Knowledge and Practices Related to Salt Intake among Saudi Adults
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample
2.2. Sodium Intake
2.3. Assessment of Anthropometric Measurements
2.4. Assessment of Blood Pressure
2.5. Assessment of Salt-Related Knowledge
2.6. Assessment of Salt-Related Practices
2.7. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Alkhunaizi, A.M.; Al Jishi, H.A.; Al Sodah, Z.A. Salt Intake in Eastern Saudi Arabia. East. Mediterr. Heal. J. 2013, 19, 915–918. [Google Scholar] [CrossRef]
- Brown, I.J.; Tzoulaki, I.; Candeias, V.; Elliott, P. Salt Intakes Around the World: Implications for Public Health. Int. J. Epidemiol. 2009, 38, 791–813. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mozaffarian, D.; Fahimi, S.; Singh, G.M.; Micha, R.; Khatibzadeh, S.; Engell, R.E.; Lim, S.; Danaei, G.; Ezzati, M.; Powles, J.; et al. Global Sodium Consumption and Death From Cardiovascular Causes. N. Engl. J. Med. 2014, 371, 624–634. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases. World Health Organ. Tech. Rep. S. 2003. [Google Scholar] [CrossRef] [Green Version]
- World Health Organization. WHO | Sodium Intake for Adults and Children. Available online: https://www.who.int/elena/titles/guidance_summaries/sodium_intake/en/#:~:text=WHO%20recommendations,%2Fday%20salt)%20in%20adults. (accessed on 27 June 2020).
- Shaldon, S.; Vienken, J. Beyond the Current Paradigm: Recent Advances in the Understanding of Sodium Handling–Guest Editors: Stanley Shaldon and Joerg Vienken: Salt, the Neglected Silent Killer. Semin. Dial. 2009, 22, 252. [Google Scholar] [CrossRef]
- World Health Organization. Salt Reduction. Available online: https://www.who.int/news-room/fact-sheets/detail/salt-reduction#; World Health Organization, 2020:~:text=Salt%20intake%20of%20less%20than,stroke%20and%20coronary%20heart%20attack.&text=WHO%20Member%20States%20have%20agreed,a%20relative%2030%25%20by%202025 (accessed on 27 June 2020).
- World Health Organization. Noncommunicable Diseases Progress Monitor 2015. 2015. Available online: https://www.who.int/nmh/publications/ncd-progress-monitor-2015/en/ (accessed on 27 June 2020).
- American Heart Association. Shaking the Salt Habit to Lower High Blood Pressure. Available online: https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/shaking-the-salt-habit-to-lower-high-blood-pressure#; American Heart Association, 2020:~:text=The%20American%20Heart%20Association%20recommends,blood%20pressure%20and%20heart%20health (accessed on 27 June 2020).
- Webster, J.L.; Dunford, E.K.; Neal, B.C. A Systematic Survey of the Sodium Contents of Processed Foods. Am. J. Clin. Nutr. 2010, 91, 413–420. [Google Scholar] [CrossRef] [Green Version]
- Mattes, R.D.; Donnelly, D. Relative Contributions of Dietary Sodium Sources. J. Am. Coll. Nutr. 1991, 10, 383–393. [Google Scholar] [CrossRef]
- Alhamad, N.; Almalt, E.; Alamir, N.; Subhakaran, M. An Overview of Salt Intake Reduction Efforts in the Gulf Cooperation Council Countries. Cardiovasc. Diagn. Ther. 2015, 5, 172–177. [Google Scholar] [CrossRef]
- Moradi-Lakeh, M.; El Bcheraoui, C.; Afshin, A.; Daoud, F.; AlMazroa, M.A.; AlSaeedi, M.; Basulaiman, M.; Memish, Z.A.; Al Rabeeah, A.A.; Mokdad, A.H. Diet in Saudi Arabia: Findings From a Nationally Representative Survey. Public Heal. Nutr. 2017, 20, 1075–1081. [Google Scholar] [CrossRef] [Green Version]
- Alawwa, I.; Dagash, R.; Saleh, A.; Ahmad, A. Dietary Salt Consumption and the Knowledge, Attitudes and Behavior of Healthy Adults: a Cross-Sectional Study From Jordan. Libyan J. Med. 2018, 13, 1479602. [Google Scholar] [CrossRef]
- Nasreddine, L.; Akl, C.; Al-Shaar, L.; Almedawar, M.M.; Isma’eel, H. Consumer Knowledge, Attitudes and Salt-Related Behavior in the Middle-East: the Case of Lebanon. Nutrients 2014, 6, 5079–5102. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sarmugam, R.; Worsley, A.; Wang, W. An Examination of the Mediating Role of Salt Knowledge and Beliefs on the Relationship Between Socio-Demographic Factors and Discretionary Salt Use: a Cross-Sectional Study. Int. J. Behav. Nutr. Phys. Act. 2013, 10, 25. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Strategies to Monitor and Evaluate Population Sodium Consumption and Sources of Sodium in the Diet; Report of a Joint Technical Meeting Convened by WHO and the Government of Canada; World Health Organization, 2011; Available online: https://apps.who.int/iris/bitstream/handle/10665/44614/9789241501699_eng.pdf?sequence=1 (accessed on 27 June 2020).
