H, Tanaka-Mizuno S, Chan Q, Arima H, et al. Urinary sodium-to-potassium ratio and intake of sodium and potassium among men and women from multiethnic general populations: the INTERSALT Study. Hypertens Res 2019;42(10):1590- 8.
Contreras RJ. Salt taste and disease. Am J Clin Nutr 1978;31(6):1088-97.
Xue Y, Wen Q, Xu C, Zhang X, Zeng J, Sha AM, et al. Elevated salt taste threshold is associated with increased risk of coronary heart disease. J Cardiovasc Transl Res 2020;13(6):1016-23.
Farquhar WB, Edwards DG, Jurkovitz CT, Weintraub WS. Dietary sodium and health: more than just blood pressure. J Am Coll Cardiol 2015;65(10):1042-50.
Robinson AT, Edwards DG, Farquhar WB. The influence of dietary salt beyond blood pressure. Curr Hypertens Rep 2019;21(6):42.
Lucarini M, Durazzo A, Sette S, Lombardi-Boccia G, Santini A, Strazzullo P. Sodium intake and related diseases. Int J Mol Sci 2021;22(14):7608.
Dotsch M, Busch J, Batenburg M, Liem G, Tareilus E, Mueller R, et al. Strategies to reduce sodium consumption: a food industry perspective. Crit Rev Food Sci Nutr. 2009;49(10):841-51.
Fang K, He Y, Fang Y, Lian Y. Dietary Sodium Intake and Food Sources Among Chinese Adults: Data from the CNNHS 2010-2012. Nutrients 2020;12(2):1-10.
Wiriyatanakorn S, Mukdadilok A, Kantachuvesiri S, Mekhora C, Yingchoncharoen T. Impact of self-monitoring of salt intake by salt meter in hypertensive patients: A randomized controlled trial (SMAL-SALT). J Clin Hypertens 2021;23(10):1852-61.
Iwahori T, Ueshima H, Ohgami N, Yamashita H, Miyagawa N, Kondo K, et al. Effectiveness of a self-monitoring device for urinary sodium-to-potassium ratio on dietary improvement in free-living adults: a randomized controlled trial. J Epidemiol 2018;28(1):41-7.
Neal B, Wu Y, Feng X, Zhang R, Zhang Y, Shi J, et al. Effect of salt substitution on cardiovascular events and death. N Engl J Med 2021;385(12):1067-77.
Perez V, Chang ET. Sodium-to-potassium ratio and blood pressure, hypertension, and related factors. Adv Nutr 2014;5(6):712-41.
Iwahori T, Miura K, Ueshima H. Time to consider use of the sodium-to-potassium ratio for practical sodiumreduction and potassium increase. Nutrients 2017;9(7): 1-11.
Weaver CM, Martin BR, McCabe GP, McCabe LD, Woodward M, Anderson CA, et al. Individual variation in urinary sodium excretion among adolescent girls on a fixed intake. J Hypertens 2016;34(7):1290-7.
Doenyas-Barak K, Beberashvili I, Bar-Chaim A, Averbukh Z, Vogel O, Efrati S. Daily sodium and potassium excretion can be estimated by scheduled spot urine collections. Nephron 2015;130(1):35-40.
Luta X, Hayoz S, Grea Krause C, Sommerhalder K, Roos E, Strazzullo P, et al. The relationship of health/food literacy and salt awareness to daily sodium and potassium intake among a workplace population in Switzerland. Nutr Metab Cardiovasc Dis 2018;28(3):270-7.
D’Elia L, Brajovic M, Klisic A, Breda J, Jewell J, Cadjenovic V, et al. Sodium and potassium intake, knowledge attitudes and behaviour towards salt consumption amongst adults in Podgorica, Montenegro. Nutrients 2019;11(1): 1-12.
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