National survey to estimate sodium and potassium intake and knowledge attitudes and behaviours towards salt consumption of adults in the Sultanate of Oman

Dietary risk factors for non-communicable diseases among Omani adults by latent class analysis and structural equation modelling

BACKGROUND

Risk factor surveillance is vital for public health interventions in non-communicable diseases (NCD) control due to a noticeable nutrition transition among the population affecting dietary patterns. The objective was to investigate the dietary risk factors and its associations based on a first-of-its-kind analysis employing both Latent Class Analysis (LCA) and Structural equation modelling (SEM) to explore the hidden heterogeneity and subgroups with shared dietary pattern and to demonstrate the complex interaction of dietary factors with other risk factors in the development of NCDs.

METHODS

A cross-sectional survey was used. Secondary analysis of the 2017 Oman NCD Risk Factors Survey data was performed to investigate three major dietary risk factors (fruits and vegetables intake, eating out, and the type of oil used in cooking) of Omanis using LCA and SEM.

RESULTS

Dietary risk factors are prevalent in Omanis with 55.8% reporting intake of less than five fruit and vegetable servings per day, 45.3% ate outside the home 1-3 times per week, and 87.3% used vegetable oil for cooking. LCA showed two distinct classes of Omani population with majority belonging to the class mainly eating out 1-3 times per week, eating less than the recommended servings of fruits and vegetables, vegetable oil users, educated, and married young adults. SEM showed the intricate interplay of dietary factors with 8 direct paths and several indirect paths with NCD indicators.

CONCLUSIONS

These findings may have important implications for targeting health promotion strategies among the high-risk group of Omanis identified in this analysis and inform decision makers for the reduction of NCDs.

Twenty-four hour urinary sodium and potassium excretion in adult population of Slovenia: results of the Manjsoli.si/2022 study

OBJECTIVE

The objective of study was to assess 24-h urinary Na and K excretion and estimate the average salt and K intakes in a nationally representative sample of the adult population of Slovenia.

DESIGN

A nationally representative cross-sectional study was conducted in four stages between September and November 2022: study questionnaire, physical measurements, 24-h urine collection and laboratory analysis.

SETTING

Slovenia.

PARTICIPANTS

We invited 2000 adult, non-institutionalised inhabitants of Slovenia, aged between 25 and 64 years. A stratified two-staged sample was selected from this population by the Statistical Office of Slovenia, using sampling from the Central Population Register. According to the WHO methodology, additional eligibility criteria were screened before participating. A total of 518 individuals participated in all four stages of the study, resulting in a response rate of 30 %.

RESULTS

The mean 24-h urinary Na excretion was 168 mmol/d (95 % CI 156, 180), which corresponds to a mean estimated intake of 10·3 g salt/d (95 % CI 9·6, 11·1). Mean 24-h urinary K excretion was 65·4 mmol/d (95 % CI 63·2, 67·5), and the estimated mean K intake was 2·93 g/d (95 % CI 2·84, 3·03). There were statistically significant differences in mean intakes between males and females. The mean sodium-to-potassium ratio was 2·7 (95 % CI 2·5, 2·8).

CONCLUSIONS

The study results highlighted that the salt intake in the adult population of Slovenia remains much higher than recommended by the WHO, and K intakes are insufficient, as most participants did not meet the recommendations.

Pertinence of Salt-Related Knowledge and Reported Behaviour on Salt Intake in Adults: A Cross-Sectional Study

The association between salt-related knowledge, attitude, behaviour (KAB) and actual salt consumption in Greek adults is uncertain. This study investigates the correlation between salt intake, gauged by 24-h urinary sodium excretion, with salt-related KAB. It further explores how socio-demographic factors influence these behaviors. Salt consumption was evaluated using a 24-h urinary sodium test, and compared to self-reported KAB data. Knowledge and behavior scores related to salt were computed. An overall cohort-adjusted model examined the relationship between daily salt consumption, knowledge and behavior scores, and certain covariates. Through the stratification by the cohort random effect, two models were established (Cohort I Adults; Cohort II Students) examining the same relationships of the overall cohort model. 463 Greek adults participated. The average salt intake was 9.54 g/day, nearly double the WHO recommendation. Significant differences in knowledge scores were noted based on sex, age, education, and BMI. A trend suggesting lower discretionary salt use with increased salt intake was observed (p = 0.06). However, comprehensive analysis revealed no direct correlation between salt intake and either knowledge (p = 0.562) or behavior scores (p = 0.210). The results emphasize the need for food product reforms by industry stakeholders and accelerated efforts towards reducing salt intake.

