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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015
AFRICA
57
Knowledge, attitude and behaviour regarding dietary salt
intake among medical students in Angola
Pedro Magalhães, Edgar JR Sanhangala, Isildro M Dombele, Henrique SN Ulundo, Daniel P Capingana,
Amílcar BT Silva
Abstract
Background:
Levels of salt consumption and its awareness
among medical students in Angola remain insufficiently stud-
ied. This study determined salt intake and assessed medical
students’ knowledge, attitude and behaviour regarding salt
consumption.
Methods:
Were collected 24-hour urine samples from a
random sample of 123 undergraduate medical students aged
17–43 years who were studying at the University of Agostinho
Neto in Luanda. Their knowledge, attitude and behaviour
regarding dietary salt were surveyed. Socio-demographic,
clinical and anthropometric data were collected.
Results:
Average salt intake was 14.2
±
5.1 g/day, without
significant difference between genders (
p
=
0.221). In total,
96.7% consumed over 5 g/day, but only 6.5% of participants
were aware of their excessive salt intake. The majority knew
about salt-related health consequences and 45.5% reported
they controlled their salt intake.
Conclusions:
This study indicated a high salt intake and inad-
equate behaviour regarding dietary salt consumption among
medical students studying at the University of Agostinho
Neto. This highlights the need for nutritional education to
improve their dietary habits and future role in counselling.
Keywords:
salt intake, behavioural, medical students
Submitted 8/7/14, accepted 27/1/15
Cardiovasc J Afr
2015;
26
: 57–62
www.cvja.co.zaDOI: 10.5830/CVJA-2015-018
High salt (sodium chloride) consumption is an important
determinant of high blood pressure and cardiovascular risk.
According to World Health Organisation (WHO) statistics, over
80% of cardiovascular disease (CVD) deaths take place in low-
and middle-income countries, and elevated blood pressure levels
were a major cause of these CVD deaths in those countries.
1
Lifestyle factors such as unhealthy diet, physical inactivity,
tobacco use and harmful use of alcohol have been considered
the most important behavioural risk factors for heart disease
and stroke.
2
Among dietary factors, high salt intake has been the most
strongly associated with raised blood pressure and increased
risk of stroke and CVD.
3
Therefore dietary sodium restriction
has been recommended as a non-pharmacological approach to
blood pressure lowering,
4-6
and for the prevention and control of
non-communicable diseases at the population level.
7,8
Cumulative evidence has shown that even a modest reduction
in salt intake was associated with blood pressure lowering
and therefore with a significant reduction in incidence of
cardiovascular events.
9-12
Furthermore, data from the most
recent systematic review and meta-analyses has shown the
benefit of lowering sodium intake in apparently healthy adults
and children,
13
and in both hypertensive and normotensive
individuals, irrespective of gender and ethnic group.
9
Since hypertension is associated with CVD worldwide, a
public health intervention to reduce high blood pressure must
target the role of lifestyle, particularly reduced sodium intake.
7
Therefore, several countries have initiated strategies to reduce
dietary salt intake in the general population by a combination of
various procedures such as public education, food labelling, and
collaboration with the food industry to reduce the salt content
of processed food.
14
Among sub-Saharan African countries, only Nigeria and
South Africa have developed dietary guidelines regarding salt
intake.
15
Recently, the South African government implemented
important specific legislation towards decreasing salt intake in
the population by reducing sodium content of processed foods by
industries.
16
Therefore, the current public health recommendation
is that countries should launch national initiatives to reduce
the over-consumption of salt as part of non-communicable
disease prevention and healthy nutrition policies for limiting salt
intake to less than 5 g/day for the general population including
children.
7
Despite of this guideline, however, high sodium intake
remains prevalent around the world, with average daily salt
intake varying from 5 to 18 g/day per person.
17
Although processed foods have been found to be the principal
source of excessive dietary salt intake,
18
sources of dietary sodium
vary largely worldwide and may be influenced by cultural context
and dietary habits of the population.
19
In sub-Saharan African
countries experiencingdemographic andepidemiological transition,
the rapid rise in prevalence of CVD (chiefly hypertension) has
been attributed to lifestyle change, including high dietary sodium
intake.
20,21
However, consistent data from studies on risk factors are
lacking for the majority of these countries.
With regard to Angola, available data from a cross-sectional
study reported a high prevalence of multiple cardiovascular
risk factors, such as hypertension, sedentary lifestyle,
electrocardiographic left ventricular hypertrophy,
22
and high rate
of the metabolic syndrome
23
in an apparently healthy middle-
aged population of university public employees living in urban
and peri-urban areas.
Department of Physiology, Faculty of Medicine, University
Agostinho Neto, Luanda, Angola
Pedro Magalhães, MD,
pedromagalhaes24@hotmail.comEdgar JR Sanhangala, MD
Isildro M Dombele, MD
Henrique SN Ulundo, MD
Daniel P Capingana, MD
Amílcar BT Silva, MD