- He, F.J.; MacGregor, G.A. Salt Reduction Lowers Cardiovascular Risk: Meta-Analysis of Outcome Trials. Lancet 2011, 378(9789), 380–382. [Google Scholar] [CrossRef]
- Bibbins-Domingo, K.; Chertow, G.; Coxson, P.; Moran, A.; Lightwood, J.M.; Pletcher, M.J.; Goldman, L. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010, 362, 590–599. [Google Scholar] [CrossRef] [Green Version]
- World Health Organization. Reducing Salt Intake in Populations: Report of a WHO Forum and Technical Meeting, 5–7 October 2006; World Health Organization: Paris, France, 2014. [Google Scholar] [CrossRef]
- Alkhalaf, M.M.; Edwards, C.A.; Combet, E. Validation of a Food Frequency Questionnaire Specific for Salt Intake in Saudi Arabian Adults Using Urinary Biomarker and Repeated Multiple Pass 24-Hour Dietary Recall. Proc. Nutr. Soc. 2015, 74. [Google Scholar] [CrossRef] [Green Version]
- World Health Organization. Global Health Observatory (GHO) Data: Mean Body Mass Index (BMI). Available online: https://www.who.int/gho/ncd/risk_factors/bmi_text/en/ (accessed on 27 June 2020).
- Whelton, P.K.; Carey, R.M.; Aronow, W.S.; Casey, D.E., Jr.; Collins, K.J.; Himmelfarb, C.D.; DePalma, S.M.; Gidding, S.; Jamerson, K.A.; Jones, D.W.; et al. 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults a Report of the American College of Cardiology. Am. Heart Assoc. 2018, 71, e127–e248. [Google Scholar]
- Ismail, L.C. Knowledge, Attitude, and Practice on Salt and Assessment of Dietary Salt and Fat Intake Among University of Sharjah Students. Nutrients 2019, 11, 941. [Google Scholar] [CrossRef] [Green Version]
- Othman, F.; Ambak, R.; Siew Man, C.; Mohd Zaki, N.A.; Ahmad, M.H.; Abdul Aziz, N.S.; Baharuddin, A.; Salleh, R.; Aris, T. Factors Associated With High Sodium Intake Assessed From 24-Hour Urinary Excretion and the Potential Effect of Energy Intake. J. Nutr. Metab. 2019, 2019, 6781597. [Google Scholar] [CrossRef]
- McKenzie, B.; Santos, J.A.; Trieu, K.; Thout, S.R.; Johnson, C.; Arcand, J.; Webster, J.; McLean, R. The Science of Salt: a Focused Review on Salt-Related Knowledge, Attitudes and Behaviors, and Gender Differences. J. Clin. Hypertens. (Greenwich) 2018, 20, 850–866. [Google Scholar] [CrossRef] [Green Version]
- Webster, J.L.; Li, N.; Dunford, E.K.; Nowson, C.A.; Neal, B.C. Consumer Awareness and Self-Reported Behaviours Related to Salt Consumption in Australia. Asia Pac. J. Clin. Nutr. 2010, 19, 550–554. [Google Scholar] [CrossRef]
- Dickson-Spillmann, M.; Siegrist, M. Consumers’ Knowledge of Healthy Diets and Its Correlation With Dietary Behaviour. J. Hum. Nutr. Diet. 2011, 24, 54–60. [Google Scholar] [CrossRef] [PubMed]
