Adults and children ingested an average of 8.0–4.7 grams (444.45–261.11 mmol) of sodium daily, with an average urine sodium excretion of 151.78–54.78 mmol/l. As a result, it is strongly advised to limit sodium intake. The objective of this study to investigate and identify sodium intake by estimating urinary sodium excretion in hypertensive patients. A cross-sectional assessment of the 24-hour urine collection procedure using the KME-03 salinity checker and blood pressure (BP). Estimates of average daily salt (sodium) consumption (6.44 grams; 110.104 mmol). Female participants had greater estimated average sodium intake than males (6.49 grams-110.99 mmol; 6.35 g-108.57 mmol). The correlation with systolic BP had a small significant negative correlation (r=-.330, p = .014) and positive correlation with diastolic BP (r = .343, p = .003). The participants' average urine salt excretion exceeded the reference norm and salt consumption was more than five g/d. Diverse population, repeated measurements, and determining the frequency of meals were needed.
Article
Estimation of sodium consumption in hypertensive patients based on urine sodium excretion: A Preliminary study
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24-urine
Hypertension affects 1.28 billion adults worldwide between the ages of 30 and 79, with the majority (two-thirds) living in low- and middle-income countries. Of those with hypertension cases, approximately 46% of healthy people were unaware of their condition. Less than half (42%) of adults with hypertension receive controllable treatment, or about 1 in 5 cases (21%). Hypertension is an important factor in premature death [1].
One of the global goals is to achieve a 33% reduction in the prevalence of hypertension among non-communicable disorders between 2010 and 2030. Indonesia ranks third in deaths from hypertension, with fatal conditions like stroke and kidney failure [2]. A person is said to have hypertension when the blood vessels are under too much pressure (140/90 mmHg or higher) [1]. Although common, if not treated or managed, it can be dangerous.
Management of hypertension can be done of them by reducing sodium intake and controlling blood glucose intake [1, 3, 4]. Dietary Guidelines recommend consuming less than 2300 mg of salt daily for a healthy diet, as salt consumption increases the risk of severe health issues. [5]. A recommendation to limit salt intake to 2000mg per day was given to people with moderate to severe heart failure conditions [6]. The recommended daily salt intake is 2.3–4 grams, or about one teaspoon [7].
Studies show that younger people prefer fast food with high salt content, while those with high BMIs have a less healthy lifestyle. Limiting sodium intake is recommended. 24-hour urine levels can measure daily salt intake, with males and females having mean sodium excretion of 1028 and 1006 mmol/d, respectively [8]. Adults and children ingested an average of 8.0–4.7 grams (444.45–261.11 mmol) of sodium daily, with an average urine sodium excretion of 151.78–54.78 mmol/l [9]. Meanwhile, a Chinese study of urine sodium estimation found an increase of 5.3 g/day with an average urinary salt output of 3175 g/day, or 176.39 mmol/day [10, 11].
Another study by He et al., (2019) showed that pre-hypertensive respondents who did not follow a low-salt diet program had an estimated 3766–1290 mg/d salt intake habits. Excessive salt intake (salt is sodium chloride; 2.5 g of salt contains 1 g of sodium) is the key determinant of blood pressure in individuals and groups [13]. Therefore, this study aims to investigate and identify sodium intake by estimating urinary sodium excretion in hypertensive patients. It will provide a basis for developing and selecting the most effective management strategy.
This descriptive correlational cross-sectional investigation was conducted in a city in North Sulawesi, Indonesia. Province has higher rates of hypertension, diabetes, stroke, and heart disease than the rest of the country [14]. Manado, located on Sulawesi's northernmost point, is a city known for fast food, salty dishes, and smoked fish. A survey was conducted using home visits, focusing on accuracy and convenience for urine analysis.
Study participants and sampling methods
Based on Indonesian government normative standards, participants were young to older adults diagnosed with hypertension in their neighborhood, aged 20–69 [15]. The study excluded residents with severe diseases, fasting, or other conditions affecting 24-hour urine collection. The city administration provided information, and age and sex groups were randomly assigned.
