Knowledge and behaviors related to dietary salt and sources of dietary sodium in north India

Dietary Salt-Related Knowledge, Attitudes and Behaviors in Healthy and Hypertensive Turkish Adults from Food Choice Perspective

Food choices are influenced by knowledge, attitudes, and behaviors (KABs); therefore, determining KABs regarding salt is a key point for salt reduction, which is a primary public health problem in Turkey. This study aimed to assess salt-related KABs in Turkey. This cross-sectional study was conducted on 415 adults in a hospital in Turkey. A structured questionnaire assessing salt-related KABs was administered, and blood pressure was measured. The majority of participants were aware of the health risks associated with high salt intake. Higher overall attitude scores increased the odds of performing most behaviors to reduce salt, except for checking food labels, using spices instead of salt, and purchasing foods labeled as low-sodium, by almost three-fold. These results suggest that both normotensive and hypertensive adults need to improve their knowledge of the health effects and dietary sources of salt, and how to reduce it. Salt-related KABs were not found to be aligned with all positive attitudes toward salt consumption; this indicates the need for regulations that operate independently of public perceptions, such as policies for reducing salt in the food industry and making reduced-salt products more affordable to encourage healthier food choices.

Ethnic differences in knowledge, attitudes, and practices related to dietary salt intake and association with hypertension in Malaysia: a multi-centre cross-sectional study

The association between high salt intake and elevated blood pressure levels has been well-documented. However, studies on how effectively this knowledge translates into actionable practices, particularly across different ethnic groups, remain limited. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) towards dietary salt intake across ethnicities and determine its association with hypertension. 5128 Malaysian adults recruited from a national blood pressure screening study completed questionnaires on demographics, and KAP related to dietary salt intake. There were 57.4% Malay, 23.5% Chinese, 10.4% Indian, and 8.7% individuals of other ethnic groups. Overall, more than 90% of the participants knew that a high salt intake causes serious health problems, but only around one-third knew the relationship between high salt intake and strokes and heart failure. Participants of different ethnic groups displayed significant differences in the KAP domains, where Indians generally exhibited better knowledge, attitudes, and reported better practices such as reading salt labels and using spices. Those who were unaware of the difference between salt and sodium and who reported not reading salt labels had higher odds of having elevated blood pressure. These findings demonstrate that while there is a suboptimal translation of salt knowledge into practice in Malaysia, with significant differences in KAP observed between ethnic groups, the potential of improving health outcomes by improving the clarity and awareness of salt labels is substantial. Tailored education promoting salt-label reading, minimizing processed foods intake and discretionary salt use should be ethnic-specific to better curb this escalating hypertension epidemic.

Understanding knowledge, attitudes and behaviours related to dietary sodium intake in a multi-ethnic population in Singapore

OBJECTIVE

This study aimed to fill the current gap in the understanding of the knowledge, attitudes and behaviours (KAB) related to dietary Na among adult residents in Singapore.

DESIGN

A cross-sectional online survey was conducted between October and December 2020 on 955 participants selected through random sampling.

SETTING

The survey was conducted in Singapore.

PARTICIPANTS

Participants were recruited from the Singapore Population Health Study Online Panel.

RESULTS

Participants' mean age was 46·6 ± 14·1 years old and 58 % of them were females. Most of the participants were Chinese (82·1 %), 10·5 % were Indian and 4·5 % were Malay. Findings from the weighted data showed that most participants were aware of the health impact of high Na consumption. However, many participants were unaware of the recommended intake for salt (68%) and Na (83%), had misconceptions, and were unable to correctly use food labels to assess NA content (69%). Findings also alluded to the presence of knowledge gaps in the sources of Na in their diet. While 59 % of the participants reported to be limiting their consumption of Na, many reported facing barriers such as not knowing how to limit their Na intake. Participants also felt that there were limited options for low-Na foods when eating out and were lacking awareness of low-Na products.

CONCLUSIONS

Findings highlighted substantial gaps in participants' knowledge and skills in managing their Na consumption. This suggests the need for more public education and improvements in the food environment.

