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Hikita N, Batsaikhan E, Sasaki S, Haruna M, Yura A, Oidovsuren O. Evaluation of salt intake estimated from 24-h urinary sodium excretion in medical professionals in Darkhan-Uul Province, Mongolia: a cross-sectional study. Sci Rep 2023; 13:10456. [PMID: 37380730 DOI: 10.1038/s41598-023-37631-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/24/2023] [Indexed: 06/30/2023] Open
Abstract
This cross-sectional study aimed to estimate the daily salt intake of medical professionals working in public health facilities in Darkhan-Uul Province, Mongolia. We conducted a multiple logistic regression analysis to identify factors associated with their consumption of salt exceeding the recommended daily salt intake (≥ 5 g/day). A self-administered questionnaire and 24-h urine samples were used to obtain data on the participants' salt intake. Of 338 participants, 159 completed the 24-h urine collection. The mean sodium excretion into urine was 122.3 mmol/day, which was equivalent to a mean salt intake of 7.7 g/day when the urinary excretion rate was considered as 93%. Body mass index was positively correlated with excess salt intake (adjusted odds ratio [AOR]: 1.27; 95% confidence interval [CI] 1.10-1.46), while age was negatively correlated with excess salt intake (AOR: 0.95; 95% CI 0.91-1.00). Participants who consumed ≥ 2 cups of salted suutei tsai (Mongolian milk tea) daily had a higher risk of consuming ≥ 5 g/day of salt than those who consumed ≤ 1 cup/day. The average estimated salt intake of the participants was higher than the recommended value. Medical professionals should be aware of factors associated with excessive salt consumption and make appropriate adjustments to minimize it.
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Affiliation(s)
- Naoko Hikita
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Enkhtungalag Batsaikhan
- Department of Nutrition Research of the National Center for Public Health, Peace Avenue -17, Ulaanbaatar, 210349, Mongolia
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Megumi Haruna
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Ariunaa Yura
- Darkhan-Uul General Hospital, 13-Bag, Darkhan Soum, Darkhan-Uul, Mongolia
| | - Otgontogoo Oidovsuren
- Darkhan-Uul Medical School, Mongolian National University of Medical Sciences, P.O. Box 903, Darkhan-Uul, Mongolia
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Jarrar AH, Al Dhaheri AS, Lightowler H, Cheikh Ismail L, Al-Meqbaali F, Bataineh MF, Alhefeiti A, Albreiki M, Albadi N, Alkaabi S, Thondre PS. Using Digital Platform Approach to Reduce Salt Intake in a Sample of UAE Population: An Intervention Study. Front Public Health 2022; 10:860835. [PMID: 35685760 PMCID: PMC9172248 DOI: 10.3389/fpubh.2022.860835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading causes of mortality globally, accounting for more deaths than all other causes combined. World Health Organization launched its initiative in 2013 to reduce the intake of salt, the number of countries that have national sodium reduction strategies reached to 89 countries in 2017. In 2020, a study conducted in UAE showed more than 65% of the population exceeded WHO recommendations for salt intake. This study aimed to measure effectiveness of using digital platform approach to deliver educational materials to facilitate salt reduction in a sample of UAE population. Methods A controlled parallel intervention study was conducted in 2020. A sample of 121 participants completed the study and fulfilled the inclusion criteria with female to male ratio of (0.95:1.05). Participants were distributed randomly into three groups Control group, WhatsApp group, and Electronic Brochures group. Educational materials were distributed among participants of WhatsApp and Electronic brochures groups for 6-weeks. 24-h urinary excretion for sodium, potassium and creatinine, were measured in addition to KAP questionnaire and physical activity on two occasions at baseline and endpoint after 10-weeks (6-weeks of educational intervention). Results Both intervention groups showed a reduction in sodium with 278 mg (p < 0.001) for WhatsApp group (n = 41) and 169 mg (p < 0.018) for Electronic brochures group (n = 41), while Control group didn't show any significant change. Moreover, the percentage of participants exceeding WHO recommendation of sodium intake was significantly reduced at the end of intervention, (p = 0.004). WhatsApp group was more efficient in the percentage of reduction of participants exceeding WHO recommendation compared with baseline, with p = 0.023. A significant reduction in the practice toward adding salt during cooking, use of table salt, adding salt before tasting the foods and use of chicken stocks for both intervention groups was noted with p < 0.05. Intervention groups showed a significant improvement (p < 0.001) in Food and Health related knowledge after 6-weeks of intervention. Conclusion The digital platform approach such as WhatsApp and Electronic Brochure were effective in salt reduction. This study proves that UAE population is ready to reduce salt intake with appropriate education materials and easy delivery approach.