A computer-based random number generator selects samples from residents' identification cards for sodium levels in the study population [16]. The previous study used 28 participants (α .05; power .80) [17]. To account for potential depletion, 10% of participants were added to 31, but in this 120-invitation study, 73 willing participants were included.
Data collection
The data collection took three days, starting with a visit to the resident's home, defining inclusion and exclusion criteria, and providing written consent. Participants were recorded, and a 24-hour urine collection procedure was explained. Tools were provided, and adverse occurrences were confirmed on the third day.
Participant’s characteristics. STEPS developed a questionnaire for participant characteristics, including age, sex, education, medical history, occupation, and drug use. [18]. Older adults primarily used the SPMSQ (Pfeiffer, 1975) to assess mental health.
The study used a 24-hour urine collection technique to calculate daily sodium consumption. Participants disposed of their first-morning urine at 5:00 a.m. on the first day, and all subsequent samples were collected. The method was accurate for gauging 24-hour urine completion in population-based biomarker investigations [9, 19, 20].
After accounting for collection times based on the collection data, the measurement of salt concentration in participants' urine using the KME-03 salinity checker (Kawano Me Lab, Yokohama, Japan) was validated and recommended by The Japanese Society of Hypertension for decreasing salt intake [21]. A portable Muranaka medical device, an Osaka (Japan) style sphygmomanometer, and a traditional Littmann stethoscope are used to test blood pressure. St. Paul, Minnesota, 3M Science, United States. Measurements of height and weight were made with the Camry BR-9707 (kg/m2). A set protocol is carried out for every measurement.
The average participant age in Table 1 is 47–48 years old, within Indonesia's productive age range. [22]. Women made up 63% of the participants (46 persons). Most respondents (34, 46.6%) had a secondary education, and most worked as entrepreneurs (31, 42.5%). There are 47 people (64.4%) who smoke. Fifty-one individuals, or 69.9%, did not drink alcohol. Estimates of individuals' average daily salt (sodium) consumption (6.44 grams; 110.104 mmol). Next, female participants had greater estimated average salt (sodium) intake than males (6.49 grams; 110.99 mmol). Also, both men and women who participated fell under grade 2 hypertension (with an average systolic pressure in male participants of 150.22 and females of 146.24).
Table 2 shows a significant connection between individuals' systolic and diastolic blood pressure (SBP and DBP) and urine salt levels. Urine sodium total excretion significantly correlates with SBP and DBP, with a positive correlation for female participants. Age, urine salt excretion, and systolic and diastolic blood pressure are strongly associated. Smoking behavior and drinking patterns have no significant correlation.
Study shows age significantly impacts sodium content in urine discharges, with older individuals prioritizing high-salt fast food menus over nutritional value.[8]. Research shows hypertension patients often overindulge in salt, fail to follow recommendations, and are unaware of recommended daily intake limits. [4]. A person's level of hypertension will be impacted by not following therapy or treatment plans.
Participants often exceed sodium control limits, exceeding 2–4 g/day and exceeding five g/day, according to studies [23]. Also backed by research by Kartono et al. (2014), Researchers found that adults and children consume 8.0–4.7 grams of sodium daily, with an average urine excretion of 2732–986 mg/L [24]. Study shows Japan, Britain, US produce over 51.3 mmol/day sodium secretion during 24-hour collections [11]. In contrast, investigations of urine sodium estimates carried out in China had an average increase of 2.3 g (5,3 g/day) [10]. Similar research shows pre-hypertension individuals aged 30–54 consume 209.23–71.67 mmol/l of salt, with 24-hour urine sodium excretion measuring sodium concentrations [12].
The study finds a significant association between urine salt and blood pressure, consistent with previous research showing salt reduction leads to lower blood pressure [25]. The INTERSALT study found a strong correlation between salt intake and a gradual rise in blood pressure with age, with sodium significantly correlated with increased blood pressure [26]. A study found that trials lasting less than 15 days had less effect on 24-hour urine sodium excretion than longer trials, with no connection between trial length and SBP drop (2.13 mm Hg; 0.85 to 3.40; P = 0.002) [27]. Regardless of its type, sodium physiologically affects variations in blood pressure in people, which can raise vascular resistance due to fluid retention in plasma/blood vessels.
