Normally, What Is the Relationship of the Amount of Sodium Excreted to the Amount Ingested That Day?

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Research Article

Urinary Sodium Excretion and Dietary Sources of Sodium Intake in Chinese Postmenopausal Women with Prehypertension

• Zhao-min Liu,
• Suzanne C. Ho,
• Nelson Tang,
• Ruth Chan,
• Yu-ming Chen,
• Jean Woo

10

• Published: Baronial 1, 2014
• https://doi.org/10.1371/journal.pone.0104018

Figures

Abstract

Background

Reducing salt intake in communities is i of the about constructive and affordable public health strategies to prevent hypertension, stroke and renal disease. The present study aimed to decide the sodium intake in Hong Kong Chinese postmenopausal women and place the major food sources contributing to sodium intake and urine excretion.

Methods

This was a cross-sectional study amid 655 Chinese postmenopausal women with prehypertension who were screened for a randomized controlled trial. Data collection included 24 h urine drove for the measurement of sodium, potassium and creatinine, iii-day dietary records, anthropometric measures and questionnaire survey on demographic data and dietary habits.

Results

The average common salt intake estimated from urinary excretion was 7.8±3.2 g/d with 82.1% women above WHO recommendation of 5 g/day. Food groups as soup (21.six%), rice and noodles (13.5%), baked cereals (12.three%), salted/preserved foods (10.8%), Chinese dim sum (10.2%) and sea foods (x.1%) were the major contributors of non-discretionary salt. Discretionary common salt use in cooking made a modest contribution to overall intake. Vegetable and fruit intake, age, sodium intake from salted foods, ocean foods and soup were the independent determinants of urinary sodium excretion.

Conclusions

Our data revealed a significant room for reduction of the sodium intake. Efforts to reduce sodium from diets in Hong Kong Chinese postmenopausal women should focus on both candy foods and discretionary salt during cooking. Sodium reduction in soup and increase in fruit intake would be potentially effective strategy for reducing sodium.

Citation: Liu Z-m, Ho SC, Tang N, Chan R, Chen Y-m, Woo J (2014) Urinary Sodium Excretion and Dietary Sources of Sodium Intake in Chinese Postmenopausal Women with Prehypertension. PLoS Ane nine(8): e104018. https://doi.org/x.1371/journal.pone.0104018

Editor: Pal Bela Szecsi, Gentofte Academy Hospital, Denmark

Received: February eleven, 2014; Accepted: July 7, 2014; Published: August 1, 2014

Copyright: © 2014 Liu et al. This is an open up-access article distributed nether the terms of the Artistic Eatables Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The study was funded by the Chinese University of Hong Kong Research Committee Directly Grant No. 2041783. The funders had no function in study design, data drove and assay, decision to publish, or grooming of the manuscript.

Competing interests: The authors have alleged that no competing interests exist.

Introduction

Reducing table salt intake in communities is one of the most effective and affordable public health strategies to forestall hypertension, subtract the gamble of stroke, heart and renal diseases,the 3 major causes of mortality globally as well aslocally [1]. Elevated blood pressure level (BP) may also aggravate the positive association between urinary sodium excretion and risk of coronary heart illness [2]. Despite campaigns that encourage reduced sodium intake, excessive consumption remains a major public health problem in most populations [3].

In addition to the sodium naturally present in foods and drinking water, other important sources of sodium in our nutrition come from the salt used during cooking or at the table (discretionary salt), salt added in processed foods, as well equally non-table salt sodium containing ingredients such as monosodium glutamate (MSG) (season enhancer), sodium nitrate (preservative) and sodium carbonate (tenderizers) etc. Dietary survey methods tend to underestimate sodium intakes since only a portion of sodium can be captured by dietary cess. The timed 24-hour urinary sodium excretion is considered the gold standard method to estimate intake since 85–ninety% of ingested sodium is excreted through the kidneys and provide an judge of total sodium intake from all sources.

