Assessment of Salt, Potassium, and Iodine Intake in the Croatian Adult Population Using 24 h Urinary Collection: The EH-UH 2 Study
Abstract
:1. Introduction
1.1. Global Burden of Salt and World Health Organization Recommendations
1.2. Cardiovascular Disease Burden in Croatia and Croatian Action on Salt and Health
2. Materials and Methods
2.1. Study Design and Recruitment
2.2. Procedures of 24 h Urine Collection
2.3. Statistical Analysis
3. Results
3.1. Completion of 24 h Urine Collection
3.2. Characteristics of the Participants Who Attended the Outpatient Visit and Were Asked to Participate in a 24 h Urine Examination
3.3. Daily Urinary Excretions of Creatinine, Sodium, Potassium, and Iodine and Estimated Salt, Potassium, and Iodine Intake in the Whole Group
3.4. Daily Salt, Potassium, and Iodine Intake according to Residency and Geographic Regions
4. Discussion
4.1. Salt Consumption in the General Adult Population
4.2. Potassium Consumption in the Adult Population
4.3. Sodium-to-Potassium Ratio
4.4. Salt and Potassium Intake according to the Residency and Geographical Differences
4.5. Iodine Intake in the Adult Population
5. Strengths and Limitations
6. Actionable Recommendations and Policy Suggestions
7. Research Questions and Plans for Further Studies
8. 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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Whole Group | Men | Women | p | |
---|---|---|---|---|
N | 1067 | 374 | 693 | |
Age (years) | ||||
Mean (SD) | 57.2 (13.9) | 57.2 (13.8) | 56.4 | 0.352 |
S.E. | 0.37 | 0.75 | 0.55 | |
Median (IQ range) | 59.0 (48.0–67.0) | 59.0 (48–68) | 59.0 (48–66) | |
Systolic BP (mmHg) | ||||
Mean (SD) | 133.7 (19.0) | 137.9 (18.3) | 131.4 (19.2) | <0.001 |
S.E. | 0.5 | 0.99 | 0.77 | |
Median (IQ range) | 132 (120.0–145.0) | 137.0 (124.5–149.0) | 130.0 (117.0–133.8) | |
Diastolic BP (mmHg) | ||||
Mean (SD) | 82.5 (10.2) | 83.9 (10.2) | 81.5 (10.0) | <0.001 |
S.E. | 0.2 | 0.55 | 0.4 | |
Median (IQ range) | 82.0 (76.0–89.0) | 84.0 (77.5–90.5) | 81.0 (75.1–87.5) | |
Heart rate (bpm) | ||||
Mean (SD) | 75.7 (12.2) | 75.1 (13.0) | 76.4 (12.0) | 0.084 |
S.E. | 0.3 | 0.71 | 0.48 | |
Median (IQ range) | 75.0 (67.0–83.0) | 73.0 (65-0-83.3) | 75.6 (68.0–83.0) | |
Height (cm) | ||||
Mean (SD) | 169.1 (16.7) | 178.4 (7.7) | 165.3 (6.8) | <0.001 |
S.E. | 0.4 | 0.42 | 0.27 | |
Median (IQ range) | 168 (162–175) | 178.0 (174.0–183.0) | 165.0 (161.0–170.0) | |
Weight (kg) | ||||
Mean (SD) | 81.4 (16.7) | 92.4 (16.1) | 76.6 (14.5) | <0.001 |
S.E. | 0.4 | 0.88 | 0.58 | |
Median (IQ range) | 80.0 (69.0–91.0) | 90.0 (82.0–100.7) | 75.5 (66.0–85.8) | |
