Salt and potassium intake among adult Ghanaians: WHO-SAGE Ghana Wave 3

Abstract

Though Ghana has high hypertension prevalence, the country lacks current national salt consumption data required to build and enhance advocacy for salt reduction. We explored the characteristics of a randomly selected sub sample that had valid urine collection, along with matched survey, anthropometric and BP data (n = 839, mean age = 60y), from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE), Ghana Wave 3, n = 3053). We also investigated the relationship between salt intake and blood pressure (BP) among the cohort. BP was measured in triplicate and 24 h urine was collected for the determination of urinary sodium (Na), potassium (K), creatinine (Cr) and iodine levels. Hypertension prevalence was 44.3%. Median salt intake was 8.3 g/day, higher in women compared to men (8.6, interquartile range (IQR) 7.5 g/day vs 7.5, IQR 7.4 g/day, p < 0.01), younger participants (18–49 y) compared to older ones (50+ y) (9.7, IQR 7.9 g/day vs 8.1, IQR 7.1 g/day, p < 0.01) and those with higher Body Mass Index (BMI) (> 30 kg/m2) compared to a healthy BMI (18.5–24.9 kg/m2) (10.04, IQR 5.1 g/day vs 6.2, IQR 5.6 g/day, p < 0.01). More than three quarters (77%, n = 647) of participants had salt intakes above the WHO maximum recommendation of 5 g/d, and nearly two thirds (65%, n = 548) had daily K intakes below the recommended level of 90 mmol. Dietary sodium to potassium (Na: K) ratios above 2 mmol/mmol were positively associated with increasing BP with age. Population-based interventions to reduce salt intake and increase K consumption are needed.

Consumption of Discretionary Salt and Salt from Bouillon among Households, Women, and Young Children in Northern Region, Ghana: A Mixed-Methods Study with the Condiment Micronutrient Innovation Trial (CoMIT) Project

“…The face validity and reliability of the qualitative data were enhanced through triangulation with notes from the FGDs and discussions with fieldworkers, independent FGD transcript transcription and translation, independent transcript double-coding verified with Cohen’s Kappa, and the inclusion of exemplar quotes to illustrate and support each salient FGD theme [ 28 , 54 ]. Additionally, our estimates of salt consumption align with other salt consumption estimates in Ghana, with research specifying discretionary salt as the main dietary source of sodium and that salt is mainly added during cooking [ 14 , 20 , 60 ].…”

“…Few studies have assessed salt consumption in Ghana. In studies among adults, salt consumption was ∼6–12 g/d using data from 24-h urinary sodium excretion [ [12] , [13] , [14] , [15] ] and household salt inventories [ 16 ]. Among children (aged 5–12 y), salt consumption was ∼6.4 g/d from 24-h urine data [ 17 ].…”

Effect of South Africa’s interim mandatory salt reduction programme on urinary sodium excretion and blood pressure

“…In Ghana, a comparative sub Saharan African country that does not have a salt reduction policy, salt intake is estimated to be much higher than in South Africa from data collected in WHO-SAGE W3 in that country and with similar methodology. In Ghana, median salt intake in 2018–19 was 8.3 g/day, and higher in younger participants (18–49 y) compared to older ones (50 + y) (9.7 (IQR 7.9) vs 8.1 (7.1) g/day, respectively; p < 0.01) ( Menyanu et al, 2020 ). While the median salt intake is higher than in South Africa, the pattern of elevated intakes in younger adults appears consistent across the two countries.…”

Serum potassium concentration and its association with hypertension among Ghanaian migrants and non-migrants: The RODAM study

“…Although this questionnaire was developed in an extensive process including standardised description of portion sizes, 24 h-dietary recalls and the German Nutrient Database (BLS 3.01) (2010) and the West African Food Composition Table (2012) to translate usual food intake into energy consumption and intake of nutrients [24], the questionnaire was not validated against urinary excretion, and potassium intake could have been under-or overestimated. However, as recent studies from Ghana and South-Africa did not find an association between 24 h urinary sodium or potassium excretion and BP [34,35], it is unclear whether other measuring techniques would have impacted our results. Future research is needed using data of both FPQ as well as 24 h urinary excretion to disentangle the complex interplay between potassium intake, serum potassium concentration and BP.…”