Factors associated with salt intake in the Brazilian adult population: National Health Survey

Mill, José Geraldo; Malta, Deborah Carvalho; Nilson, Eduardo Augusto Fernandes; Machado, Ísis Eloah; Jaime, Patrícia Constante; Bernal, Regina Tomie Ivata; Cardoso, Laís Santos de Magalhães; Szwarcwald, Célia Landman

doi:10.1590/1413-81232021262.37492020

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ARTICLE • Ciênc. Saúde Colet. 26 (02) • Feb 2021 • https://doi.org/10.1590/1413-81232021262.37492020 copy

Factors associated with salt intake in the Brazilian adult population: National Health Survey

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper aims to identify the factors associated with high salt intake in the Brazilian adult population. This is a cross-sectional study with 8,083 adults participating in the National Health Survey (PNS, 2014/15). Salt intake was based on the estimation of 24-hour urinary sodium calculated from the sodium/creatinine ratio in spot urine samples. The highest quartile of the distribution was considered high salt intake. The relationship between high salt consumption and sociodemographic factors, lifestyles, morbidity, and self-rated health status was analyzed by calculating the crude prevalence ratios and the prevalence ratios adjusted for age and gender. Approximately 28.1% had an estimated salt intake higher than 10.56 g/day. Overweight (Adjusted Prevalence Ratio; 95%CI - PRadj 1.23; 1.09-1.39), obesity (PRadj 1.61; 1.43-1.83), and diabetes (PRadj 1.36; 1.17-1.58) were positively associated with high salt intake. Female gender (PRadj 0.73; 0.66-0.80), high schooling level (PRadj 0.88; 0.79-0.99), living in the North and chronic kidney disease (PRadj 0.71; 0.56-0.90) were protective factors. Salt consumption is elevated nationwide and in all population subgroups, requiring coordinated actions.