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Affiliation(s)
- Amjad H. Jarrar
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
- Oxford Brookes Center for Nutrition and Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
- *Correspondence: Amjad H. Jarrar
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Helen Lightowler
- Oxford Brookes Center for Nutrition and Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Fatima Al-Meqbaali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Mo'ath F. Bataineh
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
- Department of Sport Rehabilitation, Faculty of Physical Education and Sport Science, Hashemite University, Zarqa, Jordan
| | - Aseilah Alhefeiti
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Maithah Albreiki
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Nouf Albadi
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Salama Alkaabi
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Pariyarath S. Thondre
- Oxford Brookes Center for Nutrition and Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
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Barriers, Enablers, and Perceptions on Dietary Salt Reduction in the Out-of-Home Sectors: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158099. [PMID: 34360392 PMCID: PMC8345971 DOI: 10.3390/ijerph18158099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
In this review, we have investigated the perceptions, barriers, and enabling factors that were responsible for a dietary salt reduction in the out-of-home sectors. For this purpose, we examined different knowledge databases such as Google Scholar, Ebscohost, MEDLINE (PubMed), Ovid, and Cochrane Library for research articles from September to December 2020. The inclusion criteria for the research articles were that they had to be published in English and had to be a qualitative or quantitative study that was conducted after 2010. These studies also had to report the various enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors. After implementing the inclusion criteria, we successfully screened a total of 440 studies, out of which 65 articles fulfilled all the criteria. The perceived barriers that hindered salt reduction among the out-of-home sectors included lack of menu and food variabilities, loss of sales due to salt reduction, lack of technical skills for implementing the salt reduction processes for cooking or reformulation, and an absence of environmental and systemic support for reducing the salt concentration. Furthermore, the enablers for salt reduction included the intervention programs, easy accessibility to salt substitutes, salt intake measurement, educational availability, and a gradual reduction in the salt levels. With regards to the behavior or perceptions, the effect of organizational and individual characteristics on their salt intake were reported. The majority of the people were not aware of their salt intake or the effect of salt on their health. These people also believed that low salt food was recognized as tasteless. In conclusion, the enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors were multifaceted. Therefore, for the implementation of the strategies, policies, and initiatives for addressing the barriers, the policymakers need to encourage a multisectoral collaboration for reducing the salt intake in the population.
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Santos JA, McKenzie B, Rosewarne E, Hogendorf M, Trieu K, Woodward M, Cobb LK, Dodd R, Webster J. Strengthening Knowledge to Practice on Effective Salt Reduction Interventions in Low- and Middle-Income Countries. Curr Nutr Rep 2021; 10:211-225. [PMID: 34224108 DOI: 10.1007/s13668-021-00365-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The objective of this review was to consolidate available published information on the implementation and evaluation of salt reduction interventions in low- and middle-income countries (LMICs). RECENT FINDINGS The Science of Salt database (made up of studies identified in a weekly Medline search) was used to retrieve articles related to the implementation of salt reduction interventions from June 2013 to February 2020. Studies that measured the effects of the interventions in LMICs, based on four outcome measures-salt intake; sodium levels in foods; knowledge, attitudes, and behaviours (KABs) towards salt; and blood pressure-were included. Results were summarised overall and according to subgroups of intervention type, duration, sample size, country's income class, and regional classification. The review identified 32 studies, representing 13 upper middle-income and four lower middle-income countries. The main salt reduction interventions were education, food reformulation, and salt substitution; and many interventions were multi-faceted. More studies reported a positive effect of the interventions (decreased salt intake (12/17); lower sodium levels in foods or compliance with agreed targets (6/6); improved KAB (17/19); and decreased blood pressure (10/14)) than a null effect, and no study reported a negative effect of the intervention. However, many studies were of small scale and targeted specific groups, and none was from low-income countries. Consumer education, food reformulation, and salt substitution, either alone or in combination, were effective in their target populations. Supporting scale-up of salt reduction interventions in LMICs is essential to cover broader populations and to increase their public health impact.
