Salt intake among Iranian population: national and subnational report from STEPS 2021

Salt intake among Iranian population: national and subnational report from STEPS 2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Salt intake among Iranian population: national and subnational report from STEPS 2021 Nasim Nosratinia, Sina Azadnajafabad, Masoud Masinaei, Ali Golestani, and 21 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3869388/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract High salt intake is a major risk factor for non-communicable diseases, resulting in numerous deaths and disability-adjusted life-years worldwide. The study aimed to analyze data from a 2021 nationwide survey of 25,202 Iranian adults, investigating daily salt intake. Participants were randomly chosen by a systematic proportional size cluster sampling. All of them completed questionnaires and their anthropometric and physical measurements were taken. Using Tanaka method and necessary equations, spot urine samples were taken to estimate 24-hour urine sodium and evaluate daily sodium intake in grams. The mean amount of salt intake was 9.71g (95% CI: 9.66–9.76) in 2021. Furthermore, 98.0% of participants consumed more than 5g of salt daily. Salt intake in men was higher than in women (9.95g (95% CI: 9.87–10.3) vs 9.51g (9.44–9.58) daily. Rural areas’ residents and people with lower years of schooling consumed higher levels of salt per day, 10.02g (9.96–10.07) and 9.99g (9.88–10.1), respectively. Mean salt consumption in married people was higher than in single individuals by 0.37g per day. Salt consumption was higher in obese participants in comparison to people with normal BMI (10.16g (10.06–10.26) vs 8.72g (8.43–9.01)). The risk of high salt consumption was significantly lower in hypertensive participants than normotensive ones (adjusted OR = 0.467, 95% CI: 0.345–0.631), as well as being aware of hypertension in hypertensive patients (adjusted OR = 0.338, 95% CI: 0.190–0.603). Iranians’ salt intake was nearly double the WHO-recommendation. Approved effective interventions must be considered to lower salt consumption in Iran like food labeling, educating people, and using salt substitutes. Health sciences/Medical research Health sciences/Risk factors Health sciences/Health care/Public health Figures Figure 1 Figure 2 Introduction Salt intake and diet high in sodium contribute to non-communicable diseases particularly high systolic blood pressure, and this notion has been excessively investigated 1 , 2 . Globally, high intake of salt contributed to 1.89 million deaths and 44.87 million disability-adjusted life-years (DALYs) in 2019, which leads to the fact that high salt intake was the leading dietary risk factor for deaths and DALYs, worldwide 1 . World Health Organization (WHO) has estimated that the reduction of salt intake for the amounts of less than 5 grams per day would vehemently prevent 2.5 million deaths, annually 3 . In this regard, the 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, provides Sustainable Development Goals targeted a 30% reduction in mean salt intake by 2025, compared with that of 2010 as a baseline year 4 . Although high salt intake exacts a massive toll on healthcare systems through a surge in non-communicable diseases burden, some studies demonstrated the gaps in nationally representative individual-level data on intake of key nutritional elements including salt 5 , 6 . Highlighting the paramount significance of establishing national surveillance services for non-communicable diseases through addressing its risk factors, the WHO recommended the stepwise approach for non-communicable disease surveillance (STEPS) as a cardinal framework for periodically evaluating the non-communicable diseases status in countries and territories 7 . The first national survey of salt intake in Iran using the STEPS method was done in 2016. The mean salt intake was 9.5 grams per day among the Iranian adult population 8 . Iran as a developing country faces a major socioeconomic transition during the past century including population growth, an increase in the number of elderly people, and rapid and unplanned urbanization, which has led to a reduction in the burden of communicable diseases and shift to non-communicable diseases epidemic in the recent decades 9 . Nevertheless, the healthcare system has not yet been aligned commensurate with such dramatic changes 10 . Therefore, intermittently monitoring of non-communicable diseases situation and its risk factors would empower the policy makers to capture the clearer picture from the situation. The objective of this study was to investigate the salt intake among Iranian population along with their attitudes and practices about high sodium consumption in various provinces, age groups and socioeconomic status in 2021. Materials and methods Overview This study is designed based on the WHO recommended STEPwise Approach to NCD Risk Factor Surveillance (STEPS) 2021 11 . In this study, we used the data from the STEPs 2021 and reported the mean salt consumption in the Iranian adult population in 2021. The details about data collection and the method of the study has been explained in detail in another paper 12 . The