Journal of Public Health Policy

, Volume 38, Issue 3, pp 327–344 | Cite as

Salt intake, blood pressure, and socioeconomic disparities among government employees in Sri Lanka: a cross-sectional study

  • Anuji Upekshika Gamage
  • Rohini De Alwis Seneviratne
  • Fahad S. Hanna
Original Article


Our study estimated salt intake, examined the association between blood pressure (BP) and salt intake, and explored the socioeconomic variations in salt intake among administrators (government employees). This is a cross-sectional study. We studied 168 randomly selected administrators aged 30–60 years attached to government offices in Colombo, Sri Lanka. Self-administered questionnaire gathered information on socio-demographic, work-related information, lifestyle practices, and medical history. BP, 24-hour urine collection, and anthropometric indices were measured. Mean salt intake levels measured by 24-hour Sodium (Na) excretion in hypertensives and non-hypertensives were 202.56 (SD ± 85.45) mmol/day and 176.79 (SD ± 82.02) mmol/day, respectively. A 100-mmol increase in sodium was associated with an average increase of 3.1 (95 per cent CI 2–4.2) mmHg in systolic BP and 1.8 (95 per cent CI 0.89–2.6) mmHg in diastolic BP. Higher salt intake was found in managerial assistants (12.38 ± 5.0 g) compared with senior officers (10.84 ± 4.9 g). Salt intake among these administrators was alarmingly high. High salt intake was positively associated with hypertension and more prevalent in lower socioeconomic strata.


salt intake 24-hour urinary sodium excretion hypertension socioeconomic inequalities 