A study shows that five grams of salt intake reduction reduces carotid-femoral diameter by 2.8%, aiding the cardiovascular system, lowering blood pressure, and improving vascular function [28]. According to research, consuming more salt strongly correlates with higher blood pressure [29]. Low-salt diets improve blood pressure control and adherence [30]. Most investigations have discovered that sodium plays a significant role in blood pressure increases, hypertension, and disruptions in blood vessel circulation.
Most people's blood pressure starts to drop within weeks of reducing their salt intake [31]. Blood pressure is lowered by consuming less sodium, with hypertensive individuals experiencing larger benefits [32]. Americans must consume 2,300 mg of salt daily to reduce heart disease, stroke, and high blood pressure (Centers for Disease Control and Prevention, 2021).
What is known about this topic
The study found that participants' average urine salt excretion exceeded the reference norm, and salt consumption exceeded five g/d.
Age influences salt consumption patterns, and excessive sodium intake increases the risk of hypertension, stroke, and heart problems.
Other factors contributing to hypertension include excessive alcohol, smoking, inactivity, unhealthy diets, and medication inactivity
The study's limitations include a one-time sodium urine sample collection and a preliminary test. Future research should use larger samples, repeated measurements, and meal frequency determination
What this study adds
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This study provides preliminary data on daily sodium consumption through a 24-hour urine examination.
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Future interventions should follow recommendations for preventing hypertension, cardiovascular disease, and nervous system damage.
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Health professionals should support limiting sodium intake to recommended amounts (720–4000 mg/day).
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The study found that local culture, menus, and food composition contribute to chronic diseases like hypertension, heart issues, and blood vessel disorders.
Data Availability Statement
Before including any data in our study, the research team reviewed and examined it. Raw data is kept private until it is necessary.
Acknowledgment
Sam Ratulangi University's non-tax state revenue fund (NSRF or PNBP) funded this study. The authors further acknowledge the involvement of the participants and the General Hospital, Prof. Dr. R.D. Kandou Manado, as stakeholders and contribution in providing data for this study.
Author contributions
All authors participated in conceptualization, formulation, data retrieval, validation, critical evaluation, editing, and manuscript revision, ultimately accepting the final version.
Ethical Approval
The General Hospital Prof. Dr. R.D. Kandou Manado's research ethics committee granted clearance for this study with protocol number DP.04.03/D.XV/2986/2023. The study's official consent was obtained from each of the selected participants.
Competing Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Consent for publication
The authors permit this manuscript to be published in its entirety.
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Table 1. Characteristics of demography participant
|
Variable |
n |
% |
|
Age Mean (SD) Gender Male Female Education background Low Middle High College/University Work Farmer or worker Self-employed Civil servant Professional Not work Habits of smoking Yes Not Alcohol consumption Yes Not |
χ̅=47.35
27 46
23 9 34 7
7 31 16 8 11
47 26
22 51 |
±8.72
37 63
31.5 12.3 46.6 9.6
9.6 42.5 21.9 11.0 15.1
64.4 35.6
30.1 69.9 |
|
|
n (χ) |
±SD |
|
Urine total (gram) Urine total (mmol) Blood pressure Systole Diastole Urine Na+ secretion (gram) Male Female Urine Na+ secretion (mmol) Male Female Blood pressure male Systole Diastole Blood pressure female Systole Diastole |
73 (6.44) 73 (110.104)
73 (147.36) 73 (68.26)
27 (6.35) 46 (6.49)
27 (108.57) 46 (110.99)
27 (150.22) 27 (70.56)
46 (146.24) 46 (67.02) |
2.03 34.81
23.32 11.21
1.96 2.09
33.51 35.88
24.41 12.62
22.86 10.13 |
χ̅, mean score; SD, standard deviation
Table 2. Urinary sodium and systolic and diastolic blood pressure are correlated with demographics.
There is NO conflict of interest to disclose.