Key words:
Dietary Sodium; Feeding Behavior; Health Surveys; Urine

Variables	Estimated salt intake (g/day)				p*
	Less than P75 (<10.56 g/day)		Greater or equal to P75 (≥10.56 g/day)
	%	95%CI	%	95%CI
Total	71.86	[70.48 - 73.21]	28.14	[26.79 - 29.52]
Gender
Male	67.16	[64.93 - 69.32]	32.84	[30.68 - 35.07]	0.00
Female	76.12	[74.43 - 77.73]	23.88	[22.27 - 25.57]
Age group
18-29 years	72.16	[68.97 - 75.15]	27.84	[24.85 - 31.03]	0.04
30-44 years	69.41	[66.86 - 71.84]	30.59	[28.16 - 33.14]
45-59 years	72.20	[69.65 - 74.62]	27.80	[25.38 - 30.35]
60 years and over	75.20	[72.40 - 77.79]	24.80	[22.21 - 27.60]
Schooling
Illiterate	70.98	[68.92 - 72.95]	29.02	[27.05 - 31.08]	0.13
Elementary school	69.77	[66.02 - 73.27]	30.23	[26.73 - 33.98]
High school and over	73.34	[71.19 - 75.40]	26.66	[24.60 - 28.81]
Skin color
White	72.18	[70.05 - 74.22]	27.82	[25.78 - 29.95]	0.80
Black	70.10	[65.10 - 74.65]	29.90	[25.35 - 34.90]
Brown	71.82	[69.85 - 73.71]	28.18	[26.29 - 30.15]
Other	74.97	[62.20 - 84.51]	25.03	[15.49 - 37.80]
Region
North	79.36	[77.44 - 81.15]	20.64	[18.85 - 22.56]	0.00
Northeast	74.48	[72.70 - 76.17]	25.52	[23.83 - 27.30]
Southeast	68.41	[65.72 - 70.99]	31.59	[29.01 - 34.28]
South	73.56	[70.49 - 76.42]	26.44	[23.58 - 29.51]
Midwest	72.66	[69.39 - 75.72]	27.34	[24.28 - 30.61]
Fatty red meat consumption
No	72.80	[71.11 - 74.42]	27.20	[25.58 - 28.89]	0.04
Yes	69.59	[66.88 - 72.16]	30.41	[27.84 - 33.12]
Soft drinks consumption 5 days/week and over
No	72.09	[70.55 - 73.58]	27.91	[26.42 - 29.45]	0.52
Yes	70.96	[67.78 - 73.95]	29.04	[26.05 - 32.22]
Alcoholic beverage consumption once a month and over
No	72.80	[71.25 - 74.30]	27.20	[25.70 - 28.75]	0.02
Yes	69.00	[65.96 - 71.89]	31.00	[28.11 - 34.04]
Tobacco use
No	71.56	[70.07 - 73.01]	28.44	[26.99 - 29.93]	0.37
Yes	73.39	[69.58 - 76.88]	26.61	[23.12 - 30.42]
Body mass index
Underweight/normal weight	76.58	[74.45 - 78.59]	23.42	[21.41 - 25.55]	0.00
Overweight	71.11	[68.79 - 73.33]	28.89	[26.67 - 31.21]
Obesity	64.16	[61.13 - 67.08]	35.84	[32.92 - 38.87]
Diabetes (HbA1C≥6.5 or medication use)
No	72.31	[70.83 - 73.74]	27.69	[26.26 - 29.17]	0.00
Yes	65.70	[60.99 - 70.12]	34.30	[29.88 - 39.01]
Measured high blood pressure
No	72.21	[70.74 - 73.62]	27.79	[26.38 - 29.26]	0.13
Yes	68.79	[64.32 - 72.93]	31.21	[27.07 - 35.68]
High total cholesterol (≥200 mg/dL)
No	71.34	[69.57 - 73.06]	28.66	[26.94 - 30.43]	0.46
Yes	72.43	[70.11 - 74.64]	27.57	[25.36 - 29.89]
CKD (GFR <60 mL/min/1.73 m2)
No	71.07	[69.60 - 72.50]	28.93	[27.50 - 30.40]	0.00
Yes	81.04	[76.39 - 84.96]	18.96	[15.04 - 23.61]
Anemia (Hb <12 g/dL)
No	71.52	[69.97 - 73.03]	28.48	[26.97 - 30.03]	0.54
Yes	72.81	[68.84 - 76.44]	27.19	[23.56 - 31.16]
Self-assessed health status
Very good/good	72.00	[70.22 - 73.72]	28.00	[26.28 - 29.78]	0.80
Fair	71.79	[69.35 - 74.10]	28.21	[25.90 - 30.65]
Poor/very poor	70.17	[65.00 - 74.88]	29.83	[25.12 - 35.00]

