Knowledge, attitudes, and practices related to salt consumption in Nepal: Findings from the community‐based management of non‐communicable diseases project in Nepal (COBIN)

Abstract

High salt/sodium intake is associated with an increased risk of hypertension, which is a major risk factor for cardiovascular diseases. This paper aims to examine the association between salt consumption and salt‐related knowledge, attitudes, and practices (KAP) in Nepal. The cross‐sectional data used in this study were collected as part of the community‐based management of non‐communicable diseases project (COBIN) to understand the amount and KAP related to salt consumption in Nepal. Multivariate hierarchical logistic regression was performed to assess the association of salt‐related KAP and determinants of high salt consumption in Nepal. The mean per capita salt intake was 8.0 (±3.7) g/day, with 81.6% of the population reporting higher intake than the WHO recommendation of <5 g/day. People of upper castes [adjusted odds ratio (aOR) = 0.7; 95% confidence interval (CI): 0.5‐0.9], people in large families (aOR = 0.6; 95% CI: 0.5‐0.7), respondents who were advised to lower salt intake (aOR = 0.6; 95% CI: 0.4‐0.9) and who checked salt/sodium labels in food (aOR = 0.6; 95% CI: 0.4‐0.9) were less likely to consume higher amounts of salt. Similarly, people who added extra salt to their food at the table (aOR = 1.4; 95 CI: 1.1‐1.9) and who reported consuming high amounts of salt (aOR = 1.5; 95% CI: 1.1‐2.3) were more likely to have high salt intake. High salt intake was documented in this population. This study suggests the need for culturally tailored community‐based behavior modification through health education and dietary counseling to effectively reduce salt consumption and thereby support a reduction in hypertension and cardiovascular diseases in Nepal.

Mean dietary salt intake in Nepal: A population survey with 24‐hour urine collections

“…The estimated salt intake based on 24‐hour urinary samples is 5.0 g higher than the salt intake reported by dietary assessment methods in the same study area . Previous study used a salt spoon method to measure salt added during cooking for the two main meals of the day (the traditionally larger morning meal and evening meal).…”

“…Previous study used a salt spoon method to measure salt added during cooking for the two main meals of the day (the traditionally larger morning meal and evening meal). Salt consumption in Nepal is derived mainly from salt added during cooking, and the previous estimate of 8.0 g/d likely accurately reflects discretionary salt added during preparation of the two main meals of the day. However, use of the salt spoon methodology did not assess salt intake from salty condiments, snacks (including packaged or street foods), salty drinks, food eaten outside home, and additional meals consumed during the day.…”

“…No study conducted in Nepal has measured sodium consumption using 24‐hour urine samples. In our earlier study on knowledge, attitudes, and practices related to salt consumption in Nepal, we highlighted the need for estimating salt consumption by the 24‐hour urine collection method, given the context of rapidly changing lifestyle and food habits in Nepal . This study aims to estimate the amount of salt intake using 24‐hour urine analysis from a population‐based survey among the Community‐Based Management of Non‐Communicable Diseases in Nepal (COBIN) cohort.…”

Dietary salt reduction for primary prevention of cardiovascular disease in Nepal

“…11 Although the present study was unable to describe sources of dietary salt due to the lack of dietary data, a previous study using the COBIN cohort suggests that the majority (around 8 g/d) of consumption is from discretionary salt added during cooking and at the table. 12 A recent analysis of population dietary data suggests that Nepal is moving from agricultural food supply system to a diet based on processed foods, particularly in urban areas. 13 This will have implications for salt intake strategies into the future.…”

“…20 Nepal currently has no national salt reduction strategy, 21,22 although the government of Nepal has plans to develop initiatives in the future in partnerships with WHO and other non-governmental organizations. 12,23 The WHO SHAKE technical package outlines how countries can design and implement such a strategy, and includes action in five key areas: surveillance and monitoring, collaboration with industry to reformulate foods, improvements in food labeling, educating consumers and creating settings based approaches to healthy eating. 24 It is vital that any salt reduction strategy in Nepal takes account the importance of maintaining iodine status.…”