Salt Consumption Research Articles

Household Salt consumption and urinary iodine levels in Schoolchildren aged 8-10 in Darab City, Iran: 2022.

Iodized salt serves as an effective intervention strategy, combating iodine deficiency disorders (IDD) and promoting overall health. This study aimed to assess the household salt consumption status and its relationship with urinary iodine (UI) levels among school-aged children. This is a descriptive-cross-sectional study that was selected by cluster-random sampling from 5 girls' schools (182) and 5 boys' schools (169), with a total of 351 primary school students (8-10 years old) of Darab. To explore the relationship between independent variables and dependent variable, urinary iodine (UI) levels, linear regression model was applied. A significance level of 0.05 was adopted for all analyses. The median UI level was 138µg/L (IQR = 111). Our findings revealed that 66% of used iodized salt. A significant majority of participants properly stored their salt in containers with lids. Nearly half of the students in Darab have insufficient iodine intake. Despite controlling for the effect of iodized foods consumption, no significant association (P-value = 0.693) was observed between the storage method and iodized foods. Our study showed that students do not receive enough iodine or have received more than the required amount of iodine. Therefore, efforts should be focused on increasing awareness of diseases caused by iodine deficiency.

Abstract 4119926: Inadequate calorie and macronutrient intake in a population with congestive heart failure in a non-cardiovascular tertiary hospital.

Introduction: Chronic Heart Failure (HF) is a clinical syndrome that as a consequence of the compensatory mechanisms to maintain an adequate level of perfusion, causes dyspnea, peripheral edema, fatigue, lack of appetite, changes in body weight, cachexia, sarcopenia, among others. The presence of these signs and symptoms, with other factors such as restrictions on salt and water consumption, early satiety, and poor mobility, producing changes in the patient's nutritional status that can indirectly increase the risk of inadequate dietary intake, which over a prolonged period will lead to the development of nutritional deficiencies. Objective: To analyze the dietary intake of energy, macronutrients, and micronutrients of patients with chronic HF in outpatient care. Methods: Cross-sectional study, including 75 outpatients with HF, who attended a Heart Failure Clinic. Data collection on dietary intake was obtained using a multi-step 24-hour recall. The ESHA Food Processor program was used to calculate the energy, macronutrient, and micronutrient intake. The presence of congestion was evaluated by bioelectrical impedance vectorial analysis and VEXUS. Results: The baseline characteristics of the population are shown in Table 1. Of the total population, 34% presented with deficient caloric intake, and the subjects who presented congestion also ingested significant fewer calories compared with those who do not present congestion (p= 0.031). Only 15% of patients had an adequate protein intake that resulted in lower NYHA class; among those subjects with a deficient protein intake, 72% had congestion measured by VExUS or bioelectrical impedance. For the sodium intake in the subjects' diet, 45% exceeded the recommendation stated in the guidelines of less than 2,400 mg of sodium per day which was not statistically significant (p=0.077). Discussion and Conclusions: The inadequate intake of calorie or macronutrients in patients with CHF led the patients to more congestion and higher NYHA class, this provide a perspective on the importance of adequate nutritional advice by an expert in the area, which is also essential to improve the clinical course of heart failure. Likewise, future studies are deeded to investigate whether this poor dietary intake is inversely related to some clinical manifestations such as congestion, suggesting that improving these conditions could positively impact patients' volume status and improve functional class.

Knowledge, attitudes, and practices of oil and salt intake and related influencing factors in Southwestern China

ObjectsExcessive oil and salt consumption is a public health issue, notably in China where intakes surpass WHO guidelines. The present study aims to examine the knowledge, attitudes, and practices of Southwestern China residents regarding oil and salt and explore the influencing factors.MethodsThis study used convenience sampling to collect data from 7,367 participants aged 18–75 in the Sichuan, Chongqing, Yunnan, and Guizhou regions of China via on-site face-to-face surveys. Descriptive statistics and generalized linear models were used to analyses knowledge, attitudes, and practices about oil and salt intake and their influencing factors among residents of Southwestern China.ResultsIn Southwestern China, residents of Guizhou Province exhibited poor KAP regarding oil and salt. There were urban–rural differences in Yunnan, Sichuan, and Chongqing, and residents living in towns and cities were the favored factors for KAP scores. Groups engaged in self-employment/sales and freelance were risk factors for KAP score. Individuals with higher education was a favorable factor for KAP score. In Yunnan, Sichuan, and Chongqing groups with preference of salty tastes were favorable factors in KAP score. Diabetic patients were more likely to score low on oil and salt-related KAP performance.ConclusionIn Southwestern China, residents of Guizhou Province displayed poor results in their KAP regarding oil and salt. The region of the province, ethnicity, urban and rural residence, education, taste preference, and prevalence of chronic diseases were the influencing factors of oil and salt-related KAP scores.