- Zhang, J.; Xu, A.Q.; Ma, J.X.; Shi, X.M.; Guo, X.L.; Engelgau, M.; Yan, L.X.; Li, Y.; Li, Y.C.; Wang, H.C.; et al. Dietary Sodium Intake: Knowledge, Attitudes and Practices in Shandong Province, China, 2011. PLOS ONE 2013, 8, e58973. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Evans, M.; Cohen, J.; Kumanyika, S. Implementing Recommendations for Dietary Salt Reduction. Where Are We? Where Are We Going? How Do We Get There? A Summary of an NHLBI Workshop; DIANE Publishing: Bethesda, MD, USA, 1996. [Google Scholar]
- Magalhães, P.; Sanhangala, E.J.R.; Dombele, I.M.; Ulundo, H.S.N.; Capingana, D.P.; Silva, A.B.T. Knowledge, Attitude and Behaviour Regarding Dietary Salt Intake Among Medical Students in Angola. Cardiovasc. J. Afr. 2015, 26, 57–62. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Adam, A.; Osama, S.; Muhammad, K.I. Nutrition and Food Consumption Patterns in the Kingdom of Saudi Arabia. Pakistan J. of Nutrition 2014, 13, 181–190. [Google Scholar] [CrossRef] [Green Version]
- Saeedi, M.; AlMadani, A.J.; Alsafi, Y.H.; Arif, S.H.; Mustafa, S.M.; Jamo, A.I. Estimation of Sodium and Potassium Intake in 24-Hours Urine, Aljouf Region, Northern Saudi Arabia. Chronic Dis. Int. 2017, 4, 1026. [Google Scholar]
- Parmenter, K.; Waller, J.; Wardle, J. Demographic Variation in Nutrition Knowledge in England. Health Educ. Res. 2000, 15, 163–174. [Google Scholar] [CrossRef] [Green Version]
- Dallongeville, J.; Marécaux, N.; Cottel, D.; Bingham, A.; Amouyel, P. Association Between Nutrition Knowledge and Nutritional Intake in Middle-Aged Men From Northern France. Public Health Nutr. 2001, 4, 27–33. [Google Scholar] [CrossRef] [Green Version]
- Wardle, J.; Parmenter, K.; Waller, J. Nutrition Knowledge and Food Intake. Appetite 2000, 111, 1713–1726. [Google Scholar] [CrossRef]
Characteristics | n | (%) |
---|---|---|
Age (years) | ||
20–29 | 294 | 63.0 |
30–39 | 91 | 19.5 |
≥40 | 82 | 17.5 |
Sex | ||
Male | 186 | 39.8 |
Female | 281 | 60.2 |
Marital status | ||
Single | 196 | 42.0 |
Married | 271 | 58.0 |
Education level | ||
High-school/Diploma | 229 | 49.0 |
University degree/Postgraduate degree | 238 | 51.0 |
Family income (SR) | ||
<5000 | 243 | 52.0 |
5000–10,000 | 102 | 21.9 |
>10,000 | 122 | 26.1 |
City of residence | ||
Madinah | 368 | 78.8 |
Jeddah | 99 | 21.2 |
Weight status (BMI in kg/m2) | ||
Underweight (<18.5) | 40 | 8.57 |
Healthy weight (18.5–24.99) | 179 | 38.3 |
Overweight (25–29.99) | 122 | 26.1 |
Obese (≥30) | 126 | 27.0 |
Blood pressure (mm Hg) | ||
Normal (<120/80) | 158 | 33.8 |
Elevated (systolic 120–129 and diastolic <80) | 42 | 8.99 |
Stage 1 hypertension (systolic 130–139 or diastolic 80–89) | 186 | 39.8 |
Stage 2 hypertension (systolic >140 or diastolic ≥90) | 81 | 17.3 |