study aimed to determine the amount of salt intake in Iranian adult population and give practical information to policy makers in order to make plans to reduce salt consumption as an important risk factor for NCDs. Study design and participants This study was part of a population-based survey in 2021, recruiting 27,874 individuals older than 18 years old for the assessment of major risk factors for non-communicable diseases from 31 provinces of Iran. The study protocol was published previously 12 . Briefly, data were gathered through the methodology of systematic cluster classification, considering the required sample size for evaluating risk factors of NCDs in each province in the Non-communicable Diseases Research Center (NCDRC) in early 2020 based on the WHO recommended STEPwise approach to conduct nationwide surveillance for non-communicable diseases and their risk factors. A systemic proportional size cluster sampling scheme was applied to randomly select a representative sample of Iranian adults. The survey included three phases including completing a questionnaire, anthropometric measurements, and laboratory assessments. Salt intake measurement and variable definition Questionnaire Participants were asked to complete the questionnaire, regarding their salt intake habits. The questions included using saltshakers, adding salt to the food just before the consumption, frequency of consuming salty foods, and their attitudes regarding salt consumption, including whether they had been advised regarding lowering salt consumption within the past 12 months. After the completion of the questionnaire, each participant was assessed by anthropometric and physical measurements. Salt intake measurement and method selection Spot urine samples from all participants (who completed the questionnaire and were assessed by anthropometric and physical measurements) aged at least 25 years, a total of 18,119 individuals underwent urine sodium measurement. The urine samples were collected in the morning and transferred to the central laboratory of the Non-Communicable Diseases Research Center considering the optimal condition criteria defined in the protocol 12 . In addition to urine sodium, the kinetic colorimetric assay was applied to assess the spot urine creatinine based on the Jaffe method 13 . 24-hour (24-h) urine sodium estimation was mainly determined by applying three known equations namely Kawasaki, Tanaka, and INTERSALT methods 14 . To choose the most appropriate model among the abovementioned validated methods, 24-h urine samples were collected from a subsample of 609 participants. Root means square error was calculated for all equations. The root means square error for Tanaka, Kawasaki, and INTERSALT equations is presented in Table 1 . Finally, due to the lower mean root square error value and no negative values in the confidence intervals, the Tanaka method was chosen for this study. Considering the 10% excretion of sodium through sweating, the value was added to the selected equation results. Table 1 Estimated mean salt intake and 24-h urine sample Method N of participants Mean (SD) Min Max Root mean square error (SD) Kawasaki 17910 11.2 (0.00) 1.36 195.19 5.11 (1.39) Tanaka 17910 8.82 (0.00) 1.77 81.55 3.83 (1.14) INTERSALT 17888 8.14 (0.00) -1.12 19.08 3.53 (1.06) 24h urine 623 7.94 (0.2) 1.64 26.59 N/A Variable definition The WHO recommended amount of salt consumption is less than 5g/day 3 . Body weight, height, and body mass index (BMI) were measured according to the World Health Organization's data-gathering protocol. BMI was defined as underweight (BMI < 18.5 kg/m 2 ), normal weight (18.5 < BMI < 25 kg/m 2 ), overweight (25 ≤ BMI < 30 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ) for adults. A calibrated digital sphygmomanometer was used to measure sitting blood pressure. Participants were asked to rest in a sitting position for 15 minutes. Then the blood pressure was measured in three rounds with at least three minute intervals and the mean of the second and third time was reported as the participant’s BP. Hypertension was diagnosed when the systolic or diastolic BP was ≥ 140 and/or ≥ 90 mmHg respectively, or the participant had been diagnosed with hypertension by a health professional or was on anti-hypertensive medications. Diabetes was defined as a fasting plasma glucose value ≥ 7.0 mmol/L (126 mg/dl) or being on medication for raised blood glucose. National Cholesterol Education Program ATP III guideline was applied to assess the total cholesterol (TC), which was classified as desirable (less than 200 mg/dl), borderline high (200– 239 mg/dl), and high (greater than 240 mg/dl) 15 . Physical activity was assessed using Global Physical Activity Questionnaire (having at least 150 minutes of moderate-intensity physical activity OR 75 minutes of vigorous-intensity physical activity OR an equivalent combination of moderate- and vigorous-intensity physical activity achieving at least 600 MET-minutes in a week is considered active). 