Household Consumption of Adequately Iodized Salt: A Multi-Country Analysis of Socioeconomic Disparities.

Despite global efforts to promote universal salt iodization, iodine deficiency remains a public health issue in developing countries. This study assessed the proportion and sociodemographic characteristics of households consuming adequately iodized salt in 49 low- and middle-income countries. Data from DHS surveys of 49 low- and middle-income countries (2005-2021) were used to analyze household iodized salt prevalence. R version 4.0 was employed for statistical analyses. A random-effects meta-analysis was conducted to estimate overall and regional prevalence. We found that 83.4% of households consume adequately iodized salt, although with high heterogeneity (I2 = 100.0%). The East Asia and Pacific and the Europe and Central Asia regions showed high consumption rates of 87.6% and 87.7%, respectively, while Latin America and the Caribbean presented a significantly lower proportion of 30.8%. The study highlights the need for enhanced public health strategies to increase iodized salt consumption, especially in low-income and rural households. Addressing disparities in access, education, and affordability is crucial for improving iodine intake and preventing deficiency disorders, particularly among vulnerable populations like children and pregnant women.

High-Salt Diet Accelerates Neuron Loss and Anxiety in APP/PS1 Mice Through Serpina3n.

High salt (HS) consumption is an independent risk factor for neurodegenerative diseases such as dementia, stroke, and cerebral small vessel disease related to cognitive decline. Recently, Alzheimer's disease-like pathology changes have been reported as consequences of a HS diet in wild-type (wt) mice. However, it has not been revealed how HS diets accelerate the progress of Alzheimer's disease (AD) in APP/PS1 mice. Here, we fed APP/PS1 mice a HS diet or normal diet (ND) for six months; the effects of the HS/ND on wt mice were also observed. The results of our behavior test reveal that the HS diet exacerbates anxiety, β-amyloid overload, neuron loss, and synapse damage in the hippocampi of APP/PS1 mice; this was not observed in HS-treated wt mice. RNA sequencing shows that nearly all serpin family members were increased in the hippocampus of HS-treated APP/PS1 mice. Gene function analysis showed that a HS diet induces neurodegeneration, including axon dysfunction and neuro-ligand-based dysfunction, and regulates serine protein inhibitor activities. The mRNA and protein levels of Serpina3n were dramatically increased. Upregulated Serpina3n may be the key for β-amyloid aggregation and neuronal loss in the hippocampus of HS-treated APP/PS1 mice. Serpina3n inhibition attenuated the anxiety and increased the number of neurons in the hippocampal CA1(cornu ammonis) region of APP/PS1 mice. Our study provides novel insights into the mechanisms by which excessive HS diet deteriorates anxiety in AD mice. Therefore, decreasing daily dietary salt consumption constitutes a pivotal public health intervention for mitigating the progression of neuropathology, especially for old patients and those with neurodegenerative disease.

Consumers’ Willingness to Pay for Gamy Salt in Jabodetabek

Seaweed, being an abundant resource, has the potential to be processed into raw material for salt. This potential is supported by the high demand for salt consumption and the serious problem of hypertension in Indonesia. Consuming salt made from seaweed can be an alternative with low sodium content, which can help manage hypertension. Currently, the salt made from seaweed that is available to be purchased is Gamy salt. However, Gamy salt is more expensive than other low-sodium salts. This research aims to estimate the amount of consumers’ willingness to pay for Gamy salt and identify factors that influence their willingness to pay. The analytical methods used in this research include descriptive analysis, Contingent Valuation Method, and logistic regression. The research involved 103 respondents aged 30 years and above, residing in Jabodetabek, and having a history or risk of hypertension. The results indicate that the average willingness to pay for Gamy salt is Rp17,873.79 per 100 grams. Factors that significantly influence consumers to pay an extra price for Gamy salt are income, knowledge regarding seaweed salt, and health awareness.

