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Dietary Salt Intake Survey in the Republic of Moldova, 2016

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Dietary Salt Intake Survey in the Republic of Moldova, 2016 DIETARY SALT INTAKE SURVEY IN THE REPUBLIC OF MOLDOVA, 2016 DIETARY SALT INTAKE SURVEY IN THE REPUBLIC OF MOLDOVA, 2016 AUTHORS Francesco P Cappuccio Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom; and Head of the WHO Collaborating Centre for Nutrition. Lanfranco D’Elia Department of Medicine, Federico II University of Naples, Italy; and WHO Collaborating Centre for Nutrition, Coventry, United Kingdom. Galina Obreja State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chișinău, Republic of Moldova. Angela Ciobanu Public Health Officer, WHO Country Office in the Republic of Moldova, Chișinău, Republic of Moldova. KEYWORDS SALT INTAKE SODIUM POTASSIUM IODINE DIETARY INTAKE REPUBLIC OF MOLDOVA DISCLAIMER The authors’ views expressed in this report do not necessarily reflect the views of the World Health Organization, the Swiss Agency for Development and Cooperation, the Ministry of Health, Labour and Social Protection of the Republic of Moldova, and the National Public Health Agency. Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2018 All rights reserved. The World Health Organization Regional Office for Europe welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recom- mended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omis- sions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this pub- lication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. ABSTRACT High salt consumption is an important determinant of high blood pres- sure and reducing it would improve health outcomes by lowering car- diovascular disease and therefore death rates. Reducing salt intake has been identified as one of the most effective public health measures and is one of the leading targets at global, regional and national levels to reduce the burden of noncommunicable diseases. The purpose of the Dietary Salt Intake Survey in the Republic of Moldova was to establish current baseline average consumption of salt (sodium), potassium and iodine through 24-hour urinary excretion testing among a random sample of the adult population (aged 18–69 years), and to assess the knowledge, attitudes, practices and behaviour around dietary salt in order to enable more efficient planning and the implementation of an effective salt-reduction strategy in the Republic of Moldova. The survey was a population-based survey of adults aged 18–69 years and carried out in three stages: questionnaire survey, physical measurements, and 24-hour urine collections. The sample for the survey was selected us- ing a stratified probabilistic method in three stages from the master sample used by the National Bureau of Statistics, to be nationally rep- resentative. From a total of 1950 individuals selected from the sampling frame, 1307 (67%) provided suitable data for inclusion and the final sample included 858 participants. CONTENTS List of illustrations .......................................................................................................VII List of abbreviations .................................................................................................. VIII Foreword ........................................................................................................................IX Acknowledgements ........................................................................................................ X Executive summary .....................................................................................................XII 1. Background ............................................................................................................. 1 2. Survey goal and objectives ....................................................................................3 3. Survey methodology...............................................................................................4 3.1 Survey design ...................................................................................................4 3.2 Survey population and sampling ...................................................................4 3.3 Sample size .......................................................................................................5 3.4 Sampling ...........................................................................................................5 3.5 Ethical considerations .....................................................................................6 3.6 Training of field data collectors in survey methodology ............................6 3.7 Pilot testing .......................................................................................................7 3.8 Data collection process ....................................................................................7 3.9 STEP 1 Questionnaire survey ..........................................................................8 3.9.1 Assessing diet ........................................................................................8 3.9.2 History of NCDs and their risk factors ................................................8 3.9.3 Lifestyle advice ......................................................................................9 3.10 STEP 2 Physical measurements ......................................................................9 3.11 STEP 3 Laboratory analysis ........................................................................... 10 3.11.1 Analytical methods ............................................................................. 10 3.12 Survey data collection ................................................................................... 10 3.12.1 24-hour urine sample collections ...................................................... 10 3.12.2 Sampling of various foods ...................................................................11 3.13 Monitoring of data collection ........................................................................11 3.14 Data entry ........................................................................................................11 3.15 Data cleaning and weighting ........................................................................11 3.15.1 Data cleaning ....................................................................................... 12 3.15.2 Data weighting .................................................................................... 12 3.16 Data analysis .................................................................................................. 13 4. Survey results ....................................................................................................... 14 4.1 Recruitment and response rate .....................................................................14 4.2 Sex and age distribution of respondents ..................................................... 15 Dietary Salt Intake Survey in the Republic of Moldova, 2016 V 4.3 Demographic and socioeconomic characteristics ...................................... 15 4.4 History of NCDs and their risk factors ......................................................... 16 4.4.1 History of CVD ...................................................................................... 16 4.4.2 History of raised blood pressure ........................................................ 16 4.4.3 History of diabetes .............................................................................. 16 4.5 Anthropometry ...............................................................................................17 4.6 Blood pressure and pulse rate ...................................................................... 18 4.7 UNa excretion .................................................................................................20 4.8 UK excretion ...................................................................................................22 4.9 Urinary volume and UCr excretion ..............................................................24 4.10 UI excretion.....................................................................................................24
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