Abstract
ObjectiveTo evaluate the association of salt consumption with blood pressure in Viet Nam, a developing country with a high level of salt consumption.Design and settingAnalysis of a nationally representative sample of Vietnamese adults 25–65 years of age who were surveyed using the World Health Organization STEPwise approach to Surveillance protocol. Participants who reported acute illness, pregnancy, or current use of antihypertensive medications were excluded. Daily salt consumption was estimated from fasting mid-morning spot urine samples. Associations of salt consumption with systolic blood pressure and prevalent hypertension were assessed using adjusted linear and generalized linear models. Interaction terms were tested to assess differences by age, smoking, alcohol consumption, and rural/urban status.ResultsThe analysis included 2,333 participants (mean age: 37 years, 46% male, 33% urban). The average estimated salt consumption was 10g/day. No associations of salt consumption with blood pressure or prevalent hypertension were observed at a national scale in men or women. The associations did not differ in subgroups defined by age, smoking, or alcohol consumption; however, associations differed between urban and rural participants (p-value for interaction of urban/rural status with salt consumption, p = 0.02), suggesting that higher salt consumption may be associated with higher systolic blood pressure in urban residents but lower systolic blood pressure in rural residents.ConclusionsAlthough there was no evidence of an association at a national level, associations of salt consumption with blood pressure differed between urban and rural residents in Viet Nam. The reasons for this differential association are not clear, and given the large rate of rural to urban migration experienced in Viet Nam, this topic warrants further investigation.
Highlights
The associations did not differ in subgroups defined by age, smoking, or alcohol consumption; associations differed between urban and rural participants (p-value for interaction of urban/rural status with salt consumption, p = 0.02), suggesting that higher salt consumption may be associated with higher systolic blood pressure in urban residents but lower systolic blood pressure in rural residents
There was no evidence of an association at a national level, associations of salt consumption with blood pressure differed between urban and rural residents in Viet Nam
While numerous epidemiological studies have reported an association between dietary salt intake and blood pressure, the majority of this evidence has come from developed countries. [1,2,3] Few studies on this topic have been conducted in developing countries, and those studies were focused on unique, geographically isolated populations with low levels of salt consumption.[2, 4,5,6]
Summary
While numerous epidemiological studies have reported an association between dietary salt intake and blood pressure, the majority of this evidence has come from developed countries. [1,2,3] Few studies on this topic have been conducted in developing countries, and those studies were focused on unique, geographically isolated populations with low levels of salt consumption.[2, 4,5,6] The impact of salt on blood pressure in developing countries with a high level of salt intake, such as those of South-east Asia, is unclear.[7, 8]Viet Nam has undergone a period of rapid economic growth in the past 10–20 years, during which the country experienced substantial rural to urban migration, increased tobacco use, the adoption of unhealthier diets, and decreased levels of physical activity.[8,9,10,11,12] These changes align with the “epidemiological transition,” the concept that as countries become more developed, the burden of disease shifts to chronic non-communicable diseases as the number of deaths from communicable diseases decreases and the average life expectancy increases.[13]. While numerous epidemiological studies have reported an association between dietary salt intake and blood pressure, the majority of this evidence has come from developed countries. As a modifiable risk factor, salt consumption may be an appropriate target for public health interventions to lower population-wide blood pressure, which is hypothesized to lead to major improvements in public health.[1, 3, 16, 17] the cost of antihypertensive medications for an individual can be as little as pennies a day, salt reduction interventions are often cited as the most cost-effective means by which to lower population-wide blood pressure.[16, 18,19,20] Before any nation-wide salt reduction efforts are considered in Viet Nam, it is important to understand whether the effect of salt on blood pressure among Vietnamese is similar to that previously observed in developed countries
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