EVALUASI FAKTOR YANG BERHUBUNGAN DENGAN HIPERTENSI PADA LANSIA

Knowing what factors influence the incidence of hypertension in the elderly is a very important effort. This observational analytical research with a cross-sectional approach aims to determine the relationship between age, gender, family history, smoking habits, exercise habits, coffee drinking habits, excessive salt consumption, type A personality, obesity, stress levels and identify the most important factors. dominantly influences the incidence of hypertension in the elderly. The research subjects were 91 respondents. Hypertension was categorized using JCN, obesity using BMI, stress using the Holmes scale and personality type using the Rosenman Scale. Interview guidelines were used to collect data on age, gender, family history, smoking habits, exercise habits, coffee drinking habits, excessive salt consumption, personality type, obesity, and stress levels. Factors that influence hypertension in the elderly include; age, family history, obesity and stress. Age in this study is the factor that has (OR=53.94) the most influence on the incidence of hypertension in the elderly.

The Relationship Between Snacking and Sugar, Salt, Fat Intake on Nutritional Status of Adolescents of SMKN 30 Jakarta

Excessive consumption of sugar, salt, and fat including from snacks can increase the risk of obesity or being overweight. The objective of this study to analyze the relationship between snacking and sugar, salt, and fat intake on nutritional status in adolescents. This design is cross-sectional with a sample of 90 grade X students at SMKN 30 Jakarta. The data collected include physical activity data using the Global Physical Activity Questionnaire (GPAQ), snacking habit data, frequency of sugar, salt, and fat consumption using the SQ-FFQ. The results of the correlation test showed that there was a significant relationship between snacking habits and sugar intake (p<0.01; r=0.473), snacking habits with salt intake (p<0.01; r=0.606), snacking habits with fat intake (p<0.01; r=0.473), snacking habits with nutritional status (BMI-for-age) (p<0.01; r=0.567), physical activity with nutritional status (BMI-for-age) (p<0.01; r=0.455). The conclusion of this study is that there is a significant relationship between snacking habits and sugar intake, snacking habits and salt intake, snacking habits and fat intake, snacking habits and nutritional status (BMI-for-age), and physical activity and nutritional status (BMI-for-age).

The impact of salt consumption on cardiometabolic and cognitive health in aged female rats

Health concerns about excess dietary salt have traditionally focused on its relationship with hypertension and the increased risk of cognitive impairment. However, research has often overlooked the unique health concerns and physiological differences between men and women, leading to gaps in knowledge, particularly regarding disease prevention and treatment strategies for women. The present study examined aged female rats over 12 weeks, using control, low, and high salt diets to mimic the post-menopausal phase in human females when cardiovascular risks typically increase. Cardiometabolic parameters and cognition were monitored. The findings revealed the impact of varying salt diets on blood lipids, blood pressure (BP) and heart rate (HR) levels and variability, anxiety, and cognition. Specifically, intake of a low-salt diet led to a significant reduction in BP levels but an increase in BP variability starting from the eighth week of the diet onset. Moreover, HR levels and variability were notably higher with the low-salt diet. Aged female rats exhibited increased anxiety on the low-salt diet at the fourth week, but the anxiety began to improve starting from the eighth week. Additionally, a trend suggested that the low salt intake worsened short-term memory while improving long-term memory. Furthermore, plasma lipids decreased significantly in aged female rats on a high-salt diet compared to those on a low-salt diet. The study provides valuable insights into the effects of salt intake on cardiometabolic parameters and cognitive function in aged female rats, highlighting the importance of considering sex-specific dietary guidelines for cardiometabolic and cognitive health.

Dietary salt, vascular dysfunction, and cognitive impairment.