Dietary sodium intake and the major sources vary among different regions and populations, largely determined by cultural preference [iii]. Awareness of contemporaneous sodium intake and identification of food sources of sodium in diets will inform more specific tailoring of salt reduction policies in local population. Nonetheless, studies estimating salt consumption using timed urine samples, characterizing the nutrient groups to assess contributions to the source of sodium likewise as the associations with urinary sodium excretion are limited in Asian population. No study had been conducted amidst postmenopausal women with pre-hypertension or early hypertension, a population at high chance of cardiovascular diseases (CVD), declining renal office also as osteoporosis (the major agin medical atmospheric condition [four] [5] [6] linked with excessive sodium intake). Furthermore, potassium has been recognized every bit a protective factor for hypertension [vii] and a proposed modifier of the association between sodium intake and CVD [8]. However, studies on the potassium intake and the contribution to urinary potassium excretion are all the same express.

Thus, agreement the sodium and potassium intake among high risk populations would take enormous public health implications. The major purpose of nowadays study was to determine the sodium intake in Hong Kong Chinese postmenopausal women with prehypertension and identify the major food groups contributing to sodium and potassium intake and urine excretion. The report will provide the basis for public wellness initiatives to achieve population-broad reductions in salt intake.

Methods

The study protocol has been approved by the Ethical Research Commission of the Chinese Academy of Hong Kong (CRE Ref. No. 2012.201) and conducted according to the Declaration of Helsinki. Written informed consent has been obtained from all participants.

Subjects and recruitment

This was a cantankerous-exclusive written report among 726 Chinese postmenopausal women who attended a screening visit for a randomized controlled trial testing the consequence of soy products supplementation on BP. Subjects were recruited from the local community by advertising in newspapers or health talks from Apr to Dec, 2011. Women afterward prescreening interview were invited to health eye for an introduction talk and training for 24 h urine collection and 3 days dietary records.

Inclusion and exclusion criteria

Subjects were Hong Kong Chinese women aged 48–70 y; at least 1 year after the cessation of menstruation; with mean systolic BP 120∼180 mmHg or diastolic BP to a higher place eighty∼100 mmHg or both. Subjects were excluded if they were on anti-hypertensive medication, hormone therapy or hypoglycemic agents in recent 3 months; medical history or presence of certain chronic diseases such as stroke, cardiac infarction, severe liver and renal diseases; chest or uterine or ovarian cancer or other malignancies in recent v years. More details regarding subjects recruitment were published elsewhere [9].

Solar day urine collection

Participants were provided with a standable and graduated urine drove handbag and instructed on the method of 24 h urine collection. They were required to void their bladder before starting the collection and save all urines voided from that moment onwards for the post-obit 24 h. Participants were asked nearly the completeness of urine collection and to tape the starting and the final collection times. The total volume of urine was measured and mixed thoroughly before aliquots. Aliquoted urine samples were immediately frozen to −85°C until analysis.

Dietary survey, food groups and sodium intake adding

Nosotros used 3-day food records questionnaire to estimate dietary nutrients intake. Food items were those most oftentimes consumed based on previous local surveys [x], [11]. The food items and reference portion size (Chinese basin) in our dietary records were similar to our previously validated one-calendar week food frequency questionnaire [vi]. Subjects received a xxx-min preparation on interpretation of nutrient amounts, portion and utensil sizes. Three-day food diary was completed past subjects earlier the visit for urine submission and checked past trained research staff. Cooked dishes and not-commercial processed foods with multiple ingredients were disaggregated into individual nutrient items. Dietary nutrients including energy, protein, total fat, cholesterol and cobweb were calculated based on the Prc Food Composition Table [12].

From the three-mean solar day dietary data, the sodium consumption of the following xv food groups was calculated: rice and noodles; Chinese dim sum; baked cereals; preserved/salted foods; dairy products; creature meat; ocean foods; vegetables; soy foods; fruits; nuts; chips and cookies; beverages; soups and others. Total sodium intake was calculated by summing the estimates from all contributory nutrient items or groups. Sodium content in each food item was adopted from Chinese Limerick Table [12] and a local food sodium database [13]. Nosotros also asked participants to estimate their domestic salt consumption per month, dietary addiction on preserved vegetables, fried foods, roasted meat and pickled meat, as well as their salt gustation preference (in comparison with full general restaurants).

