JMIR Publications

ABSTRACT

Background:

World Health Organization endorses a daily sodium intake <2000 mg for adults; however, the Mexican population, as others worldwide, has reported to have higher consumption than this recommendation. Excess sodium intake is usually accompanied by deficient potassium intake. It has been observed that even though people are aware of the health implications of a high salt/sodium consumption, their knowledge, attitudes, and behavior (KAB) related to salt/sodium intake may be deficient. Also, the association of KAB and actual sodium intake has shown mixed results in diverse populations, while its association with potassium intake has been less studied. In México, salt/sodium-related KAB and its association with sodium and potassium intake has not been assessed.

Objective:

To describe salt/sodium-related KAB in a Mexican population. Secondarily, to explore the association between KAB and 24-hour urinary sodium and potassium excretion.

Methods:

We conducted a cross-sectional study in an adult population of Mexico City and the metropolitan area. Self-reported KAB related to salt/sodium intake were assessed using a survey developed by the Pan American Health Organization. Anthropometrics were measured and 24-hour urinary sodium and potassium excretion were determined. Descriptive statistics were stratified by sex and presented as mean (±standard deviation) or median (percentiles 25th, 75th) for continuous variables, and absolute and relative frequencies for categorical variables. The associations between KAB and sodium and potassium excretion were assessed using ANCOVA with age, sex, BMI, and daily energy intake as covariates, and Sidak correction for multiple comparisons.

Results:

Overall, 232 participants were recruited (women, 79.3%). Mean urinary sodium and potassium excretion were estimated to be 2582.5 mg/day and 1493.5 mg/day. Overall, 64.7% of participants responded always adding salt when preparing foods at home and 80.1% of the sample did not know the difference between salt and sodium. There was a higher proportion of men who did not know the amount of sodium they consumed compared to women (25% vs 8.2%, P=.014), more women reported to know that there was a recommended amount for daily sodium intake than men (25% vs 20.8%, P=.019), 62.5% of men reported never or rarely to read food labels compared to 52.1% among women (P=.037). Better salt/sodium-related KAB were associated with higher adjusted mean sodium and potassium excretion, while a higher urinary sodium excretion was seen among participants who reported to consume too much sodium compared to those who claimed to eat just the right amount.

Conclusions:

Salt/sodium-related KAB are poor in this study sample. In addition, KAB showed a greater impact on potassium than sodium excretion, supporting the need of implementing more strategies to improve KAB related to salt/sodium intake, but also to consider other strategies to modify the sodium content of foods, such as reformulation of processed and ultra-processed foods.