Excessive salt consumption is a major health problem worldwide leading to serious cardiovascular events including hypertension, heart disease and stroke. Additionally, high salt diet has been increasingly associated with cognitive impairment in animal models and late-life dementia in humans. High salt consumption is harmful for the cerebral vasculature, disrupts blood supply to the brain and could contribute to Alzheimer's disease pathology. Although animal models have advanced our understanding of the cellular and molecular mechanisms, additional studies are needed to further elucidate the effects of salt on brain function. Furthermore, the association between excessive salt intake and cognitive impairment will have to be more thoroughly investigated in humans. Since the harmful effects of salt on the brain are independent by its effect on blood pressure, in this review, I will specifically discuss the evidence, available in experimental models and humans, on the effects of salt on vascular and cognitive function in the absence of changes in blood pressure. Given the strong effects of salt on the function of immune cells, I will also discuss the evidence linking salt consumption to gut immunity dysregulation with particular attention to the ability of salt to disrupt T-helper 17 (Th17) cells homeostasis. Lastly, I will briefly discuss the data implicating IL-17A, the major cytokine produced by Th17 cells, in vascular dysfunction and cognitive impairment.

Dissecting Causal Relationships Between Dietary Habits and Diverse Subtypes of Stroke: Mendelian Randomization Study

Background: Understanding the causal relations between dietary habits and stroke is crucial for prioritizing public health interventions and developing effective health strategies. This study utilized Mendelian randomization (MR) analysis to examine the causal associations between 20 dietary habits and various stroke subtypes, aiming to identify potential mediators and evaluate the proportions of mediation. Methods: A two-sample MR analysis was conducted to examine the causal relationships between dietary habits and stroke incidence. Mediation analysis, two-step MR (TSMR), and multivariable MR (MVMR) were employed to identify potential mediators. Genetic data pertaining to dietary habits and stroke were obtained from extensive genome-wide association study (GWAS) consortia. The inverse variance-weighted (IVW) method served as the primary analytical approach, with the additional scrutiny of significant correlations conducted through the Egger regression, MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO), and weighted median techniques. Results: Our analyses indicated that genetically predicted intakes of dried fruits, cheese, cereal, oily fish, and hot drink temperatures were protective against stroke, whereas higher intakes of lamb/mutton, poultry, and added salt significantly elevated stroke risk. Specifically, dried fruit consumption demonstrated a protective effect against total stroke (β = −0.009, p = 0.013), ischemic stroke (β = −0.475, p = 0.003), and small-vessel ischemic stroke (β = −0.682, p = 0.033) through reductions in BMI levels, accounting for mediated proportions of 3.2%, 17.1%, and 8.5%, respectively. Furthermore, cheese intake provided a protective effect against ischemic stroke (β = −0.275, p = 0.003) by decreasing BMI and increasing HDL-C levels, with mediated proportions of 30.5% and 6.5%. Together, BMI and HDL-C accounted for 34.9% of the beneficial effect of cheese intake on reducing the risk of ischemic stroke. In contrast, an increased salt intake exhibited a positive association with large-artery ischemic stroke (β = 0.432, p = 0.033) through BMI elevation, with a mediated proportion of 10.9%. Conclusions: Our findings provide compelling evidence supporting causal relationships between dietary habits and stroke subtypes, while identifying mediators and evaluating the proportions of mediation. Adhering to a low-calorie, nutrient-dense diet enriched with dried fruits, cheese, and cereal, along with reduced salt and poultry consumption, could potentially mitigate stroke risk.

Effectiveness of Poster, Animated Video and Live Youtube on Knowledge of Metabolic Syndrome and Sugar, Salt and Fat Consumption Recommendations (GGL)

Effectiveness of Poster, Animated Video and Live Youtube on Knowledge of Metabolic Syndrome and Sugar, Salt and Fat Consumption Recommendations (GGL)

Microplastic contamination in commercially available table salts of Pakistan

ABSTRACT Microplastics (MPs) are widespread across the globe, in every part of the environment. Their presence is expected to triple by 2060, posing risks to both human and environmental health. The present study investigated microplastic contamination using a stereomicroscope and GC-MS in table salts of Pakistan from different origins – sea, rock, and lake. Seventeen branded and 2 unbranded salts showed about 30 to 35 microplastics were present per kilogram of salts on average with the highest 125 MPs/Kg and lowest 30 MPs/Kg. Morphologically, black-coloured microplastic fibres were found to be predominant, and polyethylene was the most abundant chemical component. This study showed that assuming 30–35 MPs per kilogram of salts are found on average, people in Bangladesh are ingesting more microplastics through table salts compared to other regions, and Pakistan ranks lowest because of its lower salt consumption.