16 Ever or current daily cigarette smoking was considered as a positive smoking history. Consuming at least two servings of fruit and three servings of vegetables was considered appropriate. Statistical analysis We used the National Population and Housing Census 2016 conducted by Iran's Statistical Center as the standard population for direct age standardization in order to compare provinces. Weighted frequency, proportion, mean, and standard deviation (SD) were used to describe the data. 95% confidence interval (95% CI) for each quantitative variable was reported. Categorical variables were analyzed by Chi-Square test. For analyzing the differences among means of two groups and three groups or more, an independent-sample t-test and one-way analysis of variance (ANOVA) test was used, respectively. Regarding the handling of missing data, if the response to the primary question in each part of the questionnaire, typically the first question in each section, was not provided, the entire section was considered as missing data. Multiple logistic regression was applied to calculate the adjusted odds ratio (OR) and 95% CI for high salt intake. In models 1 to 5, we included different types of covariates based on previous studies 8 , and a stepwise approach was utilized for model 6 to identify the relevant covariates, including variables with p-value < 0.2 and missing data < 30%. All data analyses were conducted using R statistical package version 4.3.1.P-value less than 0.05 was considered as statistically significant. Ethical considerations The study methodology conformed to Helsinki Declaration standards as revised in 1989. The study was approved by National Institute for Health Research under the reference code of IR.TUMS.NIHR.REC.1398.006. Participation in this study was voluntary and each participant could leave the study at any time. The aim of study and the process were explained to all participants and all provided informed consent prior to participation in study in written form. Also, study design, data collection, data analysis and paper submission were not affected by the funding source of the study. Results Sociodemographic and health characteristics of participants Among 27,874 participants with age 18 years old and above, 25,202 participants aged 25 and more were included in the study: 13,990 (55.5%) women and 11,212 (44.5%) men. The mean (SD) age of participants was 48.2 (0.1). The number of rural residents was more than twice the number of urban residents (73.2% vs 26.8%). The majority of the participants had basic and complementary health insurance 22,692 (90.7%) and 17,759 (71.3%) respectively. Other socioeconomic status of participants is presented in Table 2 . Table 2 Socio-demographic status of participants Variables N (%) Age groups, n (%) 25–34 years 5,243 (20.8) 35–44 years 6,178 (24.5) 45–54 years 5,412 (21.5) 55–64 years 4,520 (17.9) 65–70 years 1,704 (6.8) 70 + years 2,145 (8.5) Residential area, n (%) Urban 6,576 (26.8) Rural 18,446 (73.2) Years of schooling, n (%) Zero 3,988 (15.9) 1–7 6,576 (26.3) 7–12 4,661 (18.6) 12+ 9,798 (39.2) Marital status, n (%) Never married 2,284 (9.1) Married 20,675 (82.0) Divorced 544 (2.2) Widowed 1,699 (6.7) Employment status Public sector employee 1,597 (6.4) Public sector labor 245 (1.0) Private Sector Employee 713 (2.8) Private Sector labor 974 (3.9) Freelance job or self-employed 5,885 (23.5) Unpaid work 11,840 (47.3) Retired 2,531 (10.1) Unemployed due to disability 441 (1.8) Unemployed seeker job 558 (2.2) Unemployed Not seeking work 239 (1.0) Basic health insurance, n (%) Yes 22,692 (90.7) No 2,331 (9.3) Complementary insurance, n (%) Yes 17,759 (71.3) No 7,162 (28.7) Wealth index Class 1 4,835 (20.2) Class 2 4,788 (20.1) Class 3 4,777 (20.0) Class 4 4,788 (20.1) Class 5 4,684 (19.6) Salt intake Salt consumption The mean of urine sodium and creatinine was 134.35 mmol/l (95% CI: 133.10-135.59, p-value < 0.001) and 146.34 mg/dl (95% CI: 144.70-147.98, p-value < 0.001), respectively (Table 3 ). After using the Tanaka method, the mean of salt intake among the Iranian population was 9.71g (95% CI: 9.66–9.76, p-value < 0.001) in 2021. As many as 17,538 (98.0%) of participants consumed more than 5g of salt daily. Considering the sociodemographic features of participants, male participants (mean(95% CI): 9.95g(9.87g-10.3g)), residents of rural regions (mean(95% CI): 10.2g (9.96g-10.07g)), people with lower years of schooling (mean(95% CI): 9.99g (9.88g-10.01g)) and married ones (mean(95% CI): 9.99g (9.88g-10.1g) (p < 0.001)consumed higher levels of salt per day. Participants aged 25–34 years and 65–70 years showed the lowest and the highest levels of salt intake among various age groups (mean (95% CI): 9.36g (9.24g-9.47g) vs 9.92g (9.76g-10.08g), p < 0.001). Smokers consumed lower amounts of salt than non-smokers (mean (95% CI): 9.45g (9.35g-9.54g) vs 9.75g (9.71g-9.79g), p < 0.001). There were no statistically significant differences in salt intake among participants with different employment status, basic health insurance coverage and wealth index level. Also, participants’ condition regarding diabetes mellitus or total cholesterol level, did not make statistically significant impact on their salt consumption (Table 4 ). Table 3 Participant’s laboratory data Variables Total (Mean, 95% CI) Men (Mean, 95% CI) Women (Mean, 95% CI) p-value Spot urine sodium (mmol/l) 134.35, (133.1-135.59) 142.15, (140.28-144.02) 128.12, (126.47-129.76) < 