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Affiliation(s)
- Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia.
| | - Briar McKenzie
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
| | - Martyna Hogendorf
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia.,Independent Nutrition Consultant, Geneva, Switzerland
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia.,The George Institute for Global Health, School of Public Health, Imperial College, London, UK
| | - Laura K Cobb
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, USA
| | - Rebecca Dodd
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
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Factors Related to Lacking Knowledge on the Recommended Daily Salt Intake among Medical Professionals in Mongolia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083850. [PMID: 33916892 PMCID: PMC8067531 DOI: 10.3390/ijerph18083850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
In Mongolia, the recommendations are to restrict salt intake to less than 5 g/day to reduce the risk of cardiovascular disease. We aimed to reveal factors associated with not knowing the recommended daily salt intake among medical professionals in Mongolia. Of the recruited 538 medical professionals working at public health facilities in Darkhan-Uul Province, the data from 338 (62.8%), obtained using self-administered questionnaires, were analyzed. Among these, 175 (51.8%) did not know the recommended daily salt intake. Compared with medical doctors, midwives and nurses had higher odds of not knowing the recommendations (adjusted odds ratio (AOR): 4.20, 95% confidence interval (CI): 1.40–12.59; AOR: 2.10, 95% CI: 1.15–3.76, respectively). Compared to participants who consumed more than four cups/day of salted suutei tsai (Mongolian milk tea), those who consumed approximately two cups/week had lower odds of not knowing the recommendations (AOR: 0.21, 95% CI: 0.07–0.63). With most participants lacking accurate knowledge on this topic, and considering that people who are aware of the recommendations are more likely to take action to reduce dietary salt intake, it is imperative to urgently address this knowledge deficit because medical professionals have a responsibility to educate the community by disseminating accurate health information.
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Menyanu EK, Corso B, Minicuci N, Rocco I, Russell JC, Ware LJ, Chidumwa G, Naidoo NN, Biritwum RB, Kowal PR, Schutte AE, Charlton KE. Determinants of change in blood pressure in Ghana: Longitudinal data from WHO-SAGE Waves 1-3. PLoS One 2021; 16:e0244807. [PMID: 33417616 PMCID: PMC7793275 DOI: 10.1371/journal.pone.0244807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/16/2020] [Indexed: 01/19/2023] Open
Abstract
The prevalence of hypertension is increasing in low- and middle-income countries, however statistics are generally derived from cross sectional surveys that utilize different methodologies and population samples. We investigated blood pressure (BP) changes over 11-12 years in a large cohort of adults aged 50 years and older (n = 820) included in the World Health Organization's Study on global AGEing and adult health (WHO-SAGE Ghana) Wave 1 (2007/8) with follow up in Wave 3 (2019). Participants' BP were measured in triplicate and a survey completed at both time points. Survey instruments collected information on sociodemographic characteristics, lifestyle, health behaviors and chronic conditions. While no significant difference was found in systolic BP between Waves 1 and 3, diastolic BP decreased by 9.7mmHg (mean = 88.6, 15.4 to 78.9, 13.6 respectively) and pulse pressure increased by 9.5mmHg (44.8, 13.7 to 54.3, 14.1). Awareness of hypertension increased by 37%, from (20% to 57%), but no differences were found for the proportion of hypertensives receiving treatment nor those that had controlled BP. Mixed effects modelling showed a decrease in diastolic BP was associated with increasing age, living in rural areas and having health insurance. Factors associated with an increased awareness of hypertension were residing in urban areas, having health insurance and increasing body mass index. While diagnosis of hypertension has improved over time in Ghana, there is an ongoing need to improve its treatment in older adults.
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Affiliation(s)
- Elias K. Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Nadia Minicuci
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Ilaria Rocco
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Joanna C. Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lisa J. Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Glory Chidumwa
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nirmala N. Naidoo
- World Health Organization Data, Analytics and Delivery for Impact Division, Geneva, Switzerland
| | | | - Paul R. Kowal
- Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
- World Health Organization SAGE, Geneva, Switzerland
| | - Aletta E. Schutte
- School of Public Health and Community Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen E. Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
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Arantes AC, Sousa ALL, Vitorino PVDO, Jardim PCBV, Jardim TDSV, Rezende JM, Lelis EDS, Rodrigues RB, Coca A, Barroso WKS. Effects of added salt reduction on central and peripheral blood pressure. Arq Bras Cardiol 2020; 114:554-561. [PMID: 32267330 PMCID: PMC7792722 DOI: 10.36660/abc.20180426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/15/2019] [Accepted: 05/15/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce. OBJECTIVE To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals. METHODS This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual blood pressure measurements and ambulatory blood pressure monitoring were performed using the automated OMRON 705CP device, and central blood pressure was measured using the Sphygmocor®. Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis. RESULTS A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39-54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed. CONCLUSION The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561).
