Sodium and potassium excretion in an adult Caribbean population of African descent with a high burden of cardiovascular disease

Abstract

BackgroundHigh sodium diets with inadequate potassium and high sodium-to-potassium ratios are a known determinant of hypertension and cardiovascular disease (CVD). The Caribbean island of Barbados has a high prevalence of hypertension and mortality from CVD. Our objectives were to estimate sodium and potassium excretion, to compare estimated levels with recommended intakes and to identify the main food sources of sodium in Barbadian adults.MethodsA sub-sample (n = 364; 25–64 years) was randomly selected from the representative population-based Health of the Nation cross-sectional study (n = 1234), in 2012–13. A single 24-h urine sample was collected from each participant, following a strictly applied protocol designed to reject incomplete samples, for the measurement of sodium and potassium excretion (in mg), which were used as proxy estimates of dietary intake. In addition, sensitivity analyses based on estimated completeness of urine collection from urine creatinine values were undertaken. Multiple linear regression was used to examine differences in sodium and potassium excretion, and the sodium-to-potassium ratio, by age, sex and educational level. Two 24-h recalls were used to identify the main dietary sources of sodium. All analyses were weighted for the survey design.ResultsMean sodium excretion was 2656 (2488–2824) mg/day, with 67% (62–73%) exceeding the World Health Organization (WHO) recommended limit of 2000 mg/d. Mean potassium excretion was 1469 (1395–1542) mg/d; < 0.5% met recommended minimum intake levels. Mean sodium-to-potassium ratio was 2.0 (1.9–2.1); not one participant had a ratio that met WHO recommendations. Higher potassium intake and lower sodium-to-potassium ratio were independently associated with age and tertiary education. Sensitivity analyses based on urine creatinine values did not notably alter these findings.ConclusionsIn this first nationally representative study with objective assessment of sodium and potassium excretion in a Caribbean population in over 20 years, levels of sodium intake were high, and potassium intake was low. Younger age and lower educational level were associated with the highest sodium-to-potassium ratios. These findings provide baseline values for planning future policy interventions for non-communicable disease prevention.

The Science of Salt: Updating the evidence on global estimates of salt intake

“…The proportion of males and females were nearly equal across all studies, and age ranged between 18 and 90 years. The majority of studies used 24-hour urine volume and creatinine to assess the completeness of 24-hour urine collection 16,17,[19][20][21][22][23][24][25][26][27] ; while two studies used para-amino benzoic acid (PABA). 28,29 Details on the representativeness of each study are presented in Table 1 (with references).…”

Sodium and Salt Consumption in Latin America and the Caribbean: A Systematic-Review and Meta-Analysis of Population-Based Studies and Surveys

“…The search yielded 2350 results, and 2297 were excluded at the screening stage; thus, 53 were studied in detail. Finally, 15 reports (i.e., individual papers) were included in the systematic review providing results for 18 studies (Figure 1) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Two studies were excluded from meta-analysis (quantitative synthesis of results) because numeric results were not available, i.e., they only reported proportions or figures without the exact numbers [13,18].…”

“…Brazil contributed to the review with seven studies [11,14,15,[17][18][19][20], Chile with four [11,16,21,23] and Argentina with two [10,11]; whereas Barbados [9], Colombia [11], Ecuador [13], Peru [22] and Uruguay [12] contributed with one study each (Table 1). Three studies analyzed a nationally representative sample (Table 1) [9,15,21].…”

“…This limits the information available for the region and hampers the regional capacity to monitor sodium intake and meet global targets to achieve sodium/salt intake reduction. [9] Therefore, to improve the evidence for Latin America and the Caribbean so that it can inform local policies and surveillance systems, we aimed to synthesize the available information on sodium consumption at the general population level in these countries. For this, a systematic review was conducted to provide recent population-based estimates on sodium consumption using urine samples (i.e., 24 h, 12 h, overnight or spot samples); we also highlighted research needs and opportunities.…”

Nutritional adequacy and dietary disparities in an adult Caribbean population of African descent with a high burden of diabetes and cardiovascular disease

“…In 2012–2013, we conducted the population‐based Barbados Salt Study in adults aged 25–64 years, which included 24‐hr dietary recalls and urine collection. We have previously published the data on urine sodium and potassium excretion from this study (Harris et al, ). Here, we describe data on nutritional adequacy from this population, the most detailed account to date and including for the first time for this population analyses by social group.…”