Effect of educational intervention based on the theory of planned behavior (TPB) on amount of salt intake in pregnant women with PreHypertension

BackgroundPrehypertension is one of the common disorders during pregnancy. Reducing salt intake is among the best cost-effective interventions to reduce the risk of hypertension. The present study aimed to explore the effect of an educational intervention based on the Theory of Planned Behavior (TPB) on amount of salt consumed by prehypertensive pregnant women.MethodsThe present quasi-experimental study was conducted in 2022 on 61 prehypertensive pregnant women visiting the Comprehensive Health Services Centers in Birjand, Iran. Pregnant women were selected through a convenience sampling method and randomly assigned to intervention and control groups. A blood pressure test and a 24-hour urine test were taken in 3 stages (before, immediately after, and one month after the intervention). A reliable and valid questionnaire based on the TPB was used to measure the cognitive variables. The intervention program included three training sessions based on the TPB held on an online platform (WhatsApp social network). Data were analyzed using repeated measures ANOVA and longitudinal marginal model with the GEE approach in SPSS19. The significance level for all statistical tests was set at p < 0 0.05.ResultsAfter intervention, the mean score of perceived behavioral control (p = 0.02), intention (p = 0.004), and salt consumption behavior (p = 0.03) increased significantly in the intervention group, and the mean score of systolic blood pressure (p < 0.001) and diastolic blood pressure (P < 0.01) decreased significantly in this group. In the control group, a statistically significant difference was observed in the systolic and diastolic blood pressure of the subjects (p < 0.01). However, the score of attitude, subjective norms, perceived behavioral control, intention, salt consumption behavior and the daily salt intake did not show a statistically significant difference over time (P < 0.05).ConclusionThe present findings showed that the perceived behavioral control, intention, behavior, systolic and diastolic blood pressure can be modifiable variables to improve the amount of salt consumed by pre-hypertensive pregnant women. Therefore, we recommend that the present model be used to develop interventions to improve health indicators in pregnant women as a highly susceptible group in society.

The Effect of the Mediterranean Diet Components on Blood Pressure, Mean Arterial Pressure, and Pulse Pressure in Hypertensive Patients

According to the 2018 Basic Health Research Data (RISKESDAS), the prevalence of hypertension in West Java was 39.6%, while in Cimahi City it was 41.83%. The composition of the Mediterranean diet contains a high proportion of MUFA and PUFA which act as anti-inflammatory, antioxidant, and cardioprotective with a potential to lower blood pressure. The aim of this study is to determine the impact of Mediterranean diet components on blood pressure in patients with hypertension. The study uses observational analytic methods as the design and also employs a prospective cohort sample of 36 patients with hypertension for three months, using a systematic random sampling technique. The research subjects were checked for blood pressure in the first month (T1) and the last month of the study (T2). The relative Mediterranean Diet (rMED) was used as a source of data on component intakes by administering the Food Frequency Questionnaire (FFQ) 12 times within three months. The differences in Mediterranean diet composition and blood pressure in all Mediterranean diet adherence groups were examined using the ANOVA test and Tuckey’s post-hoc test, as well as to test comparisons of proportions between rMED adherence groups. The impact of each component of the Mediterranean Diet on blood pressure was evaluated using a linear regression analysis test. The results showed that the average age of hypertensive patients who underwent the Mediterranean diet was 57.94 years and 69.44% were female. The components of fruit and nuts, vegetables, and fish have a significant effect on systolic blood pressure. Fish components have a significant effect on diastolic blood pressure. The components of vegetables and fish have a significant effect on the mean arterial pressure (MAP). Fruit and nut components have a significant effect on pulse pressure. The limitations of this study are the short research time, the absence of salt consumption restrictions on the Mediterranean diet, and the presence of smoking and physical activity as confounding activities. Keywords: blood pressure, composition, Mediterranean diet, mean arterial pressure, pulse pressure

Exploring Dietary Salt Knowledge, Attitude, and Practices among People of African Descent in the United Kingdom: A Qualitative Study.

