Association between Salt-Related Knowledge, Attitudes, and Behaviours and 24 h Urinary Salt Excretion in Nepal
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Settings
2.2. Sample Size Calculations
2.3. Measurements
2.3.1. Salt-Related Knowledge, Attitudes, and Behaviours
2.3.2. Twenty-Four-Hour Urine Collection
2.3.3. Socio-Demographic Characteristics (Covariates)
2.4. Statistical Analysis
2.5. Ethical Approval
3. Results
3.1. Socio-Demographic Characteristics
3.2. Mean 24 h Urinary Salt Excretion
3.3. Association between Socio-Demographic Characteristics and Salt-Related Knowledge Attitudes and Behaviours (Bivariate Analysis)
3.3.1. Association with Salt-Related Knowledge and Attitudes
3.3.2. Association with Salt-Related Behaviours
3.4. Association between Socio-Demographic Characteristics and Salt-Related Knowledge, Attitudes, and Salt-Related Behaviours (Logistic Regression)
3.5. Association between Salt Related Knowledge, Attitudes, and Behaviours and 24 h Urinary Salt Excretion (General Linear Model)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Mean or (n) | SD or (%) |
---|---|---|
Age (years) | 49.60 | 9.82 |
Weight (kg) | 63.70 | 11.59 |
Height (cm) | 156.03 | (8.2 |
BMI (kg/m2) | 26.15 | 428 |
Systolic blood pressure (mm Hg) | 129.06 | 18.03 |
Diastolic blood pressure (mm Hg) | 83.37 | 10.26 |
Hypertension | (178) | (39.47) |
Diabetes (self-reported) | (45) | (10.90) |
24 h urine | ||
Sodium (g/day) | 5.31 | 1.89 |
Potassium (g/day) | 1.94 | 0.77 |
Creatinine (mg/day) | 1232.77 | 524.94 |
Sodium-to-potassium ratio | 5.04 | 2.04 |
Urine volume (mL/day) | 2584.03 | 1100.14 |
Salt excretion, g/day | 13.28 | 4.72 |
Proportion with ≥5 g/day | (441) | (97.78) |
Characteristics | Total, n (%) | Mean (±SD) Salt Intake (g/day) * | Proportion of Participants with Salt-Related Knowledge and Attitudes (%) * | ||||||
---|---|---|---|---|---|---|---|---|---|
Knowledge | Attitudes | ||||||||
High Salt Intake Causes Health Problems | Self-Perceived Salt Intake | Importance of Lowering Salt Intake | |||||||
Yes | No † | Extremely High/ High | Normal | Very Low/ Low | Very Important/ Somewhat Important | Not Important ¶ | |||
Age, years | |||||||||
18–44 | 153 (33.92) | 14.34 (4.91) | 86.93 | 13.07 | 22.88 | 57.52 | 19.61 | 86.93 | 13.07 |
45–70 | 298 (66.08) | 12.73 (4.53) | 80.87 | 19.13 | 17.11 | 53.69 | 29.19 | 86.91 | 13.09 |
p-value | <0.01 | 0.10 | 0.06 | 0.10 | |||||
Sex | |||||||||
Male | 156 (34.59) | 14.40 (5.06) | 84.62 | 15.38 | 14.74 | 50 | 35.26 | 89.10 | 10.90 |
Female | 295 (65.41) | 12.69 (4.43) | 82.03 | 17.97 | 21.36 | 57.63 | 21.02 | 85.76 | 14.24 |
p-value | <0.01 | 0.49 | <0.01 | 0.32 | |||||
Ethnicity | |||||||||
Dalit | 51 (11.31) | 12.90 (5.45) | 76.47 | 23.53 | 19.61 | 45.10 | 35.29 | 84.31 | 15.69 |
Disadvantaged caste | 67 (14.86) | 13.12 (5.04) | 80.60 | 19.40 | 22.39 | 62.69 | 14.93 | 83.58 | 16.42 |
Upper caste | 333 (73.84) | 13.37 (4.54) | 84.38 | 15.62 | 18.32 | 54.95 | 26.73 | 87.99 | 12.01 |
p-value | 0.76 | 0.32 | 0.13 | 0.52 | |||||
Highest education | |||||||||