0.001 Spot urine creatinine (mg/dl) 146.34, (144.7-147.98) 161.18, (158.69-163.68) 134.49, (132.41-136.57) < 0.001 Table 4 Salt intake attitudes and practices among women and men of various age-groups Groups Salt intake p-value Number of participants consuming ≥ 5g/day p-value Mean 95% CI N (%) Sex Female 9.51 9.44–9.58 < 0.001 9923 (97.7) 0.021 Male 9.95 9.87–10.3 7615 (98.4) Age 25–34 years 9.36 9.24–9.47 70 years 9.81 9.58–10.03 1402 (97.5) Residency Urban 9.60 9.56–9.65 < 0.001 11861 (97.9) 0.557 Rural 10.02 9.96–10.07 5677 (98.1) Years of schooling Zero 9.99 9.88–10.1 12 years 9.4 9.31–9.49 6174 (97.65) Marital status Single 9.40 9.31–9.49 < 0.001 2896 (97.14) 0.013 Married 9.77 9.73–9.81 14642 (98.16) Employment Unemployed 9.65 9.55–9.75 0.391 2552 (97.8) 0.767 employed 9.72 9.68–9.76 14872 (98.0) Basic health insurance Yes 9.71 9.67–9.75 0.814 15996 (97.9) 0.045 No 9.69 9.56–9.82 1428 (98.6) Complementary health insurance Yes 9.62 9.55–9.69 0.037 4712 (97.53) 0.091 No 9.74 9.70–9.79 12647 (98.2) Wealth index Class I 9.78 9.66–9.90 0.063 3545 (97.7) 0.295 Class II 9.60 9.49–9.72 3220 (97.9) Class III 9.92 9.82–10.02 3574 (98.4) Class IV 9.66 9.56–9.77 3373 (98.3) Class V 9.61 9.47–9.75 2896 (97.8) Hypertension (BP > = 140/90) Yes 9.84 9.77–9.91 < 0.001 6412 (97.3) 0.001 No 9.63 9.59–9.68 11121 (98.4) Ever had diabetes mellitus Yes 9.80 9.69–9.92 0.162 2062 (97.1) 0.146 No 9.68 9.63–9.73 9154 (98.1) Ever had myocardial infarction or stroke Yes 9.69 9.55–9.83 0.83 1443 (96.4) 0.083 No 9.71 9.67–9.75 16081 (98.1) Body Mass Index 18.5 ≤ BMI < 25 8.72 8.43–9.01 < 0.001 447 (95.8) 0.001 Under 18.5 9.27 9.18–9.36 5433 (97.2) 25 ≤ BMI = 30 10.16 10.06–10.26 4763 (98.6) Low physical activity Yes 9.63 9.57–9.68 0.148 7799 (97.6) 0.013 No 9.71 9.66–9.76 8125 (98.3) Smoker Yes 9.45 9.35–9.54 < 0.001 2384 (97.7) 0.516 No 9.75 9.71–9.79 15138 (98.0) Total cholesterol level Desirable 9.67 9.61–9.73 0.218 13811 (98.0) 0.995 Borderline high 9.83 9.7–9.96 2949 (97.9) High 9.87 9.56–10.17 758 (98.0) Using saltshaker Yes 9.91 9.85–9.96 < 0.001 6585 (98.7) < 0.001 No 9.59 9.54–9.63 10942 (97.5) How often do you add salt to your food right before starting or while eating your meal? Always 9.89 9.75–10.03 0.002 2297 (98.7) 0.014 Often 9.86 9.71–10.02 1769 (98.5) Sometimes 9.69 9.58–9.8 3437 (98.4) Barely 9.67 9.56–9.77 4001 (97.8) Never 9.63 9.54–9.72 6023 (97.5) How often do you add salt while preparing/cooking meals? Always 9.76 9.69–9.83 0.703 8907 (98.3) 0.145 Often 9.76 9.64–9.88 2741 (98.3) Sometimes 9.59 9.46–9.73 2741 (97.3) Barely 9.53 9.4–9.67 2094 (97.5) Never 9.81 9.59–10.02 1044 (97.9) How often do you eat salty processed food? (pickled cucumbers, popcorn, etc.) Always 9.97 9.75–10.19 0.005 791 (99.2) < 0.001 Often 9.82 9.66–9.97 1643 (98.9) Sometimes 9.74 9.65–9.84 5597 (98.1) Barely 9.68 9.59–9.76 5650 (98.3) Never 9.61 9.49–9.72 3846 (96.6) How much salt do you think you use? Excessive 9.71 9.41-10.00 0.07 587 (97.6) 0.06 High 10.04 9.86–10.21 1651 (98.6) Appropriate 9.74 9.67–9.81 9147 (98.3) Low 9.66 9.55–9.76 4250 (98.0) Very low 9.40 9.25–9.56 1892 (96.3) Do you think eating excessive amounts of salt or salty food cause any health problems? Yes 9.71 9.68–9.75 0.409 16210 (98.0) 0.581 No 9.63 9.50–9.76 1317 (97.5) How important is it to you to reduce the amount of food salt? Very important 9.64 9.57–9.71 0.02 14766 (59.4) < 0.001 Slightly important 9.78 9.70–9.87 8722 (35.21) Not important 9.95 9.70–10.20 1392 (5.4) Have you been advised to reduce your salt intake? Yes 9.73 9.69–9.78 0.091 12606 (97.9) 0.294 No 9.64 9.57–9.7 4853 (98.2) Fruit consumption Appropriate 9.65 9.59–9.71 0.105 6488 (98.2) 0.227 Inappropriate 9.74 9.69–9.79 11039 (97.9) Fast food consumption Yes 9.73 9.69–9.77 0.13 14401 (98.0) 0.652 No 9.63 9.55–9.71 3126 (97.9) Vegetable consumption Appropriate 9.43 9.31–9.55 0.001 1607 (96.9) 0.026 Inappropriate 9.73 9.7–9.77 15920 (98.1) Considering the health status of participants, the salt intake was higher among participants with obesity, and hypertension. People who had normal BMI had the lowest and the obese ones had the highest amount of salt intake. (8.72g (95% CI: 8.43–9.01) vs 10.16g (95% CI: 10.06–10.26), p-value < 0.001) Salt consumption was higher in hypertensive participants in comparison to the normotensive ones. (9.84g (95% CI: 9.77–9.91) vs 9.63g (95% CI: 9.59–9.68), p-value < 0.001) Although the difference in salt intake was not statistically significant, the mean salt consumption was slightly lower among patients having a history of myocardial infarction or stroke. (Table 4 ) In an age-standardized model for the sub-national level, Markazi had the highest salt consumption prevalence (99.47%, SE:0.28) and Bushehr had the lowest salt consumption (94.92%, SE:0.94) in both sexes (Fig. 1 ). Although salt consumption in all provinces was higher than the WHO recommended amount, some variations were observable, from 10.34g/day in Kurdistan, the province with the highest, to 8.73g/day in Bushehr, the province with the lowest amount of salt consumption. (Fig. 2 ). Attitudes toward salt consumption Attitudes and practices More than 70% of the participants had received advice (from a medical doctor, a health care worker, etc.) in