Dietary Salt Intake Survey in the Republic of Moldova, 2016
Francesco P Cappuccio, Lanfranco D’Elia, Galina Obreja & Angela Ciobanu
In the Republic of Moldova, noncommunicable diseases are the leading cause of death, and CVD represents the main cause of population morbidity and mortality, accounting for every second death in 2016. High blood pressure (hypertension) and unhealthy diet are the leading risk factors for most of the CVD burden in the Republic of Moldova.
High salt consumption is a significant determinant of high blood pressure and reducing it improves the blood pressure and associated health outcomes. In the Republic of Moldova it is a common habit to add salt to food at the table and when cooking, as well as eating processed foods that have high salt content. In 2013 anational survey indicated that 24.3% of those surveyed always or often added salt to food, and 32.4% always or often ate processed foods that are high in salt. The World Health Organization currently recommends that adults should consume no more than 5 g of salt daily. Since most countries in the world eat far in excess of this target, the current global action plan has set as a health priority to reduce population salt consumption by at least 30% by 2025. There is no reliable measure of salt consumption in the Republic of Moldova. Comprehensive, up-to-date data on population salt intake in the country are therefore urgently needed.
The overall objective of the present survey was to establish the current baseline average consumption of salt (sodium), potassium and iodine in a random sample of men and women in the Republic of Moldova.
The survey was carried out in three stages: questionnaire survey, physical measurements, and 24-hour urine collections. The sample for the survey was selected using a stratified probabilistic method in three stages from the master sample used by the National Bureau of Statistics (NBS), to be nationally representative. From 1950 households and individuals selected from the sampling frame, 1307 (67%) provided suitable data for inclusion. Of these, 449 (34%) were excluded during qualitycontrol checks (on completeness of urine collections). The final sample included 858 participants (66% of the suitable sample), of which 326 were men and 532 women, aged between 18 and 69 years.
The prevalence of hypertension (blood pressure >140 and/or >90 mmHg or being on antihypertensive medications) was 45.5%, with no difference between the sexes. Almost two thirds of respondents (74.3%) were not taking medication and had raised blood pressure, with higher prevalence in men (82.4%) compared to women (69.2%). Mean urinary sodium (UNa) excretion was 173  mmol/24h; higher in men than women (184  versus 166  mmol/24h, p<0.01); and higher in rural than urban areas (180  versus 160  mmol/24h, p<0.001). UNa excretion tended to increase with age, more so in men than women, and was equivalent to a mean salt consumption of 10.8 [4.9] g per day. Men consumed more salt than women (11.5 [5.4] versus 10.3 [4.6] g per day; p=0.001). Higher salt consumption was detected in rural compared to urban areas (11.3 [5.0] versus 10.0 [4.8] g per day, p<0.001). Only 11.3% of the survey respondents consumed 5 g of salt per day or less; in rural areas the proportion was lower (10.0%) than in urban areas (13.5%). Bread is the biggest contributor of salt in the diet; every 100 g of bread provides an average of 1.85 g of salt. More than half of the population (55.4%) consumed bread 2–3 times per day with a higher proportion among the rural population (61.6%) than among people living in urban areas (45.4%). One fifth of the population consumed sausages, salami and liver sausage and almost a quarter consumed cheese 2–4 days per week,
adding 1.88 g of salt with every 100 g of product eaten. Mean urinary potassium (UK) excretion was 73  mmol/24h, and higher in men than women (76  versus 71  mmol/24h, p=0.02). The proportion of participants consuming adequate amounts of potassium (>90 mmol per day) was 49.7%; again, higher in men than women (52.5% versus 47.9%). Fruit and vegetable consumption was generally low: more than half of the population surveyed (56.4%) reported eating fewer than five servings of fruit and vegetables per day; thus being at higher risk for noncommunicable diseases. Consumption of fruit and vegetables was higher among the urban population. Mean and median urinary iodine (UI) excretions were 225 and 196 mcg/24h for both sexes, respectively. UI excretion (as measure of intake) was adequate in 41% of participants, irrespective of sex and area of residence. UI excretion was above requirement or excessive in a total of 30% of respondents, while 29% were deficient (only 2.3% severely).
Salt intake in adults in the Republic of Moldova exceeds the WHO recommended maximum target of 5 g per day by more than twofold. More than half (57.2%) of the 856 households visited consumed salt containing 15 mg/kg of iodine or more, while 23% of them consumed salt that was not iodized. Awareness, attitudes and behaviours around salt and its importance indicate a need for intensive awareness and health promotion campaigns to improve the uptake of preventive strategies aiming to reduce salt consumption and increase potassium and iodine intake. A national programme for reducing salt intake and promoting increased potassium consumption in the Republic of Moldova needs to be implemented through systematic efforts, including food product reformulation; product labelling; and public education involving the health sector and the food industry, with the objective of achieving a 30% reduction in salt consumption by 2025. This would also be an opportunity to revise the criteria for iodine fortification in the adult population, aiming to correct both the deficiency still present in some people, and the excess detected in others.
Training Meeting for a National Survey on Salt Consumption
5th December 2015
Chisinau, Republic of Moldova
The W.H.O. Collaborating Centre of the University of Warwick is providing technical support to the National Centre of Public Health of the Republic of Moldova, as part of its remits to support the W.H.O. Region for Europe in the implementation of population salt reduction programmes in Member States. The technical support will help define the methodology and the tools for a national survey on salt intake in Moldova, providing training for national co-ordinators and support during data collection, process and analysis.
The first meeting was held in Chisinau on 5th December 2015 and was attended by Prof Francesco P Cappuccio from the W.H.O. Collaborating Centre, Dr Angela Ciobanu, W.H.O. Representative in Moldova, Dr Valeriu Gonceear representing the Ministry of Health and Dr Ion Salaru and Dr Galina Obreja of the National Centre of Public Health of the Republic of Moldova (see programme).
Participants to the first training day in Chisinau, Republic of Moldova
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