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      National Approaches to Monitoring Population Salt Intake: A Trade-Off between Accuracy and Practicality?

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      1 , 2 , * , 3
      PLoS ONE
      Public Library of Science

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          Abstract

          Aims

          There is strong evidence that diets high in salt are bad for health and that salt reduction strategies are cost effective. However, whilst it is clear that most people are eating too much salt, obtaining an accurate assessment of population salt intake is not straightforward, particularly in resource poor settings. The objective of this study is to identify what approaches governments are taking to monitoring salt intake, with the ultimate goal of identifying what actions are needed to address challenges to monitoring salt intake, especially in low and middle-income countries.

          Methods and Results

          A written survey was issued to governments to establish the details of their monitoring methods. Of the 30 countries that reported conducting formal government salt monitoring activities, 73% were high income countries. Less than half of the 30 countries, used the most accurate assessment of salt through 24 hour urine, and only two of these were developing countries. The remainder mainly relied on estimates through dietary surveys.

          Conclusions

          The study identified a strong need to establish more practical ways of assessing salt intake as well as technical support and advice to ensure that low and middle income countries can implement salt monitoring activities effectively.

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          Most cited references7

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          Estimation of salt intake by 24 h urinary sodium excretion in a representative sample of Spanish adults.

          The present study reports the Na intake of a representative sample of Spanish young and middle-aged adults aged 18-60 years (n 418, 53·1 % women, selected from the capitals of fifteen provinces and the surrounding semi-urban/rural area), measured with a 24 h urinary Na excretion method. To validate the paper collection of 24 h urine, the correlation between fat-free mass determined by electrical bioimpedance (50·8 (sd 11·3) kg) and that determined via urinary creatinine excretion (51·5 (sd 18·8) kg) was calculated (r 0·633, P 200 mmol/d urinary Na--a consequence of the higher salt intake in men and in participants with higher BMI. The present results help us to know the baseline salt intake in the Spanish young and middle-aged adult population, and can be used as the baseline to design policies to reduce salt consumption.
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            Policy options to reduce population salt intake.

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              Dietary salt intake and hypertension in an urban south Indian population--[CURES - 53].

              The aim of the study was to determine the mean dietary salt intake in urban south India and to look at its association with hypertension. The Chennai Urban Rural Epidemiology Study (CURES) is an ongoing population based study on a representative population of Chennai city in southern India. Phase 1 of CURES recruited 26,001 individuals aged > or = 20 years, of whom every tenth subject (n = 2600) was invited to participate in Phase 3 for detailed dietary studies and 2220 subjects participated in the present study (response rate: 84.5%). Participants with self-reported history of hypertension, diabetes or heart disease were excluded from the study (n = 318) and thus the final study numbers were 1902 subjects. Dietary salt, energy, macronutrients and micronutrients intake were measured using a validated semi-quantitative food frequency questionnaire. Diagnosis of hypertension was based on the National Cholesterol Education Programme (NCEP) Adult Treatment Panel III criteria. Logistic regression analysis was used to look at the association of dietary salt with hypertension. Mean dietary salt intake (8.5 g/d) in the population was higher than the recommended by the World Health Organization ( 1 teaspoon/day at the dining table was associated with a higher prevalence for hypertension compared to zero added salt (38.5% vs 23.3%, Chi-square = 18.95; p < 0.0001). Multiple logistic regression analysis revealed that even after adjusting for age, gender, body mass index, total energy intake and dietary fat, total dietary salt intake was positively associated with hypertension. [Odds ratio (OR): 1.161, 95% Confidence Interval (CI): 1.115-1.209, p < 0.0001]. Intake of dietary salt in urban south India is higher than currently recommended. Increasing salt intake is associated with increased risk for hypertension even after adjusting for potential confounders. This calls for urgent steps to decrease salt consumption of the population at high risk.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                17 October 2012
                : 7
                : 10
                : e46727
                Affiliations
                [1 ]World Cancer Research Fund International, London, United Kingdom
                [2 ]Independent Food Policy and Public Health Specialist, Liverpool, United Kingdom
                [3 ]The George Institute for Global Health, University of Sydney, Sydney, Australia
                Lausanne University Hospital and University of Lausanne, Switzerland
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: CH. Performed the experiments: CH. Analyzed the data: CH JW. Wrote the paper: CH JW.

                Article
                PONE-D-12-08910
                10.1371/journal.pone.0046727
                3474782
                23082128
                5815e192-1918-4cc6-b2d2-84b472151805
                Copyright @ 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 2 March 2012
                : 6 September 2012
                Page count
                Pages: 8
                Funding
                Corinna Hawkes received funding from Health Canada to conduct the survey reported in this study. Jacqui Webster was supported in her research on salt reduction throughout the period of this study by a National Health and Medical Council Partnership Project. She also received funding from the World Health Organisation to facilitate the development of salt reduction strategies in Pacific Islands and Mongolia and was commissioned by Health Canada to draft a Framework for Monitoring and Evaluation of Salt Reduction Strategies for WHO Member States. The funders were a member of a group that advised on the study. They therefore provided comments on the study design. They also participated by responding to the questionnaire. They played no role in data collection other than responding to the questionnaire. They played a role in the analysis by providing comments on drafts of the report. As recipients of the questionnaire, they also provided comments on the final manuscript (as did all recipients). The funders also provided the authors with permission to publish the manuscript in an academic journal.
                Categories
                Research Article
                Medicine
                Cardiovascular
                Hypertension
                Epidemiology
                Cardiovascular Disease Epidemiology
                Epidemiological Methods
                Survey Methods
                Global Health
                Non-Clinical Medicine
                Health Care Policy
                Geographic and National Differences
                Health Risk Analysis
                Health Statistics
                Nutrition
                Public Health
                Behavioral and Social Aspects of Health
                Health Screening
                Preventive Medicine
                Science Policy
                Research Laboratories
                Government Laboratories

                Uncategorized
                Uncategorized

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