Demographic, anthropometric data and BP measurement

Individual information was nerveless by trained interviewers by contiguous interview based on pretested and structured questionnaires on socio-demographic data, medical history, medication and dietary habits. Anthropometric measures such equally body weight, meridian, waist and hip circumferences were performed co-ordinate to standard protocols. BP was measured according to standard methods using a validated oscillometric technique (Omron M4-I Intellisense, Omron Corporation, Japan). Subjects were seated quietly for at least 5 minutes with the non-dominant arm supported at heart level. A gage float encircling at least 80% of the arm was used to ensure accuracy. Ii readings were obtained with ane minute interval. A third BP was measured if more than v mmHg departure in systolic BP between two readings was noted, and the mean of the two closest was taken as the valid BP.

Urinary biochemical testing

20 four hours urine samples were obtained for measurement of sodium, potassium and creatinine. The analyses were performed on Hitachi 7101 automated analyzer (Japan) at a certified clinical lab. Urine sodium and potassium were measured by ion selective electrode methods, and creatinine was measured past enzymatic colorimetric analysis. The intra and inter assay coefficients of variation (CV) were 0.42% and 1.69% for urinary sodium, 0.60% and 2.01% for urinary potassium, ane.25% and ii.17% for urinary creatinine. Urinary sodium excretion was analyzed every bit a proxy of salt intake (g/d) calculated by the equation: 24 h urine volume (L)×urinary sodium (mmol/50)×58.4 [3].

Statistical assay

Analyses were performed using SPSS, version 17.0 (SPSS Inc., Chicago, IL, Us). P<0.05 was considered statistically significant. All variables were tested for normality using the Kolmogorov–Smirnov test and variables with skewed distribution were reported every bit median and quartiles. The relative contribution of food groups to the salt and potassium intake in diet were expressed equally percentages. Pearson correlation and partial correlation (controlling for historic period, BMI and free energy) analyses were performed to assess the correlations of sodium intake from various food groups with urinary sodium excretion and creatinine corrected sodium excretion (urinary sodium to creatinine ratio). Multiple linear regression analyses were used to evaluate the contained determinants of creatinine corrected urinary sodium excretion as well as urinary sodium to potassium ratio past inclusion of variables displaying significant correlations with urinary sodium by a stepwise approach. Sensitivity analyses were performed by excluding women with potentially incomplete 24 h urine collection.

The level of agreement between total dietary table salt intake (table salt estimated from dietary records and additional salt in home cooking) and urinary salt excretion was assessed using the Banal and Altman method [14] to identify the mean departure between the two measures.

Results

Of the 726 women who attended the screening visit, 655 (xc.2%) donated 24 h urine sample and provided 3-day dietary records, 596 (82.1%) completed anthropometric measures and questionnaire survey. Basic characteristics were indicated in Table ane. The mean age of the participants was 57.7±iv.seven years. Of the 655 women who provided 24 h urine samples, 86 (13.1%) reported incompleteness with misses of 1–2 voids, ten (1.five%) with total urine volume <thousand ml and 491 (74.8%) with urinary creatinine excretion in the normal range (7–18 µmol/24 h) [fifteen]. We conducted several sensitivity analyses by excluding subjects with missed voids (n = 86) or subjects with xxx% or college coefficients of variation (n = 78) in weight corrected creatinine (Cr/Wt [16], 24 h creatinine excretion in milligrams divided by body weight in kilograms). However, there was no marked deviation in the urinary salt excretion (7.6±2.nine and vii.eight±three.1 chiliad/d, respectively) in comparison with the uncorrected data (vii.8±3.ii yard/d).

