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A Cross-Sectional Evaluation of Sodium Consumption by People in Cambodia

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A Cross-Sectional Evaluation of Sodium Consumption by People in Cambodia A cross-sectional evaluation of sodium consumption by people in Cambodia by Lauren Calder Ramsay A Thesis presented to The University of Guelph In partial fulfillment of requirements for the degree of Master of Science in Biomedical Sciences Guelph, Ontario, Canada © Lauren Calder Ramsay, December, 2014 ABSTRACT A CROSS-SECTIONAL EVALUATION OF SODIUM CONSUMPTION BY PEOPLE IN CAMBODIA Lauren C. Ramsay Advisor: University of Guelph, 2014 Alastair J. S. Summerlee The cross-sectional study took place in four provinces in Cambodia: Kampot, Kandal, Kampong Chhnang and Phnom Penh. This study involved the collection of 24-hour urine samples to assess sodium and potassium excretion. Demographic, anthropometric, blood pressure, physical activity level, and socio- economic data were collected in face-to-face interviews. Mean urinary sodium excretion found in the 24-hour urinary sample of the entire sample population (M=5615.93mg,) is nearly three times higher than the World Health Organization recommended intake of 2000mg of sodium, p<0.001. The mean potassium excretion in 24-hours in the sample population is 3455.79mg/day. Sodium excretion has a positive linear relationship with potassium excretion, p=<0.001. There was no relationship between sodium excretion and blood pressure. The major contributors to the high-sodium diet were added seasonings daily during cooking including: salt, fish sauce, monosodium glutamate, and prahok (a locally made fish paste). Acknowledgements I first must acknowledge Christopher Charles who taught me hands on how to conduct research and provided me guidance throughout my degree. Your commitment to and passion for Cambodia and its people is inspiring. You have taught me more than you can know about being a researcher and a development practitioner. Thank you. I also must sincerely thank my advisor, Alastair Summerlee, for giving me the opportunity to be in this program, as well as taking a chance on me. I appreciate the support and your willingness to let me explore my interests. Professor Cate Dewey has also been immensely helpful in guiding my research and spending time with me to talk to me about analysis and research ideas. Without the support and guidance of Professor Summerlee and Professor Dewey I would not have been able to succeed in this program. Of course my success in this degree also wouldn’t have been possible without the love and support of my family and friends in Canada and Cambodia. I feel so fortunate to have such strong support networks at home and abroad. iii Declaration of Work Performed I declare that with the exception of the items indicated below, all work reported in the body of this thesis was performed by me: Chapter 2 contains contributions from Christopher Charles. This chapter is forthcoming in the following publication: Ramsay, L. C., Charles, C. V. Review of Iron Supplementation and Fortification in Public Health, Prof. David Claborn (Ed.). ISBN 978-953-51-4103-7. InTech; forthcoming. The research in Chapter 4 and 5 was done in collaboration with Christopher Charles. NutriFood Cambodia conducted surveys and collected data in Cambodia and translated all results. Biomedical Laboratory in Phnom Penh, Cambodia analyzed urine samples included in Chapter 4. Food samples included in Chapter 5 were analyzed at the University of Guelph Agriculture and Food Laboratory. iv Table of Contents Acknowledgements ............................................................................................ iii Declaration of Work Performed ......................................................................... iv List of Tables ...................................................................................................... vii List of Figures ................................................................................................... viii Chapter 1: Introduction ....................................................................................... 1 Rationale ...................................................................................................................... 2 Organization of Thesis ............................................................................................... 3 Chapter 2: Review of Iron Supplementation and Fortification ........................ 5 Introduction ................................................................................................................. 5 Iron Deficiency and Iron Deficiency Anemia ............................................................ 5 Signs and Symptoms of Iron Deficiency Anemia ...................................................... 7 Iron in the Body ........................................................................................................... 8 Dietary Iron ............................................................................................................... 9 Implications of Parasitic Infections and Malaria .................................................... 10 Helminths ................................................................................................................ 10 Malaria .................................................................................................................... 11 Treating Iron Deficiency Anemia ............................................................................. 12 Iron Supplements ...................................................................................................... 14 Fortified Staples ........................................................................................................ 14 Micronutrient Powders (MNPs) ................................................................................ 17 Food Fortification Involving Sodium Ferritin ......................................................... 19 Taking Advantage of Adventitious Sources of Dietary Iron ................................. 20 Cast Iron Pots ......................................................................................................... 21 The Lucky Iron Fish™ ............................................................................................. 22 Treating ID and IDA in Cambodia ............................................................................ 22 Government Supplementation Program ................................................................. 23 Chapter 3: Sodium ............................................................................................. 26 Introduction to Sodium Intake ................................................................................. 26 Sodium in the Body .................................................................................................. 26 Regulation of Sodium Balance ................................................................................ 27 Sodium and Cardiovascular Health ........................................................................ 28 Sodium in the World Today ..................................................................................... 30 Potassium .................................................................................................................. 32 Chapter 4: Sodium Intake in Cambodia Determined by 24-hour Urine Samples .............................................................................................................. 34 Introduction ............................................................................................................... 34 Materials and Methods ............................................................................................. 36 Study Site and Population Sample Selection .......................................................... 36 Data Collection ........................................................................................................ 38 Statistics .................................................................................................................. 39 Results ....................................................................................................................... 40 Sodium Excretion .................................................................................................... 41 v Consumption of High-Sodium Foods ...................................................................... 42 Perceptions of Sodium Intake ................................................................................. 43 Blood Pressure ....................................................................................................... 44 Socioeconomic Status ............................................................................................ 45 Obesity .................................................................................................................... 45 Physical Activity ...................................................................................................... 46 Potassium Excretion ............................................................................................... 46 Discussion ................................................................................................................. 46 Chapter 5: Evaluation of 24-Hour Food Samples in Three Provinces in Cambodia ............................................................................................................ 50 Introduction ............................................................................................................... 50 Statistics .................................................................................................................
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