Primary level | 265 (58.76) | 12.70 (4.74) | 79.62 | 20.38 | 20 | 56.98 | 23.02 | 85.28 | 14.72 |
Higher secondary level | 158 (35.03) | 14.12 (4.78) | 87.97 | 12.03 | 18.99 | 53.16 | 27.85 | 88.61 | 11.39 |
University level | 28 (6.21) | 14.08 (3.16) | 85.71 | 14.29 | 10.71 | 46.43 | 42.86 | 92.86 | 7.14 |
p-value | <0.01 | 0.08 | 0.20 | 0.45 | |||||
BMI | |||||||||
Underweight | 17 (3.78) | 12.64 (4.26) | 82.35 | 17.65 | 11.76 | 47.06 | 41.18 | 88.24 | 11.76 |
Normal | 159 (35.33) | 12.82 (4.50) | 82.39 | 17.61 | 20.13 | 57.86 | 22.01 | 86.16 | 13.84 |
Overweight | 192 (42.67) | 13.42 (4.61) | 84.90 | 15.10 | 17.19 | 52.60 | 30.21 | 89.58 | 10.42 |
Obese | 82 (18.22) | 13.86 (5.34) | 80.49 | 19.51 | 23.17 | 56.10 | 20.73 | 82.93 | 17.07 |
p-value | 0.36 | 0.79 | 0.34 | 0.47 | |||||
Family size | |||||||||
Small (≤4 people) | 291 (64.52) | 13.02 (4.67) | 82.13 | 17.87 | 19.93 | 55.67 | 24.40 | 85.22 | 14.78 |
Large (>4 people) | 160 (35.48) | 13.76 (4.78) | 84.38 | 15.63 | 17.50 | 53.75 | 28.75 | 90 | 10 |
p-value | 0.11 | 0.54 | 0.57 | 0.15 | |||||
HTN status | |||||||||
Normotensive | 104 (23.06) | 13.39 (4.81) | 74.04 | 25.96 | 24.04 | 61.54 | 14.42 | 79.81 | 20.19 |
Pre-hypertensive | 169 (37.47) | 13.17 (4.59) | 84.62 | 15.38 | 18.93 | 57.99 | 23.08 | 88.76 | 11.24 |
Hypertensive | 178 (39.47) | 13.32 (4.81) | 86.52 | 13.48 | 16.29 | 48.31 | 35.39 | 89.33 | 10.67 |
p-value | 0.92 | <0.05 | <0.05 | 0.05 | |||||
Counsel to reduce dietary salt | |||||||||
Yes | 81 (17.96) | 13.20 (5.08) | 92.59 | 7.41 | 8.64 | 43.21 | 48.15 | 95.06 | 4.94 |
No | 370 (82.04) | 13.30 (4.64) | 80.81 | 19.19 | 21.35 | 57.57 | 21.08 | 85.14 | 14.86 |
p-value | 0.87 | <0.05 | <0.001 | <0.05 | |||||
History of elevated BP | |||||||||
Yes | 118 (26.16) | 13.25 (4.87) | 91.53 | 8.47 | 11.86 | 44.07 | 44.07 | 93.22 | 6.78 |
No | 333 (73.84) | 13.29 (4.67) | 79.88 | 20.12 | 21.62 | 58.86 | 19.52 | 84.68 | 15.32 |
p-value | 0.94 | <0.01 | <0.001 | <0.05 | |||||
Anti-HTN drug use in the past 2 weeks | |||||||||
Yes | 89 (19.73) | 12.99 (4.42) | 93.26 | 6.74 | 8.99 | 43.82 | 47.19 | 95.51 | 4.49 |
No | 362 (80.27) | 13.35 (4.79) | 80.39 | 19.61 | 21.55 | 57.73 | 20.72 | 84.81 | 15.19 |
p-value | 0.5120 | <0.01 | <0.001 | <0.01 | |||||
History of diabetes | |||||||||
Yes | 45 (10.90) | 13.71 (3.82) | 91.11 | 8.89 | 11.11 | 43.90 | 44.44 | 93.33 | 6.67 |
No | 368 (89.10) | 13.27 (4.74) | 82.61 | 20.11 | 19.76 | 55.16 | 24.73 | 86.41 | 13.59 |
p-value | 0.55 | 0.20 | <0.05 | 0.24 |
Characteristics | Proportion of Participants with Salt-Related Behaviours (%) * | |||||||
---|---|---|---|---|---|---|---|---|
Add Extra Salt | Processed Food Consumption | Take Actions to Control Salt | ||||||
Always/Often | Sometimes | Rarely/Never | Always/Often | Sometimes | Rarely/Never | Yes | No | |
Age, years | ||||||||
18–44 | 6.54 | 19.61 | 73.86 | 5.23 | 64.05 | 30.72 | 6.54 | 93.46 |
45–70 | 3.36 | 17.79 | 78.86 | 2.35 | 44.63 | 53.02 | 11.41 | 88.59 |
p-value | 0.25 | <0.001 | 0.10 | |||||
Sex | ||||||||
Male | 2.56 | 9.62 | 87.82 | 2.56 | 45.51 | 51.92 | 16.67 | 83.33 |
