The salty truth

Mercy Mashao
Prof M.J Maseko
Introduction
 Historical points
• Salt played an important part in civilizations
for centuries
• Its uses mentioned since 6050 BC
• Salt monopoly and taxation
Effects of dietary salt intake on
health
 Dietary salt  blood pressure
in animal research

Rats Such studies provide us

Mice with detailed information
Dogs regarding how salt may
Rabbits affect blood pressure
Chimpanzees
• its time course
• underlying mechanisms
• what to expect in humans
 Animal studies summary

• The ability of excess salt to

raise blood pressure appears to
be a general characteristic in
mammals, including humans.

• The effects of salt on blood

pressure are complex, having
several distinct components:
- acute vs slow-progressive;
- reversible vs irreversible.

• Many individual systems and

mechanisms contribute to the
effect of salt on blood pressure.
Evidence in Humans for a
Link between
High Dietary Salt &
Hypertension
Intersalt
 Fig 2. Countries’ reported progress towards reduction in population salt intake.

Trieu K, Neal B, Hawkes C, Dunford E, Campbell N, et al. (2015) Salt Reduction Initiatives around the World – A Systematic Review of Progress
towards the Global Target. PLOS ONE 10(7): e0130247. https://doi.org/10.1371/journal.pone.0130247
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0130247
Available online at www.sciencedirect.com
Cardiovascular topics

Moore, et al, 2017; Oparil, 2014; Stolarz-Skryzypek et al.,

2011; Thomas et al., 2011; Crohen et al., 2008; Alderman et al.,
1998; Alderman et al., 1995
 

Santos et al., 2017; Jabonski et al., 2013; Celermayer and Neal.,

2013; Appel et al., 2011; He and MacGregor., 2011; Koga et al.,
2008; Frohlich., 2007; Wadner and MacGregor., 2002; Sacks et
al., 2001; Graudal et al., 1998; Mattes et al., 1991
 Aim
To investigate the relationship
between BP and dietary salt intake in
a group of African descent
Study population

674 participants were randomly

recruited
≥18 years
• Questionnaire
Medical history
 Ethics

Ethics was sought from the University of

Witwatersrand human ethics research
committee. M170215
Results and discussion
Table: General characteristics of the study population
All Participants Normotensive Hypertensive
Sample number 236 205 31

Age (years) 35.3 ± 18.2 31.4±14.8 60.7±18.5*

BMI 21.5±2.2 21.3±2.1 22.6±1.8*

% Hypertensive 13.7 0 13.7*

% Diabetic 4.4 1.7 2.6*

Alcohol intake (%) 31.8 27.5 4.2

Tobacco smoking (%) 26.3 23.7 2.5

Na+ (mmol.day-1) 113.8±92.9 114.7±88.4 107.9±120.2

Whr 0.79±0.07 0.79±0.07 0.83±0.09*

Abbreviations: BMI, body mass index; Whr, waist to hip ratio; Na+, 24-hour urinary sodium
excretion; Normal BMI is defined as a BMI < 25kg.m-2. Overweight is defined as BMI ≥ 25
<30 and overweight is defined as BMI ≥ 30. * P < 0.05.
 80

60
Age (years)

40

20

0
<44 44-68 69-107 108-172 >172
Quintile of 24hour Sodium excretion (mmol/day)

Figure: Age and quintiles of 24 hour urinary

sodium excretion.
 Table: Systolic and diastolic blood pressure by quintiles of twenty-four-hour
urinary sodium excretion.
<44 mmol 44-68 mmol 69-107 mmol 108-172 mmol >172 mmol
SBPc 129.7±22.8 124.6±22.4 120.9± 21.2 120.2± 15.9 118.5±16.5*

DBPc 84.5±13.4 79.8±11.7 81.3±11.6 79.3±10.1 78.2±9.2

SBP24 116.9±12.7 116.1± 15.0 110.8±11.3 114.4±7.7 115.3±11.74

DBP24 72.9±8.6 72.9±11.1 69.8±8.8 69.3±5.7 68.5±6.8*

SBPn 109.9±12.9 110.6±18.7 104.5±14.4 106.5±9.9 107.5±13.5

DBPn 65.8±10.1 66.1±12.2 63.0±11.2 60.8±8.5 59.3±10.4*

SBPd 121.8±12.8 119.6±13.5 114.7±10.6 119.9±8.8 120.4±12.7

DBPd 78.0±8.4 77.7±10.5 74.4±8.4 75.0±7.0 74.2±8.7

Abbreviations: Abbreviations: SBPc, conventional systolic blood pressu re; DBPc, conventional diastolic blood pressure;
SBP24, 24-hour ambulatory systolic blood pressure; DBP24, 24 -hour ambulatory diastolic blood pressure; SBPn, night time
systolic blood pressure; DBPn, night time diastolic blood pressure; SBPd, day time systolic blood pressure and DBPd, day time
diastolic pressure.
 Prevalence of hypertension (%)

25

20

15

10

0
<44 44-68 69-107 108-172 >172
24 hour urinary Na excretion (mmol)

Figure :The prevalence of hypertension according to quintiles of 24-hour urinary sodium

excretion.
 r=-0.12
P=0.05
Y= 71.9-0.02x

Figures 1-4: Adjusted linear regression analysis between blood pressure

and 24 hour urinary Na+ excretion.
 Key message

 Salt intake in this community is slightly higher

than the levels recommended by WHO.

 Dietary salt is an important contributor to high

blood pressure in this community.

 Dietary salt intake still needs to be reduced,

we suggest (<2.5 g salt=<43.5 mmol/day
sodium) which is equivalent to 1.0 g
 Policies to reduce population-wide salt
intake are most effective in developed
countries and can have a high impact.

 Healthcare professionals can play a key role

in educating people of all ages regarding
their optimal dietary salt intake.
 PhD highlights

Presented a poster at the Physiological Society of

Southern Africa (PSSA) conference, 7-10 October

2018. Stellenbosch, South Africa.

 Acknowledgements
• Prof M.J Maseko
• Prof W. Daniels
• All the participants
• Mrs M.N Maseko, Ms D. Nciweni, Mr A.
Bawa-Allah, Mr F.T. Nyundu, Mr E.
Phukubje, Ms B. Mlambo, Ms M. Ngema
and Mr B. Nkosi.
Thank you