Body mass index (kg/m2) | ||||
Mean (SD) | 28.3 (5.0) | 28.0 (4.6) | 28.0 (5.3) | <0.001 |
S.E. | 0.1 | 0.25 | 0.21 | |
Median (IQ range) | 27.9 (24.8–31.2) | 28.4 (26.0–31,4) | 27.4 (24.0–31.1) |
24 h Urine | Whole Group | Men | Women | p |
---|---|---|---|---|
N | 1067 | 374 | 693 | |
Volume (mL) | ||||
Mean (SD) | 1589.9 (628.5) | 1670 (613.2) | 1546 (632.9) | <0.001 |
S.E. | 19.24 | 31.7 | 24.0 | |
Median (IQ range) | 1500 (1100–1950) | 1590 (1215–2000) | 1500 (1100–1900) | |
Creatinine (g/L) | ||||
Mean (SD) | 0.8 (0.4) | 1.0 (0.5) | 0.8 (0.4) | <0.001 |
S.E. | 0.01 | 0.02 | 0.01 | |
Median (IQ range) | 0.7 (0.5–0.1) | 0.9 (0.6–1.3) | 0.7 (0.5–0.9) | |
Sodium (mmol/24 h urine) | ||||
Mean (SD) | 151.8 (68.8) | 179.1 (74.9) | 137.1 (60.4) | <0.001 |
S.E. | 2.14 | 3.8 | 2.29 | |
Median (IQ range) | 140.5 (101.5–191.3) | 170.9 (119.7–229.7) | 130.6 (96.7–171.4) | |
Potassium (mmol/24 h urine) | ||||
Mean (SD) | 58.5 (22.3) | 64.5 (24.8) | 55.3 (20.1) | <0.001 |
S.E. | 0.68 | 1.2 | 0.76 | |
Median (IQ range) | 56.0 (43.0–71.0) | 62.0 (47.0–78.0) | 53 (41–66.5) | |
NaCl intake (g/day) | ||||
Mean (SD) | 9.3 (4.2) | 10.9 (4.5) | 8.4 (3.7) | <0.001 |
S.E. | 0.12 | 0.23 | 0.14 | |
Median (IQ range) | 8.6 (6.2–11.7) | 10.5 (7.3–14.0) | 8.0 (5.8–10.5) | |
Potassium intake (g/day) | ||||
Mean (SD) | 2.9 (1.1) | 3.3 (1.2) | 2.8 (1.0) | <0.001 |
S.E. | 0.03 | 0.06 | 0.03 | |
Median (IQ range) | 2.8 (2.1–3.5) | 3.1 (2.3–3.9) | 2.6 (2.0–3.3) | |
Na-to-K ratio | ||||
Mean (SD) | 2.8 (1.4) | 3.0 (1.6) | 2.6 (1.2) | <0.001 |
S.E. | 0.04 | 0.08 | 0.04 | |
Median (IQ range) | 2.6 (1.8–3.5) | 2.8 (1.9–3.8) | 2.5 (1.8–3.3) | |
Urinary iodine excretion (µg/L) | N = 577 | N = 208 | N = 369 | |
Mean (SD) | 156.2 (142.19) | 172.6 (144.9) | 147.3 (139.9) | <0.001 |
S.E. | 7.0 | 10.2 | 7.2 | |
Median (IQ range) | 131.8 (95.4–174) | 145.9 (108.58–191.6) | 121.7 (91.4–167.1) |
Iodine Status | Iodine Concentration (µg/L) | Whole Group N = 577 | Men N = 208 | Women N = 369 | |||
---|---|---|---|---|---|---|---|
Insufficient | N | % | N | % | N | % | |
Severe | <20 | 2 | 0.3 | 1 | 0.5 | 1 | 0.3 |
Moderate | 20–49 | 16 | 2.8 | 8 | 3.7 | 8 | 2.2 |
Mild | 50–99 | 111 | 19.2 | 31 | 14.5 | 80 | 21.7 |
Adequate consumption | 100–199 | 298 | 51.7 | 100 | 46.7 | 198 | 53.7 |
Above requirement | 200–299 | 111 | 19.2 | 54 | 25.2 | 57 | 15.4 |
Excessive consumption | >300 | 39 | 6.8 | 14 | 6.5 | 25 | 6.8 |
24 h Urine | Urban | Rural | p | Mediterranean | Continental | p |
---|---|---|---|---|---|---|
N | 608 | 376 | 434 | 473 | ||
NaCl intake (g/day) | ||||||
Mean (SD) | 8.8 (3.9) | 9.9 (4.4) | <0.001 | 8.0 (3.6) | 10.3 (4.4) | <0.001 |
