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]
- 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]
- World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases. World Health Organ. Tech. Rep. S. 2003. [Google Scholar] [CrossRef]
- 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]
- 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]
- 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]
- 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]
- 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]
- 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]
- 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]
- 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]
- 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]
- 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]
- 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]
- 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]
- 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 |
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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