Using the health belief model to understand the factors influencing the perceptions of people of Chinese ancestry about reducing salt consumption for hypertension prevention: A cross-sectional study

BACKGROUND

High-salt diets are linked to hypertension. Chinese people in Australia, are at increased risk of hypertension due to the combination of routine addition of high quantities of salt to food during cooking and high salt levels in processed western foods. There is a scarcity of salt-related behavioural studies on this population group. This study aimed to explore the habitual salt consumption of Chinese Australians and factors that influence their perceptions about sustaining salt-related behavioural changes for hypertension prevention.

METHOD

A cross-sectional descriptive study using an adapted Determinants of Salt-Restriction Behaviour Questionnaire was conducted on 188 Chinese Australians. A non-probability sampling method was used to attract participants from different parts of Australia. Statistical analyses such as descriptive analysis, t-tests and Pearson correlation tests were performed in the study.

RESULTS

Over 97% of participants did not measure the amount of salt added to their meals. Many participants reported that salt was added to their meals based on their experience (39.4%) and food taste (31.9%). Over 80% of participants did not know the recommended level of daily salt consumption. Although salt-related knowledge had no significant correlation with individuals' salty food taste preferences, there were significant correlations with the perceptions of the severity of disease and health benefits of reducing salt consumption (p = .001 and < .001 respectively). People with stronger salty taste preferences perceived a higher level of health threat than people with lighter salty taste preferences (p = .003).

CONCLUSION

Findings from this study show that knowledge about salt-reduction alone had no significant effects on salt-related behaviours. Adequate culturally relevant practice-based education in salt-reduction strategies may facilitate salt-related behavioural changes in Chinese Australians. Overall, single young Chinese Australian men with stronger salty taste preferences is the group who needs salt reduction interventions the most.

An mHealth-based school health education system designed to scale up salt reduction in China (EduSaltS): A development and preliminary implementation study

Background

High-salt diet is an important risk factor for several non-communicable diseases. School-based health education has been found effective in reducing salt intake among children and their families in China. However, no such interventions have been scaled up in the real world. For this purpose, a study was launched to support the development and scale-up of an mHealth-based system (EduSaltS) that integrated routine health education and salt reduction and was delivered through primary schools. This study aims to elaborate the framework, development process, features, and preliminary scaling-up of the EduSaltS system.

Methods

The EduSaltS system evolved from previously successfully tested interventions to reduce family salt intake by empowering schoolchildren through school health education. EduSaltS was designed by following the WHO's conceptual framework for developing a scaling-up strategy which accounted for the nature of the innovation, the capacity of the implementing organizations, the characteristics of the environment, the resources available, and type of scaling up. The system was then developed step by step from determination of online platform architecture, definition of component interventions and activities, development of specific educational materials and tools, to the development of the online/offline hybridized system. The system was tested and refined by a pilot in two schools and a preliminary scale-up in two cities in China.

Results

EduSaltS was developed as an innovative health education system, including an online WeChat-based education platform, a set of offline activities, and an actual administrative website showing the progress and setting the system. The WeChat platform could be installed on users' smartphones to automatically deliver 20 sessions of five-minute well-structured cartoon video classes, followed by other online interactive activities. It also helps support project implementation and real-time performance evaluation. As a first-stage roll-out, a one-year course has been successfully implemented among 54,538 children and their families from 209 schools in two cities, and the average course completion rate was 89.1%.

Conclusion

As an innovative mHealth-based health education system, EduSaltS was developed based on successfully tested interventions and an appropriate framework for scaling up. The early-stage roll-out has shown its preliminary scalability, and further evaluation is ongoing.

Wrangle with hypertension: lowered salt intake may not compromise iodine status among tribes of Central India

OBJECTIVES

The most important risk factor of cardiovascular disease is hypertension and high salt intake contributes to high blood pressure. However, to prevent iodine deficiency disorders, the iodisation of salt is a proven strategy. So, on one hand, we suggest people reduced salt consumption but on the other hand, we also fear an increase in the prevalence of iodine deficiency disorders. In the present study, we investigated the possibility of salt intake at WHO recommended levels resulting in higher or lower iodine status in India by assessing the urinary iodine status and its relation with blood pressure.