S.E. | 0.16 | 0.23 | 0.17 | 0.23 | ||
Median (IQ range) | 8.3 (5.8–11.2) | 9.4 (6.5–12.8) | 7.4 (5.3–10.2) | 9.9 (7.2–13.3) | ||
Potassium intake (g/day) | ||||||
Mean (SD) | 3.0 (1.1) | 2.8 (1.0) | 0.006 | 3.0 (1.2) | 2.8 (1.0) | <0.001 |
S.E. | 0.04 | 0.09 | 0.05 | 0.04 | ||
Median (IQ range) | 2.9 (2.1–3.7) | 2.7 (2.0–3.4) | 2.9 (2.2–3.8) | 2.6 (2.0–3.3) | ||
Na-to-K ratio | ||||||
Mean (SD) | 2.6 (1.4) | 3.0 (1.4) | <0.001 | 2.4 (1.4) | 3.0 (1.3) | <0.001 |
S.E. | 0.05 | 0.07 | 0.06 | 0.06 | ||
Median (IQ range) | 2.3 (1.6–3.1) | 2.9 (2.1–3.7) | 2.0 (1.5–2.9) | 3.0 (2.3–3.8) | ||
Urinary iodine excretion (µg/L) | N = 183 | N = 334 | N = 219 | N = 251 | ||
Mean (SD) | 168.9 (133.1) | 146.4 (130.0) | 0.007 | 145.8 (116.5) | 161.5 (124.3) | 0.012 |
S.E. | 9.84 | 7.1 | 7.9 | 7.8 | ||
Median (IQ range) | 127.7 (103.2–193.2) | 119.8 (92.6–109.2) | 124.9 (90.3–171.2) | 141.2 (103.9–183.0) |
Continental | Coast | ||||
---|---|---|---|---|---|
Central Part | North–East Part | North–West Part | North Part | South Part | |
N | 143 | 234 | 154 | 102 | 434 |
24 h urine volume (mL) | |||||
Mean (SD) | 1631.3 (667.3) | 1621.6 (652.5) | 1515.7 (579.4) | 1764.6 (840.2) | 1544.3 (564.1) |
S.E. | 58.9 | 44.0 | 48.9 | 101.8 | 27.2 |
Median (IQ range) | 1500.0 (1200–1972.5) | 1560.0 (1152.5–1987.9) | 1400.0 (1100.0–1800.0) | 1500.0 (1180.0–2100.0) | 1500.0 (1100.0–1900.0) |
Urine creatinine (g/L) | |||||
Mean (SD) | 0.7 (0.3) | 0.91 (0.414) | 0.6 (0.3) | 0.6 (0.3) | 0.9 (0.4) |
S.E. | 0.02 | 0.02 | 0.02 | 0.03 | 0.02 |
Median (IQ range) | 0.71 (0.52–0.93) | 0.81 (0.61–1.11) | 0.6 (0.42–0.87) | 0.5 (0.42–0.79) | 0.9 (0.6–1.2) |
24 h sodium (dU) | |||||
Mean (SD) | 169.0 (69.8) | 160.2 (75.3) | 182.3 (66.7) | 147.0 (63.4) | 130.5 (59.6) |
S.E. | 6.1 | 5.1 | 5.6 | 7.6 | 2.8 |
Median (IQ range) | 158.2 (119.7–216.3) | 146.9 (109.0–204.0) | 179.5 (133.3–220.8) | 137.8 (98.8–185.0) | 120.1 (87.0–163.2) |
24 h potassium (dU) | |||||
Mean (SD) | 55.6 (20.1) | 52.2 (20.0) | 59.4 (18.8) | 61.2 (21.4) | 62.4 (25.0) |
S.E. | 1.7 | 1.3 | 1.5 | 2.5 | 1.2 |
Median (IQ range) | 52.0 (41.0–66.8) | 49.0 (38.0–66.0) | 58.0 (46.0–71.7) | 59.5 (47.0–74.5) | 60.0 (45.0–76.0) |
NaCl intake (g/day) | |||||
Mean (SD) | 10.3 (4.2) | 9.8 (4.6) | 11.1 (4.0) | 9.0 (3.8) | 8.0 (3.6) |
S.E. | 0.3 | 0.3 | 0.3 | 0.4 | 0.1 |
Median (IQ range) | 9.7 (7.3–13.2) | 9.0 (6.7–12.6) | 11.0 (8.1–13.5) | 8.4 (6.0–11.3) | 7.3 (5.3–9.9) |
Potassium intake (g/day) | |||||
Mean (SD) | 2.8 (1.0) | 2.6 (1.0) | 3.0 (0.9) | 3.1 (1.0) | 3.1 (1.2) |
S.E. | 0.09 | 0.06 | 0.08 | 0.13 | 0.06 |
Median (IQ range) | 2.6 (2.1–3.4) | 2.4 (1.9–3.3) | 2.9 (2.3–3.6) | 3.0 (2.3–3.7) | 3.0 (2.3–3.8) |