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Affiliation(s)
- Ana Carolina Arantes
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Ana Luiza Lima Sousa
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Priscila Valverde de O. Vitorino
- Pontificia Universidade Católica de GoiásEscola de Ciências Sociais e da SaúdeGoiâniaGoiásBrasilPontificia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde - Mestrado em Atenção à Saúde, Goiânia, Goiás – Brasil
| | - Paulo Cesar B. Veiga Jardim
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Thiago de Souza Veiga Jardim
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Jeeziane Marcelino Rezende
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
| | - Ellen de Souza Lelis
- Pontificia Universidade Católica de GoiásEscola de Ciências Sociais e da SaúdeGoiâniaGoiásBrasilPontificia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde - Mestrado em Atenção à Saúde, Goiânia, Goiás – Brasil
| | - Rafaela Bernardes Rodrigues
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
| | - Antonio Coca
- Universitat de BarcelonaBarcelonaEspanhaUniversitat de Barcelona, Barcelona – Espanha
| | - Weimar Kunz Sebba Barroso
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
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Gantuya B, Bolor D, Oyuntsetseg K, Erdene-Ochir Y, Sanduijav R, Davaadorj D, Tserentogtokh T, Azzaya D, Uchida T, Matsuhisa T, Yamaoka Y. New observations regarding Helicobacter pylori and gastric cancer in Mongolia. Helicobacter 2018; 23:e12491. [PMID: 29882322 PMCID: PMC6039254 DOI: 10.1111/hel.12491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence and mortality of gastric cancer in Mongolia is among the highest in the world. METHODS This was a case-control study in which upper gastrointestinal endoscopy, gastric histology, Helicobacter pylori testing, and risk factor questionnaires were obtained. Histologic subtypes were determined by Lauren's classification. RESULTS We enrolled 45 gastric cancer and 108 non-gastric cancer patients. Gastric cancers were located in upper part of stomach in 53.3%, main gastric body in 37.8%, and lower part of stomach in 8.9%. The majority (60%) were diffuse type, followed by intestinal type (36.7%) and indeterminate type (3.3%). H. pylori infections were CagA positive in 100% with cancer vs 81% without cancer (P = .02). The majority of CagA was non-East Asian type (95% with cancer and 94.1% without cancer). Cancer patients had typically related with excessive use of salt, hot beverages, tobacco smoking, and low ingestion of fruits. CONCLUSION The characteristic topography of gastric cancer in Mongolia being in the gastric corpus differed from East Asian countries and was more similar to western countries. The risk factors for gastric cancer in Mongolia were similar to other high-risk areas (ie, H. pylori infection, excessive use of salt, tobacco smoking, and low ingestion of fruits).
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Affiliation(s)
- Boldbaatar Gantuya
- Department of Environmental and Preventive Medicine, Oita University of Medicine, Yufu, Japan,Department of Gastroenterology, Mongolian National University of Medical sciences, Ulaanbaatar, Mongolia
| | - Dashdorj Bolor
- Department of Endoscopy, National Cancer Center, Ulaanbaatar, Mongolia
| | - Khasag Oyuntsetseg
- Department of Gastroenterology, Mongolian National University of Medical sciences, Ulaanbaatar, Mongolia
| | - Yansan Erdene-Ochir
- Department of General surgery, National Cancer Center, Ulaanbaatar, Mongolia
| | - Ruvjir Sanduijav
- Department of Oncology, Mongolian National University of Medical sciences, Ulaanbaatar, Mongolia
| | - Duger Davaadorj
- Department of Gastroenterology, Mongolian National University of Medical sciences, Ulaanbaatar, Mongolia
| | - Tegshee Tserentogtokh
- Department of Gastroenterology, Mongolian National University of Medical sciences, Ulaanbaatar, Mongolia
| | - Dashdorj Azzaya
- Department of Environmental and Preventive Medicine, Oita University of Medicine, Yufu, Japan
| | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University of Medicine
| | - Takeshi Matsuhisa
- Department of Gastroenterology, Tama-Nagayama University Hospital of Nippon Medical School
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University of Medicine, Yufu, Japan,Department of Medicine, Gastroenterology and Hepatology section, Baylor College of Medicine, Houston, Texas77030, USA
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9
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Khasag O, Boldbaatar G, Tegshee T, Duger D, Dashdorj A, Uchida T, Matsuhisa T, Yamaoka Y. The prevalence of Helicobacter pylori infection and other risk factors among Mongolian dyspeptic patients who have a high incidence and mortality rate of gastric cancer. Gut Pathog 2018; 10:14. [PMID: 29636824 PMCID: PMC5883366 DOI: 10.1186/s13099-018-0240-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/23/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mongolia has not only the second highest incidence rate but also the highest mortality rate for gastric cancer globally. In addition to gastric cancer, ulcerative disease complications are also life threatening; thus, investigating Helicobacter pylori infection and other risk factors is essential. RESULTS H.pylori infection was high in tested dyspeptic patients from all parts of Mongolia, with an overall infection rate of 80.0%. Logistic regression analysis showed that H. pylori infection was associated with gastritis (odds ratio; 9.0 ([95% confidence interval 5.0-16.2]); p < 0.0001). H. pylori infection (3.3 [2.0-5.4]; p < 0.0001) and > 40 years old (1.5 [1.0-2.0]; p < 0.02) were both associated with atrophy. However, > 40 years old (3.8 [2.4-6.0]; p < 0.0001) and high salt intakes (1.6 [1.0-2.3]; p < 0.02), but not H. pylori infection, were associated with intestinal metaplasia. Excessive amount of salt usage was dramatically higher in northern and western parts of Mongolia, where precancerous diseases, such as erosive esophagitis (for cardia cancer), severe atrophy, and intestinal metaplasia (for non-cardia cancer), were highly prevalent. CONCLUSIONS H. pylori infection was the major gastric health problem among the Mongolian population. In addition, environmental factors such as high salt intake worsened the clinical outcome. Therefore, a nationwide screening and eradication of H. pylori infection as well as salt-reducing measures should be implemented.
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Affiliation(s)
- Oyuntsetseg Khasag
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gantuya Boldbaatar
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita 879-5593 Japan
| | | | - Davaadorj Duger
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Azzaya Dashdorj
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita 879-5593 Japan
| | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University of Medicine, Yufu, Japan
| | - Takeshi Matsuhisa
- Department of Gastroenterology, Tama-Nagayama University Hospital, Nippon Medical School, Tokyo, Japan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita 879-5593 Japan
- Department of Gastroenterology and Hepatology, Baylor College of Medicine and Michael De Bakey Veterans Affairs Medical Center, Houston, TX 77030 USA
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10
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Pandian JD, William AG, Kate MP, Norrving B, Mensah GA, Davis S, Roth GA, Thrift AG, Kengne AP, Kissela BM, Yu C, Kim D, Rojas-Rueda D, Tirschwell DL, Abd-Allah F, Gankpé F, deVeber G, Hankey GJ, Jonas JB, Sheth KN, Dokova K, Mehndiratta MM, Geleijnse JM, Giroud M, Bejot Y, Sacco R, Sahathevan R, Hamadeh RR, Gillum R, Westerman R, Akinyemi RO, Barker-Collo S, Truelsen T, Caso V, Rajagopalan V, Venketasubramanian N, Vlassovi VV, Feigin VL. Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review. Neuroepidemiology 2017; 49:45-61. [DOI: 10.1159/000479518] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/11/2017] [Indexed: 01/10/2023] Open
Abstract
Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.