Dietary habit and preference were indicated in Tabular array two. Most of the women (69.5%) favored lite sense of taste diet which is less salty than foods generally provided in restaurants. The boilerplate urinary salt excretion, dietary records estimated table salt intake and self-reported additional common salt intake were seven.eight±three.two, v.3±two.iii and 2.2±1.nine thousand/d respectively (Table iii). According to the estimates of urinary salt excretion, 17.9% women met the WHO target of <five yard table salt/d [17] and 31.6% met the People's republic of china Nutrition Society target of <6 g common salt/d. The urinary potassium excretion and average dietary potassium intake were 2.3±0.8 and 4.2±four.1 g/d respectively.

Figure 1 indicated the percentiles of the nutrient groups' contributions to dietary records estimated sodium consumption (non-discretionary salt). Of the fifteen food groups, soup, rice and noodles, baked cereals, salted/preserved foods, Chinese dim sum and sea foods were the major contributors to non-discretionary salt. Figure S1 indicated the percentiles of the food groups' contributions to dietary potassium intake. Rice and noodles, fruits and vegetables are the major contributors to the dietary potassium consumption.

Figure 1. Percentage contributions of food groups to non-discretionary dietary sodium intake.

Nutrient groups and non-discretionary dietary sodium intake were derived from 3-day food records. Sodium contribution expressed every bit percent of total dietary sodium intake. For nutrient groups, soup included canton soup and foam soup; baked cereals include breadstuff, cake, pizza and hamburger etc.; Preserved/salted foods included preserved/salted/pickled vegetable, meat, fish etc.

https://doi.org/ten.1371/journal.pone.0104018.g001

Person correlation analyses (Tabular array 4) indicated that creatinine corrected urinary sodium excretion was positively associated with full salt intake, sodium from Chinese dim sum, soup, preserved/salted foods and body of water foods. Similar findings were observed when further decision-making for age, body weight and total energy. While sodium from rice and noodles was negatively correlated with urinary sodium excretion, farther adjustment for creatinine and other variables, the associations became statistically non-meaning. Creatinine corrected urinary potassium excretion was also positively associated with dietary potassium intake (r = 0.09, p = 0.04) and the association remained significant after adjustment of age, BMI and full energy (r = 0.10, p = 0.03) (information not shown).

Multiple linear stepwise regression analysis (Table v) indicated that age, dietary vegetable intake, sodium from salted foods, soup and sea foods were positively, while full fruit intake were negatively associated with creatinine adapted urinary common salt excretion. Similar regression analysis on urinary sodium and potassium ratio (Table S1) indicated that BMI, sodium intake from salted foods and animal meat were positively, while dietary fruits intake, sodium intake from vegetables were negatively associated with urinary sodium and potassium ratio.

The 95% limit of understanding, defined as the mean departure between total dietary salt intake (non-discretional plus additional) and urinary salt excretion was −3.5 g (95% CI: −10.9 to 3.9 yard).

Discussion

Common salt intake estimated from 24 h urinary excretion indicated that nigh (>lxxx%) Hong Kong Chinese postmenopausal women had salt consumption in a higher place WHO recommendation of five g/d [17]. Food groups such every bit soup, salted foods, Chinese dim sum and sea foods were the major contributors to urinary sodium excretion. Discretionary common salt intake made a minor contribution to overall intake. The written report presents a comprehensive overview on salt intake in Hong Kong Chinese postmenopausal women and provides the basis for public health initiatives on the principal targets for table salt reduction at a population level.

