Dietary salt consumption and the knowledge, attitudes and behavior of healthy adults: a cross-sectional study from Jordan

ABSTRACT

High dietary sodium is recognized as a silent killer responsible for 2.3 million deaths worldwide in 2010 predominantly secondary to hypertension and its complications. Although high salt consumption is considered a worldwide public health problem, its magnitude is highly variable among different communities; therefore, it is important to study locally. This study aimed to evaluate habitual salt consumption, its important correlations, as well as the knowledge, attitude, and behavior of healthy Jordanian citizens. As potassium consumption is highly correlated and important we aimed to study both jointly. In this descriptive cross-sectional study we enrolled 103 healthy adult Jordanian citizens. All participants were interviewed for questionnaire filling, physical examination, and instructed on proper 24-hour urine collection procedure. We measured sodium and potassium concentration in the provided controlled 24-hour urine collection samples, as it is presently considered the gold standard for evaluating daily intake. The results showed an average sodium intake of 179 mmol (4.1 g) per day [higher in males at 186 mmol (4.3 g) vs. 173 mmol (4.0 g) for females], significantly above the current WHO recommendations, though only 8% regularly add salt to food. Ironically, most participants (82%) believe their salt consumption was appropriate and only 29% thought they may benefit from reducing salt intake. On the other hand, potassium intake is far below the current WHO recommendations. High sodium and low potassium intake have synergistic adverse effects on public health that is not currently addressed in Jordan. We conclude that Jordanian citizens currently consume high sodium and low potassium diet and are mostly unaware of its negative impact on their health. Hence, it is crucial for healthcare providers to intervene and adopt long-term strategies to control salt intake to reduce its negative effects in Jordan and elsewhere.

KEYWORDS:

• Salt consumption
• dietary sodium
• dietary potassium
• urinary sodium
• hypertension
• knowledge
• behavior
• Jordan

Acknowledgments

The authors acknowledge the helpful support and comments of Dr. Ayoub Al-Jawaldeh, and the generous financial support of the University of Jordan and WHO.

Authors’ contributions

Izzat AlAwwa initiated the study concept, design, and supervision; Rajaa Dagash and Abdelaziz Ahmad acquisition and extraction of data, Akram Saleh data review and analysis, all authors contributed to the analysis and preparation of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

All participants signed informed consent forms, and the study protocol was approved by the local Research Ethics Committee of JUH.

Paper context

High salt consumption is a major health hazard that hasn’t been identified previously in Jordan. In this paper we confirmed that most healthy participants consume unfavorable high sodium and low potassium diets. More importantly the participants were unaware of the negative effects of high dietary sodium on their health and don’t think they have to reduce it. Hence, it is mandatory for health authorities to act promptly to decrease salt consumption and improve citizen’s awareness to its importance.

Additional information

Funding

This study was partially supported by The University of Jordan, and the World Health Organization.