order to reduce their salt consumption within the past 12 months before answering the questionnaires (71.6%, p-value < 0.001). People who lived in the city received more recommendations than rural residents in order to decrease the salt addition to the food. (76.0% compared to 70.1%, p-value < 0.001). The higher the level of education, the less advice people received on reducing their salt intake (68.9% compared to 76.3%, p-value < 0.001). About 94.6% of the participants thought that it is important to reduce the amount of daily salt usage (p-value < 0.001). Between men and women, women cared more about decreasing salt intake (96.0% compared to 92.8%, p-value < 0.001). The salt intake attitude and practices among participants are presented in Table 5 . The majority of participants (men and women) thought that the extreme usage of salt causes health problems (92.0% vs 7.92%, p-value < 0.001). When the participants were asked about mean salt usage, men said greater amounts than women (14.1% compared to 11.0%, p-value < 0.001). More than half of women (54.3%, p-value < 0.001) always added salt while cooking or preparing a meal. Among all participants more than one-third (37.9%, p-value < 0.001) added salt to their food while eating or just before starting their meal. This amount was higher in men than women (42.1% compared to 34.6%, p-value < 0.001). People living in urban areas added more salt than people in rural areas (39.2% compared to 37.5%, p-value = 0.024). There was no significant difference between married and single people in adding extra salt to their food (p-value = 0.056). While there was a significant difference in adding salt to food and processed food consumption in different wealth indexes, there was no observable gradual increase in salt addition to food and eating processed food with increasing wealth index (p-value < 0.001). The same pattern applied to processed food consumption and wealth index. Single people used processed food more than married people (13.3% versus 1184 13.1%, p-value = 0.05) and this amount was higher in unemployed compared to the employed ones (13.9% versus 9.5%, p-value < 0.001). After including different variables for socio-demographic characteristics, lifestyle, anthropometry, and laboratory measurements variables using a stepwise approach in a multiple logistic regression model (Table 6 ), high salt intake was 88% higher in men than women (adjusted OR = 1.883, 95% CI: 1.322–2.68, p-value < 0.001). Increasing age was associated with higher salt intake, and the age group 65–70 exhibited the strongest association with an adjusted odds ratio (OR) of 3.35. (95% CI: 1.658–6.77, p-value = 0.001). There was no association between high salt intake and area of residency. High salt consumption was 40% lower in smokers than nonsmokers (adjusted OR = 0.6, 95% CI: 0.382–0.943, p-value = 0.027). Hypertensive participants had 54% lower amounts of high salt intake than normotensive participants (adjusted OR = 0.467, 95% CI: 0.345–0.631, p-value < 0.001), as well as hypertensive patients who were aware of having hypertension (adjusted OR = 0.338, 95% CI: 0.190–0.603, p-value < 0.001 (based on model 1)). High salt intake was 4.5 times higher in obese people than people who had normal BMI (adjusted OR = 4.576, 95% CI: 2.361–8.869, p-value < 0.001). Adding salt to last meal increased high salt intake by 56% (adjusted OR = 1.564, 95% CI: 1.147–2.131, p-value = 0.005). Discussion Salt intake among the Iranian adult population exceeded WHO recommendations by nearly double. Salt consumption varied based on sociodemographic factors, with men, rural residents, and married individuals consuming higher amounts. Among different age groups, those aged 65–70 had the highest salt intake, while those aged 25–34 had the lowest. Participants with obesity and the ones with hypertension consumed higher amounts of salt. There was no significant difference in salt consumption between those who received advice to reduce salt in their diet and those who didn't. Participants with unhealthy lifestyle habits, like using salt shakers, adding salt during meals, inadequate vegetable consumption, and low physical activity, had higher salt intake. The mean salt intake among the Iranian population increased from 9.52 g/day (9.48–9.56, CI: 95%) in 2016 to 9.71 (9.66–9.76, CI: 95%) in 2021 8 . In our study, high salt consumption was 56% higher in people who had added salt to their last meal. In 2016, Iranian participants who used salt shakers had higher salt intake, but there was not a significant association between high salt consumption and using a salt shaker 8 . Five-holed salt shakers instead of 17-holed ones led to lower salt consumption per meal in England 17 . These findings suggest that avoiding saltshakers or employing reduced-holed ones may be effective strategies to reduce overall salt intake. Men consumed more salt than women, possibly due to childhood habits. This aligns with a 2015 study in Shahroud, focusing on 6 to 12-year-old school children, which showed similar gender-based differences. Also, even among children, the salt intake patterns between rural and urban residents mirrored our findings 18 . In Isfahan, four cross-sectional studies in 1998, 2001, 2007, and 2013 showed salt consumption increased steadily in men during that time but in women, decreased from 2001 to 2007, probably influenced by salt reduction programs 19 . This trend is consistent with a 2016 Australian study that reported higher daily salt intake in men. 20 . These global patterns emphasize the need to consider gender differences in salt reduction initiatives. Traditional bread is a significant source of salt in the Iranian diet, with nearly half of the WHO's recommended salt limit obtainable from it. Efforts to reduce salt in bread production, such as salt substitutes and improving flour quality, have faced challenges, including limited competition in the use of flour or bread. 