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11
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Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O’Flaherty M, McGill R, Orton L, Bromley H, Cappuccio FP, Capewell S. Systematic review of dietary salt reduction policies: Evidence for an effectiveness hierarchy? PLoS One 2017; 12:e0177535. [PMID: 28542317 PMCID: PMC5436672 DOI: 10.1371/journal.pone.0177535] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 04/29/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Non-communicable disease (NCD) prevention strategies now prioritise four major risk factors: food, tobacco, alcohol and physical activity. Dietary salt intake remains much higher than recommended, increasing blood pressure, cardiovascular disease and stomach cancer. Substantial reductions in salt intake are therefore urgently needed. However, the debate continues about the most effective approaches. To inform future prevention programmes, we systematically reviewed the evidence on the effectiveness of possible salt reduction interventions. We further compared "downstream, agentic" approaches targeting individuals with "upstream, structural" policy-based population strategies. METHODS We searched six electronic databases (CDSR, CRD, MEDLINE, SCI, SCOPUS and the Campbell Library) using a pre-piloted search strategy focussing on the effectiveness of population interventions to reduce salt intake. Retrieved papers were independently screened, appraised and graded for quality by two researchers. To facilitate comparisons between the interventions, the extracted data were categorised using nine stages along the agentic/structural continuum, from "downstream": dietary counselling (for individuals, worksites or communities), through media campaigns, nutrition labelling, voluntary and mandatory reformulation, to the most "upstream" regulatory and fiscal interventions, and comprehensive strategies involving multiple components. RESULTS After screening 2,526 candidate papers, 70 were included in this systematic review (49 empirical studies and 21 modelling studies). Some papers described several interventions. Quality was variable. Multi-component strategies involving both upstream and downstream interventions, generally achieved the biggest reductions in salt consumption across an entire population, most notably 4g/day in Finland and Japan, 3g/day in Turkey and 1.3g/day recently in the UK. Mandatory reformulation alone could achieve a reduction of approximately 1.45g/day (three separate studies), followed by voluntary reformulation (-0.8g/day), school interventions (-0.7g/day), short term dietary advice (-0.6g/day) and nutrition labelling (-0.4g/day), but each with a wide range. Tax and community based counselling could, each typically reduce salt intake by 0.3g/day, whilst even smaller population benefits were derived from health education media campaigns (-0.1g/day). Worksite interventions achieved an increase in intake (+0.5g/day), however, with a very wide range. Long term dietary advice could achieve a -2g/day reduction under optimal research trial conditions; however, smaller reductions might be anticipated in unselected individuals. CONCLUSIONS Comprehensive strategies involving multiple components (reformulation, food labelling and media campaigns) and "upstream" population-wide policies such as mandatory reformulation generally appear to achieve larger reductions in population-wide salt consumption than "downstream", individually focussed interventions. This 'effectiveness hierarchy' might deserve greater emphasis in future NCD prevention strategies.
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Affiliation(s)
- Lirije Hyseni
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Alex Elliot-Green
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Chris Kypridemos
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Rory McGill
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Lois Orton
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Helen Bromley
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Francesco P. Cappuccio
- University of Warwick, WHO Collaborating Centre, Warwick Medical School, Coventry, United Kingdom
| | - Simon Capewell
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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12
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Webster J, Su'a SAF, Ieremia M, Bompoint S, Johnson C, Faeamani G, Vaiaso M, Snowdon W, Land MA, Trieu K, Viali S, Moodie M, Bell C, Neal B, Woodward M. Salt Intakes, Knowledge, and Behavior in Samoa: Monitoring Salt-Consumption Patterns Through the World Health Organization's Surveillance of Noncommunicable Disease Risk Factors (STEPS). J Clin Hypertens (Greenwich) 2016; 18:884-91. [PMID: 26843490 PMCID: PMC5067650 DOI: 10.1111/jch.12778] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Abstract
This project measured population salt intake in Samoa by integrating urinary sodium analysis into the World Health Organization's (WHO's) STEPwise approach to surveillance of noncommunicable disease risk factors (STEPS). A subsample of the Samoan Ministry of Health's 2013 STEPS Survey collected 24‐hour and spot urine samples and completed questions on salt‐related behaviors. Complete urine samples were available for 293 participants. Overall, weighted mean population 24‐hour urine excretion of salt was 7.09 g (standard error 0.19) to 7.63 g (standard error 0.27) for men and 6.39 g (standard error 0.14) for women (P=.0014). Salt intake increased with body mass index (P=.0004), and people who added salt at the table had 1.5 g higher salt intakes than those who did not add salt (P=.0422). A total of 70% of the population had urinary excretion values above the 5 g/d cutoff recommended by the WHO. A reduction of 30% (2 g) would reduce average population salt intake to 5 g/d, in line with WHO recommendations. While challenging, integration of salt monitoring into STEPS provides clear logistical and cost benefits and the lessons communicated here can help inform future programs.
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Affiliation(s)
- Jacqui Webster
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.
| | | | | | - Severine Bompoint
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Claire Johnson
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Wendy Snowdon
- WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Mary-Anne Land
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Satu Viali
- Medical Specialist Clinic and Ministry of Health, Apia, Samoa
| | - Marj Moodie
- Deakin Health Economics, Faculty of Health, Deakin University, VIC, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Melbourne, VIC, Australia
| | - Bruce Neal
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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