DESIGN

It was a cross-sectional study.

SETTING

It was a community-based study.

PARTICIPANTS

We collected 24-hour urine samples for estimation of iodine concentrations in urine from 411 adult hypertensives in the Mandla district of central India. Urinary iodine was estimated using Thermo ORION make ion-selective electrodes.

RESULTS

The median urinary iodine excretion was 162·6 mcg/l. Interestingly 371 (90·26 %) subjects were observed with > 200 mcg/l urinary iodine concentration level indicating iodine sufficiency. Individuals with high urine Na significantly had high blood pressure as compared with individuals with low urinary Na excretion (P < 0·01). There is a higher probability of high urine iodine levels among individuals with higher urine Na levels.

CONCLUSION

The study revealed that 90 % of the population were excreting excessive iodine in urine, which is more than adequate iodine uptake. This excess uptake enables a scope for reduction in salt intake to control hypertension.

Impact of a Nutrition Education Intervention on Salt/Sodium Related Knowledge, Attitude, and Practice of University Students

Background

Salt reduction strategies help reduce the risk of cardiovascular diseases (CVDs) by reducing high blood pressure. This study aimed to assess salt related knowledge, attitude, and practices (KAP) before and after administering an evidence-based nutrition education workshop.

Methods

Ninety non-medical university students were recruited to investigate KAP related to dietary salt intake. The KAP components were assessed before, immediately after, and 4-weeks after administering an evidence-based educational workshop and leaflet.

Results

Knowledge and attitudes related to salt improved significantly immediately post-intervention but were not fully retained after 4-weeks. Five of the 13 evaluated practices improved after 4-weeks: trying to buy low-salt foods increased from 10 to 19% (P = 0.022), rarely adding salt to food during cooking increased from 5 to 16% (P = 0.019), rarely adding salt to food at the table increased from 29 to 42% (P = 0.011), tried to reduce salt intake increased from 26 to 41% (P = 0.014), and tried to use spices to reduce salt increased from 31 to 45% (P = 0.044).

Conclusions

The educational intervention had a positive impact on salt-related knowledge, attitudes, and practices, but the effect was not fully retained on the long-term. Periodic educational interventions should be considered to refresh knowledge and reinforce practices.

Knowledge, attitude and behaviour of university students regarding salt and iodine: a multicentre cross-sectional study in six countries in Europe and Asia

Background

Strategies to reduce salt intake are encouraged to be implemented in parallel with those that aim to ensure iodine adequacy at the population level. The aim of the present study was to assess and compare knowledge, attitudes and behaviours related to salt and iodine among students in Europe and Asia.

Methods

A multicentre cross-sectional study was conducted with 2459 university students in total (42.7% males, median age 21 years) from four countries in Europe and two countries in Asia. Data were collected with the use of a self-administered questionnaire, and univariate and multivariate statistical analyses were performed to explore any association between variables.

Results

Only 6.5% of all participants knew the correct salt recommendations. Nearly a quarter of them (24.4%) found salt recommendations confusing and/or contradictory. There were significant differences between European and Asian participants, with those from Europe being better informed about salt recommendations, but significantly less knowledgeable about iodine. The reported frequency of use of salt and salt-containing sauces either at the table or for cooking, as well as knowledge about ways to reduce salt intake among those who indicated to make conscious efforts to do so, differed significantly between countries. Significant differences between countries were also observed with respect to the type of salt used, with about one third of all participants (34%) not being aware of the kind of salt they used.

Conclusion

The results of this survey highlight serious salt- and iodine-related knowledge gaps among university students in Europe and Asia. Raising awareness and conducting information campaigns is needed to promote changes in behaviour that would result in a reduction of salt intake and conscious use of iodised salt at the individual level.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00593-5.