21 , 22 Enhancing bakery supervision, especially for traditional bakeries, in terms of flour quality and controlled salt content, and imposing penalties for non-compliance may advance salt reduction initiatives. There might be a relationship between low-quality flour used in rural areas and higher amount of salt intake in residents of rural regions. However, further investigations are needed. In a 2018 study on 13 countries, the salt intake from 2011 to 2018 ranged from 6.75 g/d (95% CI: 6.32-7.17) in Barbados to 10.66 g/d (95% CI: 10.52‐10.81) in Portugal. While some countries like Italy, England, Canada, and Barbados showed reduced salt intake since 2010, the reasons remain unclear—whether due to population salt reduction, measurement methods, or sampling techniques 23 . In 2005, Turkish people had the world's highest salt consumption (18.01 g/day). Obese individuals, rural residents, and hypertensive participants had higher salt intake 24 . Recent data in 2017 confirmed high sodium intake in Turkey (about 14.8 g/day), primarily from bread and added salt while cooking 25 . Promoting salt avoidance while cooking and encouraging salt reduction strategies in bakeries, may be initial steps to lower salt intake, similar to Iran. Another study in Japan reported that the mean salt intake was 9.2 g/d in 2021, with the majority of extra salt coming from fish/meat and vegetable dishes 26 . In a study the main sources of dietary salt were reported: Japan: soy sauce, China: salt added to food while cooking or at the table, the UK and the US: bread, cereal, grain, and commercially processed food products 27 . This emphasizes the importance of measuring salt content in food products to plan salt reduction strategies. On the other hand, many individuals are unaware of the high salt content in certain foods, but with proper information they may consider cutting off on that food. Obese and hypertensive participants used higher amounts of salt according to our results. A 2016 study in Tabriz found that well-informed hypertensive patients significantly changed their salt consumption habits upon learning about the negative effects of excess salt. 19 Unfortunately, most of the patients got this information after they were diagnosed with hypertension 28 . Compatible with this article, our study suggests that hypertensive participants have lower salt intake, underscoring the importance of promoting healthy eating habits and education. The allowed amount of daily salt should be clearly explained to people in order to make them understand whether they are using too much salt. For example, in a study, conducted in Urban Areas in Five Sub-Saharan African Countries, most participants knew that using excessive amount of salt was unhealthy, but only few of them thought that they used too much salt 29 . In a 2015 systematic review in India, the mean salt intake was 10.98 g/day (95% CI: 8.57 to 13.40), with no significant gender or urban/rural differences, but higher salt consumption in hypertensive individuals. 30 . The high amount of salt intake is a worldwide problem. Therefore, lots of countries are trying to come up with methods to reduce extra salt intake. Informing people about the total amount of salt in different food products is one of the main steps toward salt reduction. In our country, a study in Yasuj indicated that most people underestimate the amount of salt they use every day. The main idea was to educate people and give them information about different salt substitutes, which resulted in a 3g/day reduction in salt consumption 31 . In a survey in 2018–2019 in Iran, the main reasons for high sodium, fat, and sugar intake were as following: cultural factors, lack of awareness, global trends (which advertise fast food and junk food), and not taking benefit of media to inform people 32 . Modifying lifestyle can reduce deaths associated with non-communicable diseases. Data in a study in Turkey 2020, also comes in agreement with this statement. In this particular study, if the salt consumption was reduced by the amount of what WHO recommends, lots of deaths could be averted 33 . Between different ways of salt reduction, one appeared to be the most effective according to a systematic review in China in 2019. This included using a substitute for salt 34 . According to a systematic review in 2021, using low-sodium salt substitutes (LSSS) instead of regular salt, LSSS will probably slightly reduce blood pressure and cardiovascular mortality in adults. However, the side effects of