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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Sodium and potassium excretion in an adult Caribbean population of African descent with a high burden of cardiovascular disease

Authors: Rachel M. Harris, Angela M. C. Rose, Ian R. Hambleton, Christina Howitt, Nita G. Forouhi, Anselm J. M. Hennis, T. Alafia Samuels, Nigel Unwin

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

High sodium diets with inadequate potassium and high sodium-to-potassium ratios are a known determinant of hypertension and cardiovascular disease (CVD). The Caribbean island of Barbados has a high prevalence of hypertension and mortality from CVD. Our objectives were to estimate sodium and potassium excretion, to compare estimated levels with recommended intakes and to identify the main food sources of sodium in Barbadian adults.

Methods

A sub-sample (n = 364; 25–64 years) was randomly selected from the representative population-based Health of the Nation cross-sectional study (n = 1234), in 2012–13. A single 24-h urine sample was collected from each participant, following a strictly applied protocol designed to reject incomplete samples, for the measurement of sodium and potassium excretion (in mg), which were used as proxy estimates of dietary intake. In addition, sensitivity analyses based on estimated completeness of urine collection from urine creatinine values were undertaken. Multiple linear regression was used to examine differences in sodium and potassium excretion, and the sodium-to-potassium ratio, by age, sex and educational level. Two 24-h recalls were used to identify the main dietary sources of sodium. All analyses were weighted for the survey design.

Results

Mean sodium excretion was 2656 (2488–2824) mg/day, with 67% (62–73%) exceeding the World Health Organization (WHO) recommended limit of 2000 mg/d. Mean potassium excretion was 1469 (1395–1542) mg/d; < 0.5% met recommended minimum intake levels. Mean sodium-to-potassium ratio was 2.0 (1.9–2.1); not one participant had a ratio that met WHO recommendations. Higher potassium intake and lower sodium-to-potassium ratio were independently associated with age and tertiary education. Sensitivity analyses based on urine creatinine values did not notably alter these findings.

Conclusions

In this first nationally representative study with objective assessment of sodium and potassium excretion in a Caribbean population in over 20 years, levels of sodium intake were high, and potassium intake was low. Younger age and lower educational level were associated with the highest sodium-to-potassium ratios. These findings provide baseline values for planning future policy interventions for non-communicable disease prevention.
Appendix
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Glossary
Bakes
A flour-based dumpling, which is shallow-fried in oil. Usually eaten as a breakfast item or snack, with fish cakes or on their own.
Chicken and potato roti
Chicken and potato curry wrapped in a roti skin and eaten as a meal.
Coconut bread
Dense cake made with grated coconut, vanilla essence and dried fruit (raisins, cherries). This is a traditional Barbadian delicacy
Coucou
Part of the National dish made from ground corn (cornmeal) and boiled okras, cooked into a firm paste. Usually served with steamed fish and frizzled salt fish
Ground provisions
Name given in the Caribbean to tubular root vegetables which are encased in the ground during growth; such as sweet potatoes, cassava (yucca), eddoes, tania and yams. Plantains, green bananas, corn and breadfruit, although not grown in the ground, are also considered to be ground provisions because they are often cooked with tubular root vegetables. Ground provisions are served as the main carbohydrate of the meal or as a side dish
Macaroni pie
Baked dish of macaroni mixed with a seasoned cheese-based sauce, a popular Barbadian starchy food dish
Minced meat
Sautéed ground beef, seasoned with onions, tomatoes and herbs. May be served with macaroni, chow mien or rice as part of a main meal
Peas and rice
A mixed dish of dried or fresh legumes (kidney beans, lentils, black-eye peas) and parboiled rice. Boiled in salted water seasoned with onion and herbs until dry. Salted cured meat may also be added during boiling. This dish is a staple in the Barbadian diet
Vegetable rice
A mixture of seasonal vegetables, most commonly carrots, beans or spinach, cooked with parboiled rice to form this composite dish. It is eaten as a starchy food.
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Metadata
Title
Sodium and potassium excretion in an adult Caribbean population of African descent with a high burden of cardiovascular disease
Authors
Rachel M. Harris
Angela M. C. Rose
Ian R. Hambleton
Christina Howitt
Nita G. Forouhi
Anselm J. M. Hennis
T. Alafia Samuels
Nigel Unwin
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5694-0

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