  1. 1.
    Annex A. (2009) Global Health Risks: Mortality and Burden of Disease attributable to selected major risks. Geneva Switzerland WHO.Google Scholar
  2. 2.
    WHO. (2013) A Global Brief on Hypertension; Silent Killer, Global Public Health Crisis. Geneva, Switzerland: World Health Organization, Contract No.: WHO/DCO/WHD/2013.2.Google Scholar
  3. 3.
    Kearney, P.M., Whelton M, Reynolds K, Muntner, P., Whelton, P.K. and He, J. (2005) Global burden of hypertension: Analysis of worldwide data. Lancet. 365(9455): 217–223.CrossRefGoogle Scholar
  4. 4.
    World Health Organization. (2011) Noncommunicable Diseases in the South-East Asia Region: Situation and Response 2011. World Health Organization, Regional Office for South-East Asia.Google Scholar
  5. 5.
    He, F. and MacGregor, G. (2009) A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. Journal of Human Hypertension 23(6): 363–384.CrossRefGoogle Scholar
  6. 6.
    WHO. (2012) Guideline: Sodium Intake for Adults and Children. Geneva: WHO.Google Scholar
  7. 7.
    Marmot, M. (2005) Social determinants of health inequalities. The Lancet 365(9464): 1099–1104.CrossRefGoogle Scholar
  8. 8.
    Ji, C., Kandala, N.-B. and Cappuccio, F.P. (2013) Spatial variation of salt intake in Britain and association with socioeconomic status. BMJ Open 3(1): e002246.Google Scholar
  9. 9.
    Ortega, R.M., Lopez-Sobaler, A.M., Ballesteros, J.M., Perez-Farinos, N., Rodriguez-Rodriguez, E., Aparicio, A. et al (2011) Estimation of salt intake by 24 h urinary sodium excretion in a representative sample of Spanish adults. The British Journal of Nutrition 105(5): 787–794.CrossRefGoogle Scholar
  10. 10.
    Bates, C.J., Thurnham, D.I., Bingham, S.A., Margetts, B.M. and Nelson, M. (1997) Design Concepts in Nutritional Epidemiology (2nd ed.). Margetts, B.M. and Nelson, M. (eds.). Oxford, UK: Oxford University Press.Google Scholar
  11. 11.
    Khaw, K.T., Bingham, S., Welch, A., Luben, R., O’Brien, E., Wareham, N. et al (2004) Blood pressure and urinary sodium in men and women: The Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). The American Journal of Clinical Nutrition 80(5): 1397–1403.Google Scholar
  12. 12.
    Rhee, M.Y. (2015) High sodium intake: Review of recent issues on its association with cardiovascular events and measurement methods. Korean Circulation Journal 45(3): 175–183.CrossRefGoogle Scholar
  13. 13.
    Lwanga, S.K. and Lemeshow, S. (1991) Sample size determination in health studies: a practical manual.Google Scholar
  14. 14.
    Jan, R., Shah, S., Saleem, S., Waheed, A., Mufti, S., Lone, M. et al (2006) Sodium and potassium excretion in normotensive and hypertensive population in Kashmir. JAPI 54: 22–26.Google Scholar
  15. 15.
    WHO/PAHO. (2010) Protocol For Population Level Sodium Determination in 24-Hour Urine Samples Google Scholar
  16. 16.
    Wang, C.Y., Cogswell, M.E., Loria, C.M., Chen, T.C., Pfeiffer, C.M., Swanson, C.A. et al (2013) Urinary excretion of sodium, potassium, and chloride, but not iodine, varies by timing of collection in a 24-hour calibration study. The Journal of Nutrition 143(8): 1276–1282.CrossRefGoogle Scholar
  17. 17.
    Ljungman, S. and Granerus, G. (1995) The evaluation of kidney function in hypertensive patients. Hypertension, Pathophysiology Diagnosis and Management 2: 1493–1507.Google Scholar
  18. 18.
    Nishida, C., Uauy, R., Kumanyika, S. and Shetty, P. (2004) The joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases: Process, product and policy implications. Public Health Nutrition 7(1a): 245–250.Google Scholar
  19. 19.
    WHO. Reducing Salt Intake in Populations. (2006) Report of a WHO Forum and Technical meeting 5–7 October 2006, Paris, France WHO forum on reducing salt intake in poplulations.Google Scholar
  20. 20.
    Pickering, T.G., Hall, J.E., Appel, L.J., Falkner, B.E., Graves, J., Hill, M.N. et al (2005). Recommendations for blood pressure measurement in humans and experimental animals part 1: Blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension, 45(1): 142–161.CrossRefGoogle Scholar
  21. 21.
    Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo, J.L. et al (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42(6): 1206–1252.CrossRefGoogle Scholar
  22. 22.
    O’Brien, E., Petrie, J., Little, W., de Swiet, M., Padfield, P.L., Altma, D.G. et al (1993) Short report: An outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devices. Journal of Hypertension 11(6): 677–679.CrossRefGoogle Scholar
  23. 23.
    Bonita, R., De Courten, M., Dwyer, T., Jamrozik, K. and Winkelmann, R. (2001) Surveillance of risk factors for noncommunicable diseases: The WHO STEPwise approach: Summary.Google Scholar