Is the Theory of Planned Behavior a good model for predicting salt consumption behavior in pregnant women? A structural equation modeling approach

BACKGROUND

Non-communicable illnesses are the leading reason for wide-reaching death. Reducing the burden of these illnesses is one of the significant objectives of the World Health Organization's action plan. In this respect, reducing salt consumption is one of the most cost-effective public health interventions. The present study aimed to adjust the Theory of Planned Behavior (TPB) in expecting salt consumption behavior in pregnant women visiting the health centers in Birjand.

MATERIALS AND METHODS

In this cross-sectional study, 273 pregnant women who visited the health centers in Birjand were selected through Quota sampling method. The data were collected using a self-administered questionnaire based on the TPB constructs. The data analysis was done in SPSS 19 and AMOS 24.

RESULTS

The mean age of participants was 27.33 ± 5.77 years, and their mean gestational age was 12.67 ± 4.11 weeks. The mean score of attitude construct was 86.54 ± 8.50, subjective norm construct 36.59 ± 4.47, perceived behavioral control construct 41.63 ± 7.01, intention construct 16.01 ± 2.65 and behavior construct 19.86 ± 2.57. There was a statistically significant relationship between attitude construct (p < 0.001), perceived behavioral control (p < 0.001), and intention (p < 0.001) with salt consumption behavior (p < 0.05). The goodness of fit indices showed a proper fit of data (χ2/df = 1.94, PNFI = 0.6, TLI = 0.9, CFI = 0.9 and RMSE = 0.06).

CONCLUSION

The results of this study showed that the TPB is an appropriate model for reviewing the behavior of salt consumption. Hence, this model offers a suitable basis for designing an educational intervention to regulate the quantity of salt consumed by pregnant women and; thus, its usage in health promotion programs is suggested.

Low Potassium Intake: A Common Risk Factor for Nephrolithiasis in Patients with High Blood Pressure

Hypertension (Htn) is a crucial cause of cardio-vascular and chronic kidney disease. Moreover, it is an independent risk factor for nephrolithiasis (NL). A diet rich in vegetables and fruits is indicated for both Htn and NL prevention, and the 24-h urinary potassium excretion can be used as a warning light for adherence. The aim of this study is to demonstrate the association between urinary potassium excretion and recurrent nephrolithiasis among patients affected by Htn. We have analyzed medical records of 119 patients affected by Htn and NL (SF-Hs) referring to Bone and Mineral Metabolism laboratory and 119 patients affected by Htn but without NL (nSF-Hs) referring to Hypertension and Organ Damage Hypertension related laboratory, both in Federico II University of Naples. The potassium 24-h urinary levels in SF-Hs were significantly lower compared to nSF-Hs. This difference was confirmed by the multivariable linear regression analysis in the unadjusted model and adjusted model for age, gender, metabolic syndrome, and body mass index. In conclusion, a higher potassium urinary excretion in 24-h is a protective factor against NL in patients affected by Htn and dietary interventions can be considered for kidney protection.

Effect of Potassium Supplementation on Endothelial Function: A Systematic Review and Meta-Analysis of Intervention Studies

(1) Background: Endothelial dysfunction is an early predictor of cardiovascular diseases. Although a large body of evidence shows an inverse association between potassium intake and cardiovascular risk, the studies on endothelial function provided contrasting results. Thus, we carried out a systematic review and a meta-analysis of the available intervention studies of the potassium supplementation on endothelial function. (2) Methods: A systematic search of the online databases available (up to December 2022) was conducted including the intervention trials that reported flow-mediated dilation (FMD) changes-a non-invasive method of assessing endothelial function-after two different potassium intake regimens. For each study, the mean difference (MD) and 95% confidence intervals were pooled using a random effect model. (3) Results: Five studies met the pre-defined inclusion criteria and provided eight cohorts with 332 participants. In the pooled analysis, potassium supplementation was associated with a significant increase in FMD (MD: 0.74%), with a higher effect for a urinary potassium excretion higher than 90 mmol/day. There was a moderate heterogeneity among studies (I2 = 59%), explained by the different amount of potassium supplementation. (4) Conclusions: The results of our meta-analysis indicate that dietary potassium supplement improves endothelial function. This effect is directly associated with the amount of potassium supplement. The findings support the campaigns in favour of an increase in dietary potassium intake to reduce cardiovascular risk.

