Abstract
This study aimed to evaluate the urinary excretion of sodium and potassium, and to estimate the main food sources of sodium in Maputo dwellers. A cross-sectional evaluation of a sample of 100 hospital workers was conducted between October 2012 and May 2013. Sodium and potassium urinary excretion was assessed in a 24-h urine sample; creatinine excretion was used to exclude unlikely urine values. Food intake in the same period of urine collection was assessed using a 24-h dietary recall. The Food Processor Plus® was used to estimate sodium intake corresponding to naturally occurring sodium and sodium added to processed foods (non-discretionary sodium). Salt added during culinary preparations (discretionary sodium) was computed as the difference between urinary sodium excretion and non-discretionary sodium. The mean (standard deviation) urinary sodium excretion was 4220 (1830) mg/day, and 92% of the participants were above the World Health Organization (WHO) recommendations. Discretionary sodium contributed 60.1% of total dietary sodium intake, followed by sodium from processed foods (29.0%) and naturally occurring sodium (10.9%). The mean (standard deviation) urinary potassium excretion was 1909 (778) mg/day, and 96% of the participants were below the WHO potassium intake recommendation. The mean (standard deviation) sodium to potassium molar ratio was 4.2 (2.4). Interventions to decrease sodium and increase potassium intake are needed in Mozambique.
Highlights
High sodium intake increases blood pressure (BP) and negatively affects endothelial and cardiovascular function, being positively associated with kidney disease, and cardiovascular morbidity and mortality [1,2,3]
This data was used in recently published systematic reviews that revealed sodium intakes in adult populations from African countries above the World Health Organization (WHO) recommended maximum of 2 g/day [23,39], with lower values found in Sub-Saharan Africa
Further study on political feasibility and stakeholder influence are needed in order to set targets for population salt and potassium intake and develop a strategy, involving different stakeholders, namely the government and the food industries, to reduce sodium and increase potassium intakes. In this convenience sample of Maputo inhabitants, less than one out of 10 participants met the recommended levels of sodium and potassium intakes, and the sodium-to-potassium ratio was far higher than the level recommended by WHO
Summary
High sodium intake increases blood pressure (BP) and negatively affects endothelial and cardiovascular function, being positively associated with kidney disease, and cardiovascular morbidity and mortality [1,2,3]. Monitoring sodium intake at a population level, including the assessment of the contribution of different dietary sources of sodium to the overall consumption, are key aspects when designing interventions to control this risk factor. Potassium is another key nutrient that is inversely associated with blood pressure [6,7], and its relation with sodium intake should be taken into account when assessing the adequacy of sodium intake. Potassium increases urinary sodium excretion and reduces the risk of stroke and cardiovascular disease, attenuating sodium’s negative effects [8,9]. The effects of high sodium and low potassium intake on BP levels have been regarded as synergic [10,11,12] The sodium sensitivity of blood pressure and, the risk of hypertension, have been shown to increase with diets low in potassium [13] and, of note, a higher intake of potassium has even more benefits for those with a high intake of sodium [14]
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