  24. 24.
    Craig, C.L., Marshall, A.L., Sjostrom, M., Bauman, A.E., Booth, M.L., Ainsworth, B.E. et al (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise 35(8): 1381–1395.CrossRefGoogle Scholar
  25. 25.
    StataCorp. (2011) Stata Statistical Software: Release 12. In: College Station T, editor. StataCorp LP.Google Scholar
  26. 26.
    Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. (2004) The Lancet 363(9403): 157–163.Google Scholar
  27. 27.
    Powles, J., Fahimi, S., Micha, R., Khatibzadeh, S., Shi, P., Ezzati, M. et al (2013) Global, regional and national sodium intakes in 1990 and 2010: A systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 3(12): e003733Google Scholar
  28. 28.
    Sailesh Mohan, P.D. (2012) Review of Salt and health: situation in South-East Asia Region. Background Paper for the Expert Meeting on Population. Sodium Reduction Strategies for Prevention and Control of Noncommunicable Diseases in the South-East Asia Region. New Delhi: World Health Organization, Regional Office for South-East Asia.Google Scholar
  29. 29.
    MacGregor, G.A., Markandu, N.D., Sagnella, G.A., Singer, D.R. and Cappuccio, F.P. (1989) Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet 2(8674): 1244–1247.CrossRefGoogle Scholar
  30. 30.
    Sacks, F.M., Svetkey, L.P., Vollmer, W.M., Appel, L.J., Bray, G.A., Harsha, D. et al (2001) Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. New England Journal of Medicine 344(1): 3–10.CrossRefGoogle Scholar
  31. 31.
    Rodrigues, S. (2015) Relationship between salt consumption measured by 24-h urine collection. Brazilian Journal of Medical and Biological Research 48(8): 728–735.Google Scholar
  32. 32.
    He, F.J. and MacGregor, G.A. (2003) How far should salt intake be reduced? Hypertension 42(6): 1093–1099.CrossRefGoogle Scholar
  33. 33.
    Geleijnse, J.M., Kok, F.J. and Grobbee, D.E. (2003) Blood pressure response to changes in sodium and potassium intake: A metaregression analysis of randomised trials. Journal of Human Hypertension 17(7): 471–480.CrossRefGoogle Scholar
  34. 34.
    He, F. and MacGregor, G. (2002). Effect of modest salt reduction on blood pressure: A meta-analysis of randomized trials. Implications for public health. Journal of Human Hypertension 16(11): 761–770.CrossRefGoogle Scholar
  35. 35.
    Xu, J., Wang, M., Chen, Y., Zhen, B., Li, J., Luan, W. et al (2014) Estimation of salt intake by 24-hour urinary sodium excretion: A cross-sectional study in Yantai, China. BMC Public Health 14: 136.CrossRefGoogle Scholar
  36. 36.
    Prospective Studies Collaboration. (2002) Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet 360(9349): 1903–1913.CrossRefGoogle Scholar
  37. 37.
    Brown, I.J., Tzoulaki, I., Candeias, V. and Elliott, P. (2009) Salt intakes around the world: Implications for public health. International Journal of Epidemiology 38(3): 791–813.CrossRefGoogle Scholar
  38. 38.
    Cook, N.R., Cohen, J., Hebert, P.R., Taylor, J.O. and Hennekens, C.H. (1995) Implications of small reductions in diastolic blood pressure for primary prevention. Archives of Internal Medicine 155(7): 701–709.CrossRefGoogle Scholar
  39. 39.
    Marmot, M.G. (2003) Understanding social inequalities in health. Perspectives in Biology and Medicine 46(3 Suppl): S9–S23.CrossRefGoogle Scholar
  40. 40.
    Yan, L., Bi, Z., Tang, J., Wang, L., Yang, Q., Guo, X. et al (2015) Relationships between blood pressure and 24-hour urinary excretion of sodium and potassium by body mass index status in Chinese adults. The Journal of Clinical Hypertension (Greenwich) 17(12): 916–925.CrossRefGoogle Scholar
  41. 41.
    Ganda, O.P. and Fonseca, V.A. (2010) Salt sensitivity, insulin resistance, and public health in India. Endocrine Practice 16(6): 940–944.CrossRefGoogle Scholar
  42. 42.
    Pampel, F.C., Krueger, P.M. and Denney, J.T. (2010) Socioeconomic disparities in health behaviors. Annual Review of Sociology 36: 349–370.CrossRefGoogle Scholar
  43. 43.
    Chu, C., Breucker, G., Harris, N., Stitzel, A., Gan, X., Gu, X. et al (2000) Health-promoting workplaces—International settings development. Health Promotion International 15(2): 155–167.CrossRefGoogle Scholar

Copyright information

© Macmillan Publishers Ltd 2017

Authors and Affiliations

  • Anuji Upekshika Gamage
    • 1
  • Rohini De Alwis Seneviratne
    • 2
  • Fahad S. Hanna
    • 3
  1. 1.Management Development and Planning UnitMinistry of Health Sri LankaColomboSri Lanka
  2. 2.General Sir John Kotelawala Defence UniversityColomboSri Lanka
  3. 3.Department of Public Health, College of Health SciencesQatar UniversityDohaQatar

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