Dietary Potassium Intake and Risk of Diabetes: A Systematic Review and Meta-Analysis of Prospective Studies

(1) Background: Dietary potassium intake is positively associated with reduction of cardiovascular risk. Several data are available on the relationship between dietary potassium intake, diabetes risk and glucose metabolism, but with inconsistent results. Therefore, we performed a meta-analysis of the prospective studies that explored the effect of dietary potassium intake on the risk of diabetes to overcome these limitations. (2) Methods: A random-effects dose-response meta-analysis was carried out for prospective studies. A potential non-linear relation was investigated using restricted cubic splines. (3) Results: A total of seven prospective studies met the inclusion criteria. Dose-response analysis detected a non-linear relationship between dietary potassium intake and diabetes risk, with significant inverse association starting from 2900 mg/day by questionnaire and between 2000 and 5000 mg/day by urinary excretion. There was high heterogeneity among studies, but no evidence of publication bias was found. (4) Conclusions: The results of this meta-analysis indicate that habitual dietary potassium consumption is associated with risk of diabetes by a non-linear dose-response relationship. The beneficial threshold found supports the campaigns in favour of an increase in dietary potassium intake to reduce the risk of morbidity and mortality. Further studies should be carried out to explore this topic.

Prevalence of risk factors of non-communicable diseases in the Sultanate of Oman: STEPS survey 2017

BACKGROUND

Non-communicable diseases (NCD) represent a major public health issue and currently cause 185.75 deaths per 100,000 population in Oman. Hence, there is a need for comprehensive, up-to-date and internationally comparable data on NCD risk factors in order to evaluate the effectiveness of ongoing public health policies and to develop further NCD prevention and control interventions. The aim of the study was to provide evidence-based, up-to-date, extensive, and reliable baseline data on the behavioural and biological risk factors of NCDs in the Sultanate of Oman.

METHODS

A cross-sectional, prospective, observational community-based survey designed to be nationally representative of the Sultanate of Oman was conducted based on the WHO STEPwise approach to Surveillance (STEPS). Multi-stage stratified random sampling according to geographical distribution selected a total of 9053 households (Omani nationals and non-Omani residents). Cluster sampling was used to randomly select equal clusters from each governorate. 823 households were randomly selected from the list of all households in all selected clusters from each governorate and one eligible adult selected from each household randomly accounting for 6582 consenting participants. The survey used demographic and behavioural information questionnaires along with physical and biochemical measurements among adults aged 18 years and above.

RESULTS

The prevalence of behavioural risk factors such as tobacco use was 9%, alcohol consumption was 2%, insufficient fruit or vegetable intake was 61%, and insufficient physical activity was 39%. The prevalence of biological risk factors such as overweight and obesity was 66%, raised blood pressure was 33%, raised blood glucose was 16%, and raised blood cholesterol was 36%. The prevalence of multiple risk factors was also determined and 95% of the population were found to have more than one risk factor. Three or more risk factors were found among 33% of population aged 18 years and above and 45% of the population aged 45 years and above.

CONCLUSION

A high prevalence of various NCD risk factors was found which needs to be addressed through health promotion, education, and policy. The findings are important to support the formulation and implementation of NCD-related policies and action plans that improve health status and prevent mortality due to NCDs in Oman.

Salt Reduction Initiatives in the Eastern Mediterranean Region and Evaluation of Progress towards the 2025 Global Target: A Systematic Review

This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and classified according to a pre-defined framework: salt intake assessments; leadership and strategic approach; implementation strategies; monitoring and evaluation of program impact. Salt intake levels were estimated in 15 out of the 22 countries (68%), while national salt reduction initiatives were identified in 13 (59%). The majority of countries were found to implement multifaceted reduction interventions, characterized by a combination of two or more implementation strategies. The least common implementation strategy was taxation, while the most common was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%). Monitoring activities were conducted by few countries (27%), while impact evaluations were lacking. Despite the ongoing salt reduction efforts in several countries of the region, more action is needed to initiate reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluations of ongoing programs. Such efforts are vital for the achievement of the targeted 30% reduction in salt intake.