these substitutes like increased levels of blood potassium may be unsafe, especially in people who have problems with potassium regulation and children 35 . In the Eastern Mediterranean Region progress has been made in reducing salt intake. Kuwait and Qatar managed to reduce salt in 2013 and 2014 respectively. Iran, Oman, Egypt, and some other countries are working on salt reduction. Strategies include setting standards for high-salt foods, planning salt reduction activities, informing bakers, and educating consumers 36 . A systematic review in 2011 in 28 countries, including Finland, Japan, France, the UK, and Ireland found that reducing salt intake involved educating healthcare providers and consumers, food labeling, and reducing salt in food products 37 . Another report on 75 countries in 2015, highlighted strategies like food reformulation, consumer education, food front labeling, public institution interventions, and taxation that resulted in lowering daily salt consumption and sodium in food products and behavioral change 38 . In eight Asian countries including Afghanistan, Bangladesh, India and Pakistan in 2021, the main salt reduction strategies included: consumer awareness, product reformulation, and environmental change 39 . The WHO recommends limiting daily salt intake to less than 5g/day for adults and less for children. To achieve this goal, WHO introduced the SHAKE package, which stands for Surveillance, Harness Industry, Adopt Standards for Labeling and Marketing, Knowledge, and Environment 40 . According to this package, every country should take five steps. First, gather information about salt consumption, behavior, and public opinion regarding salt sources. Second, produce salt-limited food products, reformulate existing products, and introduce taxes on high-salt items. Third, label food products correctly. Forth, raise public awareness regarding disadvantages of excessive salt. Fifth, reduce salt in schools, workplaces and hospitals 41 . Resolve to Save Lives (RTSL) has elaborated on strategies within the SHAKE package, emphasizing the need for government support, industry cooperation, and social media engagement. These strategies come in six steps. 1) Educate the public about the benefits of behavioral changes. This approach, implemented successfully in Australia, resulting in 10% reduction in salt intake 42 . 2) Encourage the use of low-sodium salt, which contains potassium chloride as a sodium chloride substitute. This technique was effectively used in China 43 . 3) Implement labeling on the front of food packages to highlight high-salt content. In Chile, mandatory front pack labeling program resulted in prevention of schools from buying products with one or more warning labels 44 . 4) Forcing food industries to meet specific salt reduction targets, as demonstrated in Kuwait, where a major bread manufacturer achieved a 20% reduction in salt content. 45 . 5) Establish salt reduction standards in hospitals, worksites, and schools, following the successful models in the UK, Australia, and the U.S. 6) Reduce salt contents in foods prepared outside of the home, specially, in restaurants. This method was used in some of the chain restaurants in the US, forcing them to put all nutrition information, including salt content in the menu. 46 Strengths and limitations This study has several strengths. First one is the large sample size. Men and women were included in a proper ratio. The sample is nationally and sub-nationally representative, covering a wide range of geographical areas in Iran (all 31 provinces) and a reasonable sample of population in each province. The next strength is the precise method of salt intake measurement. We used spot urine sample for every participant and validated our method of choice (Tanaka) with 24-hour urine samples. During the data collection, we used electronic tools to gather participants’ data, thus there was a minimum of missing data. Our study has some limitations. Firstly, we included adults aged 25 years old and more. So, we didn’t have any data from children, teenagers and younger adults and the previously mentioned groups. The second limitation is that we used spot urine samples instead of 24-h urine sample, which is the gold standard method, and necessary equation methods were used to estimate daily salt intake. To validate these methods, we collected 24-h urine sample of 609 participants and the difference of the final reports were negligible. Finally, the questionnaires were completed self-reportedly and there might be some misleading data due to the recall-bias of the participants. Conclusion This study showed that the amount of salt intake in Iranian adult population is nearly twice as the WHO recommended amount. Having some unhealthy habits like using a salt shaker, added salt during cooking a meal or while eating it and eating salty processed food are some of the main reasons why salt intake levels are so high in Iran. Focusing on better educating people on the adverse effects of salt of individuals health, advocating proper physical activity, reaching a normal weight and modifying unhealthy habits should be the main priorities. For this purpose, health authorities, food producers and legislators