Variables	Estimated salt intake (g/day)
	Greater or equal to P75 (≥10.56 g/day)		PR_crude	95%CI		PR_adjusted*	95%CI
	%	95%CI
Total	28.14	[26.79 - 29.52]
Gender**
Male	32.84	[30.68 - 35.07]	1.00			1.00
Female	23.88	[22.27 - 25.57]	0.73	0.66	0.80	0.73	0.66	0.80
Age group***
18-29 years	27.84	[24.85 - 31.03]	1.00			1.00
30-44 years	30.59	[28.16 - 33.14]	1.10	0.96	1.26	1.11	0.97	1.27
45-59 years	27.80	[25.38 - 30.35]	1.00	0.87	1.15	1.01	0.87	1.16
60 years and over	24.80	[22.21 - 27.60]	0.89	0.76	1.04	0.91	0.78	1.06
Schooling
Illiterate	29.02	[27.05 - 31.08]	1.00			1.00
Elementary school	30.23	[26.73 - 33.98]	1.04	0.91	1.20	1.00	0.86	1.15
High school and over	26.66	[24.60 - 28.81]	0.92	0.83	1.02	0.88	0.79	0.99
Skin color
White	27.82	[25.78 - 29.95]	1.00			1.00
Black	29.90	[25.35 - 34.90]	1.08	0.90	1.28	1.07	0.90	1.27
Brown	28.18	[26.29 - 30.15]	1.01	0.92	1.12	1.00	0.90	1.11
Other	25.03	[15.49 - 37.80]	0.90	0.57	1.42	0.92	0.58	1.45
Region
North	20.64	[18.85 - 22.56]	1.00			1.00
Northeast	25.52	[23.83 - 27.30]	1.24	1.10	1.38	1.25	1.11	1.40
Southeast	31.59	[29.01 - 34.28]	1.53	1.35	1.73	1.55	1.37	1.76
South	26.44	[23.58 - 29.51]	1.28	1.11	1.48	1.30	1.12	1.50
Midwest	27.34	[24.28 - 30.61]	1.32	1.14	1.53	1.33	1.15	1.54
Fatty red meat consumption
No	27.20	[25.58 - 28.89]	1.00			1.00
Yes	30.41	[27.84 - 33.12]	1.12	1.01	1.24	1.04	0.93	1.16
Soft drinks consumption 5 days/week and over
No	27.91	[26.42 - 29.45]				1.00
Yes	29.04	[26.05 - 32.22]	1.04	0.92	1.17	1.02	0.91	1.15
Alcoholic beverage consumption once a month and over
No	27.20	[25.70 - 28.75]	1.00			1.00
Yes	31.00	[28.11 - 34.04]	1.14	1.02	1.27	1.03	0.91	1.15
Tobacco use
No	28.44	[26.99 - 29.93]	1.00			1.00
Yes	26.61	[23.12 - 30.42]	0.94	0.81	1.08	1.12	0.97	1.29
Body mass index
Underweight/normal weight	23.42	[21.41 - 25.55]	1.00			1.00
Overweight	28.89	[26.67 - 31.21]	1.23	1.10	1.39	1.23	1.09	1.39
Obesity	35.84	[32.92 - 38.87]	1.53	1.36	1.73	1.61	1.43	1.83
Diabetes (HbA1C≥6.5 or medication use)
No	27.69	[26.26 - 29.17]	1.00			1.00
Yes	34.30	[29.88 - 39.01]	1.24	1.07	1.43	1.36	1.17	1.58
Measured high blood pressure
No	27.79	[26.38 - 29.26]	1.00			1.00
Yes	31.21	[27.07 - 35.68]	1.12	0.97	1.30	1.11	0.95	1.29
High total cholesterol (≥200 mg/dL)
No	28.66	[26.94 - 30.43]	1.00			1.00
Yes	27.57	[25.36 - 29.89]	0.96	0.87	1.07	0.99	0.89	1.09
CKD (GFR <60 mL/min/1.73 m2)
No	28.93	[27.50 - 30.40]	1.00			1.00
Yes	18.96	[15.04 - 23.61]	0.66	0.52	0.83	0.71	0.56	0.90
Anemia (Hb <12 g/dL)
No	28.48	[26.97 - 30.03]	1.00			1.00
Yes	27.19	[23.56 - 31.16]	0.95	0.82	1.11	0.97	0.84	1.13
Self-assessed health status
Very good/good	28.00	[26.28 - 29.78]	1.00			1.00
Fair	28.21	[25.90 - 30.65]	1.01	0.91	1.12	1.06	0.95	1.18
Poor/very poor	29.83	[25.12 - 35.00]	1.07	0.89	1.27	1.17	0.98	1.40

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[1] Collaborations

DC Malta, JG Mill, RTI Bernal participated in the conception, design, and data analysis and interpretation. DC Malta wrote the first version of the paper. RTI Bernal performed statistical analysis. EAF Nilson, IE Machado, PC Jaime, LSM Cardoso, CL Szwarcwald performed data analysis and critical review of the manuscript. All authors approved the version to be published.