Background/Objectives: People of African Descent (PoAD) in the United Kingdom (UK) are at an increased risk of hypertension and cardiovascular disease (CVD), partly due to dietary habits such as high salt intake. This study sought to understand the dietary salt-related knowledge, attitudes, and practises (KAP) of PoAD in the UK, to inform the development of culturally tailored interventions to reduce dietary salt intake in this population. Methods: We collected data on KAP from 21 PoAD across various regions in the UK through online semi-structured interviews and analysed them using reflexive thematic analysis (TA). Results: The age of the participants ranged from 20 to 70 years (43 ± 11). Six overarching themes were identified: (i) the multifaceted roles of salt in culinary practises, (ii) the increased awareness of health risks associated with high salt intake, (iii) the existence of knowledge gaps regarding recommended daily salt intake, (iv) the cultural influences on salt consumption levels, (v) the lack of engagement with food labels, and (vi) a limited awareness of salt reduction initiatives. Conclusions: Our findings highlight the significance of salt in the culture and culinary practises of PoAD. Despite general awareness of the health risks of excessive salt consumption, there was a notable deficiency in knowledge about the recommended salt intake levels as well as minimal engagement with nutritional labelling. These findings underline a need for culturally sensitive health interventions that integrate culinary practises, beliefs, and preferences of PoAD, aiming to effectively reduce salt intake and mitigate associated health risks.

SOURCES AND CONSEQUENCES OF HIGH SALT CONSUMPTION IN MOSCOW: A STUDY OF DIETARY HABITS

The aim of this study was to examine the level of salt consumption among various population groups in Moscow. The study was conducted using the 24-hour dietary recall method (24hDR) and the food frequency questionnaire (FFQ) over the course of one year. The results showed that 49.6% of Muscovites have excessive salt consumption, with this phenomenon being more prevalent among men (60.3%) compared to women (41.9%). Data analysis revealed significant consumption of high-salt foods and dishes, highlighting the need for monitoring and adjusting salt intake in the diet to prevent hypertension and cardiovascular diseases.

Prevalence And Severity Of High Blood Pressure In Morocco

Background: Hypertension, also known as high blood pressure (HBP), is a chronic medical condition characterized by persistently elevated blood pressure in the arteries. Although it may not always exhibit noticeable symptoms, hypertension can lead to serious long-term health complications, including an increased risk for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral vascular disease, vision loss, chronic kidney disease, and dementia. The objective of this study is to determine the prevalence and severity of hypertension among patients in Rabat, Morocco. Methods: This is a retrospective descriptive study that included all patients diagnosed with hypertension at the Military Hospital Mohammed V of Rabat (Morocco), during the period between 2004 and 2018. A standardized questionnaire was completed for each patient. Prior to data collection, patients were informed about the objectives of the study, and measures were taken to protect their confidentiality and anonymity. The study parameters included age, gender, time elapsed since hypertension diagnosis, and hypertension severity. Results: A total of 10,929 individuals were included in the study, with half being male. The mean age of the patients was 71 ± 17 years. The age group most affected was those aged 65 years or older, representing 62% of all groups. Of the hypertensive cases, 70% were classified as moderate hypertension. Furthermore, hypertension significantly increased with age (p˂0.001). Conclusion: Adopting positive lifestyle changes and adhering to prescribed medications are key strategies that can effectively lower blood pressure and reduce the risks of severe health complications commonly associated with hypertension. Examples of effective lifestyle changes include weight loss, regular physical exercise, reduced salt and alcohol consumption, and a healthy diet. Medications for managing hypertension may also be necessary in some cases.

Protocol for a community-based, household-randomised, dose-response trial to assess the acceptability, nutritional effects and safety of double-fortified salt containing iodine and folic acid compared with iodised salt among non-pregnant Ethiopian women of reproductive age (DFS-IoFA).