In our report, urinary salt excretion was 7.eight g/d; yet if approximately 15% non-renal loss [18] were to exist included, the overall table salt intake would be nine.0 g/d. Studies have estimated that decreasing salt intake from 10 g to 5 g per day would reduce overall stroke rate past 23% and CVD by 17% [xix]. A recent meta-analysis reported a minor salt reduction of 2.0–2.3 g/solar day was associated with a 20% decrease in cardiovascular events [twenty]. The favorable outcome was even observed in normotensive population [21] [22]. If sodium intake of the population can exist decreased, such important health gains can exist accomplished with relatively small economic delivery [23]. An economic modeling report estimated that viii.5 million cardiovascular deaths could exist prevented over x years for a fifteen% (i.vii g/day) reduction in salt intake achievable with a low cost of US$0.twoscore∼1.00/person/year. With the loftier prevalence of hypertension in Chinese population and the heavy burden of CVD on wellness resources, reducing sodium intake would exist an constructive and affordable public wellness strategy.

Two international studies, INTERSALT (10079 men and women anile 20–59 y from 1985 to 1987) and INTERMAP (4680 men and women aged 40–59 years from 1996 to 1999) were by far the largest studies around the world with collection of standardized data on 24-60 minutes urinary sodium excretion. INTERSALT [24] reported that the highest urinary sodium excretion were plant in China, ranging upwards to 299 mmol/d (17.v g common salt/d) in men and 253 mmol/d (14.8 k common salt/d) in women in the Beijing, northern People's republic of china. The sodium excretion in southern Prc (Guangxi) was much lower with 150 mmol/d (8.8 g salt/d) in men and 128 mmol/d (7.5 1000 salt/d) in women. INTERMAP [25] investigated 3 counties in rural Communist china and reported an average of sodium intake of 3.half-dozen g/d (9.one g salt/d) in the Northward and ii.5 g/d (6.35 1000 common salt/d) in the Southward. Both studies reported that sodium intake in Communist china was profoundly above the international recommended intake and considerably varied by geographic regions. Our results in salt intake are in line with the data in South China. However, the 2 studies were conducted 20∼30 years ago and did non include samples from urban areas of China.

A number of studies take been published since and so giving data on sodium intake from different regions in China. However, virtually of the reports were based on dietary survey methods and studies without timed urine collections. The Prc Health and Diet Survey cohort [26] which included 16,869 adults anile 20–60 y from 1991 to 2009 reported that sodium intake is decreasing only remains double the Institute of Medicine recommendations (ane.five grand sodium or 3.eight g salt/d). The study reported a lower proportion of sodium from added salt (69.7% in 2009) than in other studies. The sodium intake was four.7 k/d (11.9 thou salt) in 2009 and 4.4 thousand/d (11.ii m common salt) in South China. However, the sodium intake in this study was estimated by 3 consecutive 24-h dietary recalls and condiments.

In 1995/96, the Hong Kong Developed Dietary Survey [27] interviewed a random sample of 1010 Chinese adults aged 25∼74 and estimated the sodium intake by spot urinary excretion. Results showed that 78% of participants had a daily sodium intake of more than 2.3 g/d (5.8 g salt), and sodium intake increased with historic period with almost v.2 g/twenty-four hour period (xiii.2 grand salt/d) in men and 4.5 yard/day (eleven.4 g salt/d) in women aged 55 and above. However, the study using spot urine to estimate sodium intake which could be less accurate than timed urine sample.

Our results in Hong Kong postmenopausal women indicated that the sodium intake in our study (7.eight g salt/d), while lower than several previous reports [26]–[28] in China, was still generally higher (>80%) than WHO recommendation [17]. The discrepancies between our results and other studies could exist due to different methods for salt estimation and the different population characteristics investigated (such every bit region, age or health status etc.). For example, the participants in INTERMAP Chinese samples were from rural areas, younger than ours (49 vs 56) and less hypertensive patients (17%) than our subjects (45%).