Female | 5.42 | 23.05 | 71.53 | 3.73 | 54.24 | 42.03 | 6.10 | 93.90 |
p-value | <0.001 | 0.13 | <0.001 | |||||
Ethnicity | ||||||||
Dalit | 7.84 | 19.61 | 72.55 | 1.96 | 54.90 | 43.14 | 15.69 | 84.31 |
Disadvantaged caste | 2.99 | 28.36 | 68.66 | 8.96 | 59.70 | 31.34 | 10.45 | 89.55 |
Upper caste | 4.20 | 16.22 | 79.58 | 2.40 | 48.95 | 48.65 | 8.71 | 91.29 |
p-value | 0.12 | <0.05 | 0.29 | |||||
Highest education | ||||||||
Primary level | 4.91 | 20.38 | 74.72 | 3.40 | 49.06 | 47.55 | 9.43 | 90.57 |
Higher secondary level | 3.80 | 17.72 | 78.48 | 3.80 | 56.33 | 39.87 | 10.13 | 89.87 |
University level | 3.57 | 3.57 | 92.86 | 0 | 42.86 | 57.14 | 10.71 | 89.29 |
p-value | 0.20 | 0.37 | 0.90 | |||||
BMI | ||||||||
Underweight | 0 | 17.65 | 82.35 | 0 | 29.41 | 70.59 | 23.53 | 76.47 |
Normal | 4.40 | 20.75 | 74.84 | 1.89 | 52.83 | 45.28 | 8.18 | 91.82 |
Overweight | 3.65 | 18.23 | 78.13 | 3.13 | 52.08 | 44.79 | 11.46 | 88.54 |
Obese | 7.32 | 14.63 | 78.05 | 7.32 | 51.22 | 41.46 | 6.10 | 93.90 |
p-value | 0.77 | 0.18 | 0.11 | |||||
Family size | ||||||||
Small (≤ four people) | 4.12 | 19.59 | 76.29 | 4.47 | 46.74 | 48.80 | 9.62 | 90.38 |
Large (>four people) | 5 | 16.25 | 78.75 | 1.25 | 59.38 | 39.38 | 10 | 90 |
p-value | 0.66 | <0.05 | 0.90 | |||||
HTN status | ||||||||
Normotensive | 6.73 | 19.23 | 74.04 | 1.92 | 60.58 | 37.50 | 1.92 | 98.08 |
Pre-hypertensive | 4.14 | 21.89 | 73.96 | 4.14 | 54.44 | 41.42 | 8.28 | 91.72 |
Hypertensive | 3.37 | 14.61 | 82.02 | 3.37 | 42.70 | 53.93 | 9.76 | 90.24 |
p-value | 0.26 | <0.05 | <0.001 | |||||
Counsel to reduce dietary salt | ||||||||
Yes | 3.70 | 9.88 | 86.42 | 2.47 | 37.04 | 60.49 | 37.04 | 62.96 |
No | 4.59 | 20.27 | 75.14 | 3.51 | 54.32 | 42.16 | 3.78 | 96.22 |
p-value | 0.07 | <0.05 | <0.001 | |||||
History of elevated BP | ||||||||
Yes | 2.54 | 12.71 | 84.75 | 4.24 | 40.68 | 55.08 | 26.27 | 73.73 |
No | 5.11 | 20.42 | 74.47 | 3 | 54.95 | 42.04 | 3.90 | 96.10 |
p-value | 0.08 | <0.05 | <0.001 | |||||
Anti-HTN drug use in past 2 weeks | ||||||||
Yes | 3.37 | 10.11 | 86.52 | 2.25 | 39.33 | 58.43 | 26.97 | 73.03 |
No | 4.70 | 20.44 | 74.86 | 3.59 | 54.14 | 42.27 | 5.52 | 94.48 |
p-value | 0.054 | <0.05 | <0.001 | |||||
History of diabetes | ||||||||
Yes | 0 | 17.78 | 82.22 | 2.22 | 37.78 | 60 | 22.22 | 77.78 |
No | 4.62 | 17.93 | 77.45 | 3.80 | 54.08 | 42.12 | 8.15 | 91.85 |
p-value | 0.44 | 0.07 | <0.01 |
Salt-Related Knowledge and Attitudes | Salt-Related Behaviours † | |||||
---|---|---|---|---|---|---|
Adding Extra Salt Always a | Consuming Processed Food Always a | Taking Actions to Control Salt ¥ | ||||
AOR † | 95% CI | AOR † | 95% CI | AOR † | 95% CI | |
High salt intake causes health problems | ||||||
No b | 1.00 (Ref.) | |||||
Yes | 0.60 | 0.33, 1.09 | 1.73 | 0.99, 3.02 | 3.19 | 0.65, 15.70 |
Self-perceived salt consumption ¥ | ||||||
Normal | 1.00 (Ref.) | |||||
Very low/low | 0.47 | 0.22, 1.01 | 0.60 | 0.36, 0.98 * | 4.22 | 1.90, 9.37 *** |
Extremely high/high c | 3.59 | 2.03, 6.33 *** | 1.90 | 1.06, 3.40 * | 0.14 | 0.01, 2.58 |
Importance of lowering salt intake | ||||||