The prevalence of neural tube defects (NTDs) is higher in Ethiopia than most other countries, and ~84% of Ethiopian women of reproductive age (WRA) have folate insufficiency, a major risk factor for NTDs. Salt fortification with folic acid is a potential strategy to improve women's folate status, but data are needed on the acceptability, nutritional impact and safety of folic acid fortification of iodised salt. The study is designed as a community-based, household-randomised, dose-response trial. A total of 360 non-pregnant WRA 18-49 years of age will be randomly assigned to one of three intervention arms: (1) iodised salt fortified with 30 ppm folic acid to provide ~200 µg folic acid/day; (2) iodised salt fortified with 90 ppm folic acid to provide ~600 µg folic acid/day; or (3) iodised salt (comparator). The preweighed salts will be delivered to participants' homes biweekly for 26 weeks; unused salt will be collected and weighed. Fasting, venous blood samples will be collected at baseline, end line and a randomly assigned intermediate time point for assessment of folate, iodine, vitamin B12 and other micronutrient status biomarkers. Women's dietary intakes, including discretionary salt consumption, will be measured using weighed food records; 24-hour urine specimens will be analysed for sodium and iodine excretion. Primary outcomes are women's consumption of study salts, change in biomarkers of folate and iodine status and prevalence of adverse events. Results will be analysed using analysis of covariance models to estimate group mean differences for continuous outcomes, controlling for baseline measurements, and log-binomial or modified Poisson regressions for categorical outcomes. Prespecified effect modifications will be explored. The study has been approved by the Ethiopian Public Health Institute's Institutional Review Board, and the protocol has been registered with ClinicalTrials.gov (registration number NCT06223854). Study results will be published in open access scientific journals and disseminated nationally in Ethiopia. NCT06223854.

Iodine status and knowledge among pregnant and lactating women in Large City in Northern China after nearly 30years of the universal salt iodization.

With the implementation of the universal salt iodization, the iodine nutrition for children and adults has been appropriate, but pregnant women are still at risk of iodine deficiency. It is of great public health significance to explore the iodine status and knowledge, and influence factors and the appropriate health education methods among pregnant and lactating women. From January 2022 to December 2023, at least 50 pregnant women and 50 lactating women were randomly selected from the resident population annually in 16 districts of Tianjin, North China. A total of 1671 pregnant women and 1658 lactating women were recruited. All participants' households salt and random urine samples were collected. A questionnaire was conducted to collect data on iodine related knowledge and behaviors as well as needs of health education from all participants. Logistic regression models were constructed to analyze the factors affecting the iodine related knowledge level. We used the Rasch model and the quadrantal graph to analyze the participants' knowledge level on different iodine-related questions and their needs for health education. The median urine iodine concentration (UIC) of pregnant and lactating women in Tianjin were 152.40 μg/L and 124.60μg/L. In some districts, the median UIC of pregnant and lactating women below the appropriate range. The iodized salt coverage rate of pregnant and lactating women in Tianjin was 76.12% and 77.40%, respectively. In pregnant and lactating women who did not actively supplement with iodine, the median UIC in those who consumed non-iodized salt were significantly lower than that in those who consumed iodized salt (139.26μg/L and 154.40μg/L, P = 0.044; 94.60μg/L and 123.80μg/L, P < 0.001). Compared with the low knowledge score group, pregnant women in the high knowledge score group had a higher proportion of iodized salt consumption (71.25% and 78.05%, P = 0.003), and pregnant and lactating women in the high knowledge score group had a higher proportion of actively supplement iodine (44.61% and 55.34%, P < 0.001; 39.26% and 49.78%, P < 0.001). Health education may be the main factor affecting the iodine related knowledge scores for pregnant and lactating women, with adjusted odds ratios (OR) and 95% confidence intervals (CI) of 2.89 (2.30, 3.62) and 2.46 (1.97, 3.07), respectively. Pregnant and lactating women are most expected to acquire knowledge through healthcare professionals (72.11%) and wechat/website (74.91%), respectively. Pregnant and lactating women in some areas of Tianjin are at risk of iodine deficiency. Iodized salt consumption is an important way to ensure iodine nutrition of the population, and the lack of iodine related knowledge is an important factor affecting the consumption of iodized salt. Health education in different ways can be carried out for different people to improve the acceptance and efficiency of health education.