Na-to-K ratio | |||||
Mean (SD) | 3.1 (1.2) | 3.2 (1.5) | 3.1 (1.1) | 2.4 (0.8) | 2.3 (1.4) |
S.E. | 0.1 | 0.1 | 0.09 | 0.1 | 0.07 |
Median (IQ range) | 2.9 (2.2–3.9) | 2.9 (2.2–3.9) | 3.1 (2.4–3.7) | 2.3 (1.7–3.0) | 2.0 (1.4–2.9) |
Urinary iodine excretion (µg/L) | 114 | 60 | 78 | 43 | 223 |
Mean (SD) | 169.1 (164.4) | 157.3 (83.5) | 153.4 (64.2) | 110.9 (147.3) | 146.1 (136.7) |
S.E. | 15.5 | 10.7 | 7.3 | 22.4 | 9.2 |
Median (IQ range) | 140.5 (105.8–181.2) | 138.6 (99.9–196.1) | 146.6 (111.3–179.5) | 126.7 (79.0–169.3) | 122.3 (90.4–171.0) |
1. | To determine the most important predictors (demographic, socioeconomic, etc.) of high salt and low potassium intake in men and women. |
2. | To determine the most important predictors of high salt and low potassium intake, which will explain the observed differences between rural and urban areas and among different geographical regions. |
3. | To determine the association between salt and potassium consumption with cardio–kidney–metabolic diseases and other poor lifestyle habits. |
4. | To analyse the association between salt and potassium intake and BP. |
5. | To analyse the association among salt reduction, the decrease in population BP, and the decrease in CV mortality in Croatia in the period from 2005 to 2022. |
6. | To construct a model that will allow us to conclude how much additional iodine should be added per kilogram of salt if the salt intake were to be lowered by an additional 15% [66]. |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Marinović Glavić, M.; Bilajac, L.; Bolješić, M.; Bubaš, M.; Capak, K.; Domislović, M.; Džakula, A.; Fuček, M.; Gellineo, L.; Jelaković, A.; et al. Assessment of Salt, Potassium, and Iodine Intake in the Croatian Adult Population Using 24 h Urinary Collection: The EH-UH 2 Study. Nutrients 2024, 16, 2599. https://doi.org/10.3390/nu16162599
Marinović Glavić M, Bilajac L, Bolješić M, Bubaš M, Capak K, Domislović M, Džakula A, Fuček M, Gellineo L, Jelaković A, et al. Assessment of Salt, Potassium, and Iodine Intake in the Croatian Adult Population Using 24 h Urinary Collection: The EH-UH 2 Study. Nutrients. 2024; 16(16):2599. https://doi.org/10.3390/nu16162599
Chicago/Turabian StyleMarinović Glavić, Mihaela, Lovorka Bilajac, Marta Bolješić, Marija Bubaš, Krunoslav Capak, Marija Domislović, Aleksandar Džakula, Mirjana Fuček, Lana Gellineo, Ana Jelaković, and et al. 2024. "Assessment of Salt, Potassium, and Iodine Intake in the Croatian Adult Population Using 24 h Urinary Collection: The EH-UH 2 Study" Nutrients 16, no. 16: 2599. https://doi.org/10.3390/nu16162599