In Asian countries (mainland Communist china and Japan) [29], [xxx], discretionary salt use accounted for most (>lxx%) sodium intake and only a small proportion of sodium is intrinsic in foods. In contrast, in European and Northern American diets [31], [32], an estimated 75% of sodium intake comes from not-discretionary source such as processed or restaurant-prepared foods. Our study of source of common salt intake among Hong Kong postmenopausal women showed that the design is intermediate between typical Asian and western diets. Our dietary survey showed that not-discretionary salt intake was five.iii m/d accounting for 59% (5.three/9) full salt intake, thus the discretionary salt was estimated to be 41% (4.seven chiliad/d). Since participants reported a 2.2 thousand/d additional salt in home cooking, the other discretionary sodium was likely from other condiments (soy sauce, MSG etc.) or not-salt sodium ingredients that we accept non investigated. The relatively lower discretionary salt apply in Hong Kong women compared with typical Asian diet could be due to the westernization of Hong Kong cultures, increasing consumption of western foods, processed foods and eating abroad from abode. Thus, unlike strategies in many Asian and western countries, the efforts to reduce sodium from diets in Hong Kong population should focus on both not-discretionary salt such as processed foods and discretionary table salt used during habitation cooking.

In our study, food groups such as soup, salted foods, Chinese dim sum, bounding main foods and baked cereals made major contributions to the non-discretionary sodium intake. The findings are similar to Japan [29], in which the major source of non-discretionary sodium was from commercially processed fish/seafood (15%), salted soups (15%) and preserved vegetables (xiii%). Notwithstanding, data from United kingdom and USA [29], [33] showed that cereal and meat products accounted for the greatest proportion (38%) of household sodium intake. The discrepancies in food groups' contributions could be due to the cultural divergence in dietary pattern. In western countries, bread and meat are staple foods and made substantial contribution to dietary sodium [33], while in S Mainland china, Chinese dim sum, double-stewed soup, sea foods and salted fish and egg are pop in Cantonese cuisines and are the essential contributors to salt intake. However, in the regression model, only salted foods, soup and bounding main foods are independent contributory factors to urinary sodium excretion. One possible reason could be that Chinese dim sum and broiled cereals are significantly related with total energy intake, so that these variables become non-significant to the overall model when adjusting for energy and BMI.

In the regression model, nosotros observed that fruit intake was negatively while vegetable intake was positively associated with urinary sodium excretion. The possible reason could be related to the colinearity of some dietary components. The Chinese style of cooking vegetables involves liberal use of salt, which would increase urinary salt excretion. At the same fourth dimension fruits contains college amount of potassium which may better the negative impact of salt intake [34]. Our study provided show that subtract additional salt in vegetable dishes and increase fruit intake could exist effective in sodium reduction.

The observed correlation coefficient (r = 0.11, p<0.01) between sodium intake estimated from 3-24-hour interval dietary records and urinary sodium excretion in our study was lower than INTERMAP report (r = 0.42), but is still similar to studies in Finland women [35] (r = 0.xiii) and African adults (r = 0.fifteen) [36]. The relative weak correlation of dietary sodium intake and urinary excretion may be explained by measurement error of dietary assessment, the unmarried instead of multiple 24 h urine collection, variable excretion rates, and sodium losses through other metabolic pathways such as sweat and feces etc. [37]. Error in sodium intake estimated from dietary survey may occur due to inaccurate reporting, twenty-four hours-to-day variation or omission of added common salt or other condiments during cooking or at the tabular array.

In contrast with the underestimation of sodium intake using urinary sodium collection, dietary estimates of potassium intake oft exceeded those of urinary drove which was also suggested in our information. This is because 15∼20% of potassium is lost in the carrion and some other portion is excreted from sweat [37]. Compared with previous urinary data in Chinese population [38], [39], our subjects had a relatively lower urinary sodium/potassium ratio (2.4 vs 3.4 [39]) and college potassium excretion (2.3 vs ane.nine thou/24 h [38]). The relatively high potassium excretion and intake in our study might be explained by the fact that our participants were at high risk of hypertension and might be post-obit medical advice in restricting sodium intake and increasing fruits and vegetable intake.