Variable | Males (n = 186) | Females (n = 281) | Total (n = 467) | p | |
---|---|---|---|---|---|
Salt-related knowledge | |||||
1 | Could high salt intake in the diet adversely affect health? | ||||
Yes a | 169 (90.9) | 274 (97.5) | 443 (94.9) | 0.002 * | |
No | 17 (9.10) | 7 (2.50) | 24 (5.10) | ||
Could high salt intake increase the risk for…… | |||||
2 | Hypertension? | ||||
Yes a | 163 (87.6) | 262 (93.2) | 425 (91.0) | 0.038 * | |
No | 23 (12.4) | 19 (6.80) | 42 (9.00) | ||
3 | Osteoporosis? | ||||
Yes a | 23 (12.4) | 35 (12.5) | 58 (12.4) | 0.977 | |
No | 163 (87.6) | 246 (87.5) | 409 (87.6) | ||
4 | Stomach cancer? | ||||
Yes a | 9 (4.80) | 15 (5.30) | 24 (5.10) | 0.811 | |
No | 117 (95.2) | 266 (94.7) | 443 (94.9) | ||
5 | Kidney stones? | ||||
Yes a | 70 (37.6) | 155 (55.2) | 225 (48.2) | <0.001 * | |
No | 116 (62.4) | 126 (44.8) | 242 (51.8) | ||
Salt-related practices | |||||
1 | Sodium intake within the recommendation of the American Heart Association (<2,300 mg/day) | 15 (8.10) | 29 (10.3) | 44 (9.40) | 0.414 |
Sodium intake above the recommendation of the American Heart Association (≥2,300 mg/day) | 171 (91.9) | 252 (89.7) | 423 (90.6) | ||
2 | Addition of salt to food during cooking | ||||
Always/Usually/Sometime | 177 (95.2) | 270 (96.1) | 447 (95.7) | 0.629 | |
Rarely/Never | 9 (4.80) | 11 (3.90) | 20 (4.30) | ||
3 | Addition salt to food at the table | ||||
Always/Usually/Sometime | 46 (24.7) | 49 (17.5) | 95 (20.4) | 0.058 | |
Rarely/Never | 140 (75.3) | 231 (82.5) | 371 (79.6) | ||
4 | Previously tried reducing salt intake | ||||
Yes | 75 (40.3) | 134 (47.7) | 209 (44.8) | 0.117 | |
No | 111 (59.7) | 147 (52.3) | 258 (55.2) | ||
5 | Previously tried using salt alternatives | ||||
Yes | 2 (1.10) | 12 (4.30) | 14 (3.00) | 0.047 * | |
No | 184 (98.9) | 269 (95.7) | 453 (97.0) | ||
6 | Fast food consumption | ||||
Once a week or less | 41 (22.0) | 131 (46.6) | 172 (36.8) | <0.001 * | |
Twice a week or more | 145 (78.0) | 150 (53.4) | 295 (63.2) |
Characteristics | Knowledge Score Out of 5 Mean (SD) | Practice Score Out of 6 Mean (SD) |
---|---|---|
Age (years) | ||
20–29 | 3.29 (0.79) | 1.60 (0.96) |
30–39 | 3.16 (0.73) | 1.73 (0.99) |
≥40 | 3.32 (0.66) | 2.37 (0.94) |
p-value | 0.211 | <0.001 * |
Sex | ||
Male | 3.09 (0.83) | 1.50 (0.94) |
Female | 3.39 (0.68) | 1.93 (1.00) |
p-value | <0.001 * | <0.001 * |
Marital status | ||
Single | 3.25 (0.74) | 1.97 (1.00) |
Married | 3.28 (0.78) | 1.60 (0.97) |
p-value | 0.653 | <0.001 * |
Education level | ||
High-school/Diploma | 3.24 (0.77) | 1.74 (0.96) |
University degree/Postgraduate degree | 3.29 (0.75) | 1.78 (1.04) |
p-value | 0.536 | 0.684 |
Family income (SR) | ||
