Epidemiologia e prevenzione delle malattie cerebro e cardiovascolari
Epidemiologia e prevenzione delle malattie cerebro e cardiovascolari
Sodium chloride (table salt) is the main source of sodium in the diet. The scientific evidence available on the negative effects that excessive salt consumption has on health is indisputable, especially with regard to the risk of cardiovascular and cerebrovascular diseases. WHO recommends a daily salt consumption of less than 5 grams (about 2 grams of sodium).
The inadequate consumption of potassium has been associated with several non-communicable diseases, mainly cardiovascular diseases. The WHO recommends taking at least 3510 mg of potassium per day through a healthy diet. An insufficient potassium intake is mainly due to a low consumption of vegetables, fruit and legumes.
Within the Ccm projects "Minisal-GIRCSI" and "Meno sale più salute", the determination of sodium and potassium consumption in the general adult Italian population was carried out by Iss, during the Cardiovascular/Health Examination Survey 2008-2012, through the collection of 24-hour urine in population samples aged 35-79 years resident in all Italian Regions.
About 10 years later, as part of the CCM Project "Monitoring of sodium consumption in the Italian population", during the CUORE Health Examination Survey 2018-2019, the 24 hours urine excretion of sodium and potassium in samples of the Italian population aged between 35 and 74 years, enrolled in 10 (out of 20) Italian Regions distributed in North, Centre and South of the Country, was estimated.
The comparison between the OEC/HES 2008-2012 and HES 2018-2019 surveys aimed at estimating the temporal trend of the usual salt consumption in the Italian adult population is based on data from random samples of persons aged between 35 and 74 years, residents in 10 Italian regions (Piedmont, Lombardy, Liguria, Emilia Romagna, Tuscany, Lazio, Abruzzo, Basilicata, Calabria and Sicily), including about 200 people for each region, statistically necessary to obtain representative estimates of salt consumption in the population.
The average daily salt intake in the population examined was 10.8 g in men and 8.3 g in women in the period 2008-2012 and 9.5 g and 7.2 g respectively in the period 2018-2019. A significant reduction in salt intake of about 12% over 10 years was therefore observed.
The reduction resulted, albeit to varying degrees, in almost all the regions examined and in all age groups, body mass index categories (normal weight, overweight, obese) and educational levels.
In both periods the average levels of salt intake were significantly higher in men than in women, in those with overweight and obesity than in people of normal weight and in individuals less educated than in the more educated, confirming the important role of social inequalities.
In the 2008-2012 survey, the salt intake in the 24 hours was less than 5 g per day, in 4% of men and in 15% of women between the ages of 35 and 74; significantly higher values were found in the 2018-2019 survey: 9% in men and 23% in women.
Although the observed temporal trend needs confirmation through further monitoring, at the moment the data in the investigated Italian general population indicate that the reduction in salt consumption has reached more than one third of the 30% target indicated by the WHO global action for the prevention and control of chronic non-communicable diseases 2013-2020. Nonetheless, levels remaining above that recommended by the WHO (less than 5 g per day), and this applies to both men and women, in all regions examined, age groups, body mass index categories and education levels.
The comparison between the OEC / HES 2008-2012 and HES 2018-2019 surveys aimed at estimating the temporal trend of habitual potassium consumption in the adult Italian population is based on data from random samples of persons aged between 35 and 74 years, residing in 10 Italian regions (Piedmont, Lombardy, Liguria, Emilia Romagna, Tuscany, Lazio, Abruzzo, Basilicata, Calabria and Sicily), including about 200 people for each region.
For the comparative analyses between the 2008-2012 and 2018-2019 surveys, urinary potassium (mmol/24h) was converted to potassium intake (g/day) (1 mmol corresponding to 39 mg of potassium) multipling by 39 and then again by 1.30 according to WHO indications.
The results on the average daily potassium intake in the population indicate a potassium intake in the Italian adult population still below the WHO recommended of at least 3,510 mg per day: in 2008-2012, the estimated average daily potassium intake was equal to 3,147 mg in men and 2,784 mg in women and in 2018-2019 was 3,043 g and 2,561 mg respectively.
In 2008-2012, the prevalence of persons with adequate potassium intake (ie, ≥ 3510 mg per day) was 31% for men and 18% for women; in 2018-2019, it was 26% and 12% respectively.
Average urinary potassium excretion levels were higher in men than in women and in those with overweight and obesity than in people of normal weight. A decrease in the mean daily potassium excretion was found mainly among persons aged 45 to 74, and particularly among obese and less educated women and men.
The prevalence of people with a potassium intake that reaches the WHO recommended level has declined slightly over the past 10 years, albeit significantly only in women.
As a consequence of the high sodium intake and insufficient potassium intake, the sodium/ potassium ratio in the adult Italian population was found to be well above 1, a desirable level, despite a significant small reduction between the first and second surveys.
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