To our knowledge, this is the offset study in Hong Kong to report findings on the major dietary sources contributing to dietary and urinary sodium and potassium. The study evaluated the characteristics of sodium and potassium intake in a population with high risk for hypertension and other chronic diseases such every bit CVD, declining renal function and osteoporosis. The population may benefit significantly from the reduction in sodium intake. The other strengths include the relatively big number of participants with 24 h urinary based estimates of sodium and potassium intake, high completeness of urine drove, the availability of detailed covariates to adjust for a range of potential confounders. In add-on, none of the participants were on antihypertensive treatment, which may derange the relationship between intake and urinary mineral excretion and therefore reverse causation seemed unlikely.

The nowadays study has several limitations. First, dietary survey in estimation of sodium and potassium intake is prone to a number of errors. Accurate measurement of sodium and potassium intake past dietary survey is difficult due to extensive sodium and potassium distribution in foods, and widespread employ of table salt or sodium compounds in food processing [31], [40]. Every bit with iii-day food records, the included nutrient items may not necessarily be inclusive of all the sources of sodium and potassium. The other specific sources of error in sodium include: difficulties in estimating the amount of sodium added during cooking; variation in the proportion of salt retained in food; common salt loss in cooking water or left behind on the plate [31]; variation in the sodium content of manufactured foods [thirteen]. In addition, we did not specifically investigate the consumption of other condiments except for salt, such every bit soy sauce, MSG etc. in cooking or at the table.

Second, urinary sodium was assessed by a single 24 h urine collection and a possible regression dilution bias may be introduced due to the daily individual variability. Notwithstanding, a single urine measurement is considered a more than accurate mensurate of sodium intake at a population level [41], though mayhap less accurate for individuals.

Tertiary, our report was conducted among Chinese postmenopausal women with prehypertension. Thus, the findings may not exist extrapolated to the broader populations. The participants were aware of their elevated BP and willing to register for a randomized controlled trial. This population is likely to be more health consciousness in post-obit medical advice to reduce their dietary sodium intake [31]. However, the urinary sodium data still revealed that more than than 80% women had backlog common salt intake in a higher place WHO recommendation. The data is probable to be higher in sodium intake among general population. In improver, our participants were mainly housewives and responsible for cooking for family. Thus, health promotion regarding salt intake and health try targeting women of this group may be effective in community in salt reduction.

Conclusions

Our data in Hong Kong Chinese postmenopausal women with prehypertension revealed that most women had salt consumption above the international recommendation, suggesting a significant room for reduction of the sodium intake. Efforts to reduce sodium from diets in this population should focus on both discretional table salt uses during dwelling house cooking and processed foods such every bit Chinese dim sum, salted foods, and broiled cereals etc. Sodium reduction in soup and increment in fruit intake would exist potentially effective strategy for reducing sodium. Further studies are necessary in other life stage of populations to provide definitive data on salt intake, and to act as a baseline against which to monitor the impact of future common salt reduction initiatives.

Supporting Information

Figure S1.

Percentage contributions of food groups to dietary potassium intake. Food groups and dietary potassium intake were derived from 3-day food records. Potassium contribution expressed equally percentage of total dietary potassium intake. For food groups, soup included canton soup and cream soup; broiled cereals include bread, cake, pizza and hamburger etc.; Preserved/salted foods included preserved/salted/pickled vegetable, meat, fish etc.

https://doi.org/10.1371/journal.pone.0104018.s001

(TIFF)

Table S1.

Stepwise regression analysis with urinary Na/Thou ratio as dependent variable and selected variables. BMI, trunk mass alphabetize; β, standardized coefficient; SE, standard error; But dependent variables with P<0.05 were shown. Variables excluded include: age, dietary free energy, sodium intake from soup, baked cereals, sea foods, Chinese dim sum, fruits, rice and noodles.

https://doi.org/10.1371/journal.pone.0104018.s002

(DOCX)

Acknowledgments

We are indebted to our report participants and our research banana Miss Anna Tsang. Without their endeavour this investigation would not have been possible.

Author Contributions

Conceived and designed the experiments: JW ZML SCH RC. Performed the experiments: ZML. Analyzed the information: ZML. Contributed reagents/materials/analysis tools: NT YMC. Wrote the newspaper: ZML.

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