<5000 | 3.29 (0.76) | 1.69 (1.01) |
5000–10,000 | 3.14 (0.81) | 1.80 (0.96) |
>10,000 | 3.33 (0.72) | 1.85 (1.01) |
p-value | 0.205 | 0.313 |
City of residence | ||
Madinah | 3.24 (0.73) | 1.80 (0.97) |
Jeddah | 3.35 (0.82) | 1.57 (1.10) |
p-value | 0.178 | 0.043 * |
Weight status (BMI in kg/m2) | ||
Underweight (<18.5) | 3.20 (0.72) | 1.74 (0.82) |
Healthy weight (18.5–4.99) | 3.32 (0.77) | 1.59 (1.03) |
Overweight (25–29.99) | 3.16 (0.80) | 1.71 (0.99) |
Obese (>30) | 3.31 (0.72) | 2.04 (0.96) |
p-value | 0.268 | 0.001 * |
Blood pressure (mm Hg) * | ||
Normal (<120/80) | 3.32 (0.76) | 1.82 (0.98) |
Elevated (systolic 120–129 and diastolic <80) | 3.17 (0.76) | 1.48 (1.05) |
Stage 1 hypertension (systolic 130–139 or diastolic 80–89) | 3.31 (0.72) | 1.73 (1.03) |
Stage 2 hypertension (systolic >140 or diastolic ≥90) | 3.12 (0.84) | 1.85 (0.92) |
p-value | 0.213 | 0.139 |
Beta Estimate | Standard Error | p | 95% CI | F | R-Square | |
---|---|---|---|---|---|---|
Sodium intake (mg/day) | ||||||
Salt-related knowledge | −88.3 | 163 | 0.588 | −408 to 232 | 2.38 | 0.01 |
Salt-related practices | −457 | 123 | <0.001 * | −699 to −215 | 4.65 | 0.05 |
Systolic blood pressure (mm Hg) | ||||||
Salt-related knowledge | −0.33 | 0.70 | 0.643 | −1.71 to 1.06 | 35.1 | 0.13 |
Salt-related practices | 0.39 | 0.55 | 0.480 | −0.69 to 1.46 | 14.9 | 0.14 |
Diastolic blood pressure (mm Hg) | ||||||
Salt-related knowledge | −0.37 | 0.58 | 0.522 | −1.51 to 0.77 | 4.13 | 0.02 |
Salt-related practices | 0.35 | 0.45 | 0.444 | −0.54 to 1.23 | 1.80 | 0.02 |
BMI (BMI in kg/m2) | ||||||
Salt-related knowledge | 0.60 | 0.36 | 0.119 | −0.15 to 1.26 | 9.74 | 0.04 |
Salt-related practices | 0.56 | 0.25 | 0.026 * | 0.07 to 1.05 | 28.2 | 0.23 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Hanbazaza, M.A.; Mumena, W.A. Knowledge and Practices Related to Salt Intake among Saudi Adults. Int. J. Environ. Res. Public Health 2020, 17, 5749. https://doi.org/10.3390/ijerph17165749
Hanbazaza MA, Mumena WA. Knowledge and Practices Related to Salt Intake among Saudi Adults. International Journal of Environmental Research and Public Health. 2020; 17(16):5749. https://doi.org/10.3390/ijerph17165749
Chicago/Turabian StyleHanbazaza, Mahitab A., and Walaa A. Mumena. 2020. "Knowledge and Practices Related to Salt Intake among Saudi Adults" International Journal of Environmental Research and Public Health 17, no. 16: 5749. https://doi.org/10.3390/ijerph17165749
APA StyleHanbazaza, M. A., & Mumena, W. A. (2020). Knowledge and Practices Related to Salt Intake among Saudi Adults. International Journal of Environmental Research and Public Health, 17(16), 5749. https://doi.org/10.3390/ijerph17165749