Abstract
BackgroundThere is an increasing interest in finding less costly and burdensome alternatives to measuring population-level salt intake than 24-h urine collection, such as spot urine samples. However, little is known about their usefulness in developing countries like Fiji and Samoa. The purpose of this study was to evaluate the capacity of spot urine samples to estimate mean population salt intake in Fiji and Samoa.MethodsThe study involved secondary analyses of urine data from cross-sectional surveys conducted in Fiji and Samoa between 2012 and 2016. Mean salt intake was estimated from spot urine samples using six equations, and compared with the measured salt intake from 24-h urine samples. Differences and agreement between the two methods were examined through paired samples t-test, intraclass correlation coefficient analysis, and Bland-Altman plots and analyses.ResultsA total of 414 participants from Fiji and 725 participants from Samoa were included. Unweighted mean salt intake based on 24-h urine collection was 10.58 g/day (95% CI 9.95 to 11.22) in Fiji and 7.09 g/day (95% CI 6.83 to 7.36) in Samoa. In both samples, the INTERSALT equation with potassium produced the closest salt intake estimate to the 24-h urine (difference of − 0.92 g/day, 95% CI − 1.67 to − 0.18 in the Fiji sample and + 1.53 g/day, 95% CI 1.28 to 1.77 in the Samoa sample). The presence of proportional bias was evident for all equations except for the Kawasaki equation.ConclusionThese data suggest that additional studies where both 24-h urine and spot urine samples are collected are needed to further assess whether methods based on spot urine samples can be confidently used to estimate mean population salt intake in Fiji and Samoa.
Highlights
There is an increasing interest in finding less costly and burdensome alternatives to measuring population-level salt intake than 24-h urine collection, such as spot urine samples
Six hundred sixty nine and 998 individuals in Fiji and Samoa, respectively, provided consent to participate in the surveys
A further 252 participants from Fiji and 184 participants from Samoa were excluded for suspected inaccurate 24-h urine collection (n = 233 and 163, respectively) and implausible spot creatinine concentration (n = 19 and 21, respectively), leaving a final sample of 414 from Fiji and 725 from Samoa (62% participation rate in Fiji and 73% in Samoa) included in the secondary analyses
Summary
There is an increasing interest in finding less costly and burdensome alternatives to measuring population-level salt intake than 24-h urine collection, such as spot urine samples. The purpose of this study was to evaluate the capacity of spot urine samples to estimate mean population salt intake in Fiji and Samoa. It was projected that a decrease in mean salt intake from 10 to 5 g per day (g/day) would reduce stroke rate by 23% and overall CVD by 17% [6]. This is equivalent to about 1.25 million and 3 million deaths from stroke and CVDs, respectively, averted each year [6]. The use of 24-h urine collection is limited in some population surveys, since the method is expensive, and can be burdensome
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