Not important d | 1.00 (Ref.) | |||||
Very Important/somewhat important | 1.06 | 0.53, 2.14 | 1.61 | 0.87, 2.97 | 5.44 | 0.60, 49.19 |
Salt-Related KAB | n (%) | Adjusted Estimate † | ||
---|---|---|---|---|
Mean Salt Intake (g/day) | 95% CI | p-Value | ||
Knowledge | ||||
High salt intake causes health problems | ||||
Yes | 374 (82.93) | 13.28 | 12.82, 13.75 | 0.78 |
No a | 77 (17.07) | 13.14 | 12.11, 14.17 | |
Attitudes | ||||
Self-perceived salt consumption | ||||
Extremely high/high | 86 (19.07) | 14.42 | 13.45, 15.39 | 0.03 * |
Normal | 248 (54.99) | 13.11 | 12.54, 13.67 | |
Very low/low | 117 (25.94) | 12.73 | 11.89, 13.65 | |
Importance of lowering salt intake | ||||
Very important/somewhat important | 392 (86.92) | 13.33 | 12.87, 13.78 | 0.42 |
Not important b | 59 (13.08) | 12.81 | 11.63, 13.99 | |
Behaviours | ||||
Add extra salt | ||||
Always/often | 20 (4.43) | 14.67 | 12.66, 16.68 | 0.36 |
Sometimes | 83 (18.40) | 13.00 | 12.31, 14.30 | |
Rarely/never | 348 (77.16) | 13.17 | 12.69, 13.65 | |
Processed food consumption | ||||
Always/often | 15 (3.33) | 14.57 | 12.23, 16.91 | 0.53 |
Sometimes | 231 (51.22) | 13.23 | 12.64, 13.83 | |
Rarely/never | 205 (45.45) | 13.19 | 12.55, 13.83 | |
Take actions to control salt intake | ||||
Yes | 44 (9.76) | 13.51 | 12.15, 14.89 | 0.70 |
No | 407 (90.24) | 13.23 | 12.79, 13.67 | |
If yes, what are theyc(n = 44)? | ||||
Avoid eating processed foods | ||||
Yes | 14 (31.82) | 13.88 | 10.37, 17.39 | 0.88 |
No | 30 (68.18) | 13.53 | 11.30, 15.76 | |
Check salt/sodium labelling on food | ||||
Yes | 11 (25) | 15.61 | 11.83, 19.39 | 0.25 |
No | 33 (75) | 12.99 | 10.97, 15.01 | |
Buy low-salt/sodium alternatives | ||||
Yes | 1 (2.27) | 12.72 | 0.60, 24.85 | 0.88 |
No | 43 (97.73) | 13.67 | 11.94, 15.40 | |
Avoid out-of-home dinning | ||||
Yes | 9 (20.45) | 16.25 | 12.06, 20.43 | 0.18 |
No | 35 (79.55) | 12.98 | 11.04, 14.91 | |
Avoid adding extra salt | ||||
Yes | 36 (81.82) | 14.10 | 12.18, 16.02 | 0.33 |
No | 8 (18.18) | 11.60 | 7.09, 16.10 | |
Use small spoon | ||||
Yes | 10 (22.73) | 15.83 | 11.93, 19.73 | 0.22 |
No | 34 (77.27) | 13.00 | 11.03, 14.97 | |
Apply other measures | ||||
Yes | 9 (20.45) | 11.76 | 7.65, 15.86 | 0.31 |
No | 35 (79.55) | 14.13 | 12.19, 16.07 |
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Ghimire, K.; Mishra, S.R.; Neupane, D.; Kallestrup, P.; McLachlan, C.S. Association between Salt-Related Knowledge, Attitudes, and Behaviours and 24 h Urinary Salt Excretion in Nepal. Nutrients 2024, 16, 1928. https://doi.org/10.3390/nu16121928
Ghimire K, Mishra SR, Neupane D, Kallestrup P, McLachlan CS. Association between Salt-Related Knowledge, Attitudes, and Behaviours and 24 h Urinary Salt Excretion in Nepal. Nutrients. 2024; 16(12):1928. https://doi.org/10.3390/nu16121928
Chicago/Turabian StyleGhimire, Kamal, Shiva Raj Mishra, Dinesh Neupane, Per Kallestrup, and Craig S. McLachlan. 2024. "Association between Salt-Related Knowledge, Attitudes, and Behaviours and 24 h Urinary Salt Excretion in Nepal" Nutrients 16, no. 12: 1928. https://doi.org/10.3390/nu16121928