High Salt Intake Implications as Risk Factor for Hypertension and Comparison of Three Salt Estimation Methods- Findings From Islamabad, Pakistan

Abstract

Objectives: The study was designed to estimate daily salt intake, its discretionary use in healthy individuals and to validate three common methods for salt estimation in Pakistani population. Methodology: Information on demography and discretionary salt use was collected from healthy adults (>18 years) along with a blood sample, spot and 24 hour urine samples. Sodium, chloride, potassium levels and serum creatinine were measured using standard methods. For daily salt estimation, three common methods i.e. INTERSALT, Tanaka and Kawasaki were validated for their applicability in local settings. Results: Overall 24 h sodium excretion was 158 mmol/l indicating intake of 8.64 (±4.43) grams salt per day which was significantly associated with male gender (p. <0.004) and adding salt during cooking (p. <0.0001). Most (73%) of the participants know about hazardous effects of high salt intake, however, only 25% consider important to lower salt intake. None of three methods i.e. INTERSALT (bias: -19.64; CCC -0.79), Tanaka (bias: 167.35; CCC -0.37) and Kawasaki (bias: -42.49, CCC -0.79) showed any agreement between measured and estimated 24 hour sodium. Conclusion: Daily intake of salt was high which increases the risk for hypertension. Comparison of methods for estimation revealed that none of the three methods could be used for estimating daily intake of salt in local settings of Pakistan.

Estimating mean population salt intake using spot urine samples in Nepal: a cross-sectional study

“…Studies from Samoa [31], France [32], the USA [33], Norway [34] reported that the INTERSALT with potassium yielded the lowest mean bias to the predicted group-level salt intake. Similarly, studies from Pakistan [35], Portugal [36] and South Africa [37,38] concluded that none of the included equations (Kawasaki, Tanaka, INTERSALT with potassium and Mage) could predict 24-h salt intake at population level. Consistent to our results, several previous studies reported the presence of proportional biases of spot urinebased equations in the Bland-Altman plots indicating positive or negative correlation of individual difference with the average mean intake [28,31,33,[39][40][41].…”