should come to an understanding and take measures for accomplishing this goal in their country. Declarations Ethics approval The study was approved by National Institute for Health Research under the reference code of IR.TUMS.NIHR.REC.1398.006. Participation in this study was voluntary and each participant could leave the study at any time. The aim of study and the process were explained to all participants and all provided informed consent prior to participation in study in written form. Also, study design, data collection, data analysis and paper submission were not affected by the funding source of the study. Competing interests The authors have no conflict of interest to disclose. Author Contribution Conceptualization: F.F., S.D., Ne.R.; Data curation: F.F., S.D., Ne.R., Na.R., Y.F., E.G., M.Y., E.F.M., S.M.F., R.H., A.K., M.M., M-M.R., N.A., M.Ma.; Formal Analysis: A.G., M.Ma., S.K., N.A., E.G., M.N.; Funding acquisition: F.F.; Investigation: F.F., S.D., Ne.R.; Methodology: F.F., S.D., Ne.R., E.G., S.R., N.A., M.Ma.; Project administration: F.F., Ne.R.; Resources: F.F., Ne.R., Na.R.; Supervision: F.F., S.D., Ne.R.; Validation: F.F., Ne.R., S.A., S-H.G., A.G., M.Ma., N.A., E.G., M.A.-K.; Visualisation: M.Ma., N.A., E.G., A.G., S.K. S-H.G.; Writing-original draft: N.N., S-H.G., A.G., S.A., M.A.-K.; Writing-review & editing: N.N., S.A., M.M., A.G., S-H.G., M-A.K., Ne.R., S.K., S.R., N.A., A.K., E.G., Y.F., M-M.R., M.Y., Na.R., M.N., R.H., S.M.F., M.K., M.M., E.F.M., A.M.N.R.,S.D., F.F. Data availability statement The datasets used and analyzed during the current study available from the corresponding author on reasonable request. References Global burden attributable to high sodium intake from 1990 to 2019 - PubMed. https://pubmed.ncbi.nlm.nih.gov/34627699/ . Breda, J. et al. Estimating the impact of achieving Turkey’s non-communicable disease policy targets: A macro-simulation modelling study. The Lancet Regional Health – Europe 1, (2021). Guideline: Sodium Intake for Adults and Children . (World Health Organization, 2012). World Health Assembly, 66. Draft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases: formal meeting of the Member States to conclude the work on the comprehensive global monitoring framework, including indicators, and a set of voluntary global targets for the prevention and control of noncommunicable diseases: report by the Director-General . https://apps.who.int/iris/handle/10665/105633 (2013). Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 393, 1958–1972 (2019). GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1223–1249 (2020). STEPwise approach to NCD risk factor surveillance (STEPS). https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps . Rezaei, S. et al. Salt intake among Iranian population: the first national report on salt intake in Iran. Journal of Hypertension 36, 2380–2389 (2018). Danaei, G. et al. Iran in transition. Lancet 393, 1984–2005 (2019). Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 399, 1625–1645 (2022). Manual. https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps/manuals . Protocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021. Archives of Iranian Medicine 634–646 (2022). Toora, B. D. & Rajagopal, G. Measurement of creatinine by Jaffe’s reaction–determination of concentration of sodium hydroxide required for maximum color development in standard, urine and protein free filtrate of serum. Indian J Exp Biol 40, 352–354 (2002). Ma, W. et al. Validation and Assessment of Three Methods to Estimate 24-h Urinary Sodium Excretion from Spot Urine Samples in High-Risk Elder Patients of Stroke from the Rural Areas of Shaanxi Province. Int J Environ Res Public Health 14, 1211 (2017). National Cholesterol Education Program ATP III guideline - Google Search. https://www.google.com/search?q=National+Cholesterol+Education+Program+ATP+III+guideline& oq=National+Cholesterol+Education+Program+ATP+III+guideline&gs_lcrp=EgZjaHJvbWUyBggAEEUYOdIBCDIyMTFqMGo3qAIAsAIA&sourceid=chrome&ie=UTF-8. Global physical activity questionnaire (GPAQ). https://www.who.int/publications/m/item/global-physical-activity-questionnaire . Goffe, L. et al. Comparison of sodium content of meals served by independent takeaways using standard versus reduced holed salt shakers: cross-sectional study. Int J Behav Nutr Phys Act 13, 102 (2016). Emamian, M. H. Salt intake and blood pressure in Iranian children and adolescents: a population-based study. (2021). Mohammadifard, N. Trend of salt intake measured by 24-hour urine collection samples among Iranian adults population between 1998 and 2013: The Isfahan salt study. Land, M.-A., Neal, B., Johnson, C., Nowson, C. & Margerison, C. SALT CONSUMPTION OF AUSTRALIAN ADULTS: A SYSTEMATIC REVIEW AND META- ANALYSIS. Loloei, S. et al. Policy analysis of salt reduction in bread in Iran. AIMS Public Health 6, 534–545 (2019). Hadian, Z., Fatemeh, S., Reihani, S., Mirmoghtadaie, L. & Tan, T. C. Survey of the salt (NaCl) Contents of Traditional Breads in Tehran, 2016–2018: Implication for Public Health. Int J Prev Med 13, 91 (2022). Thout, S. R. et al. The Science of Salt: Updating the evidence on global estimates of salt intake. J Clin Hypertens 21, 710–721 (2019). Erdem, Y. et al. The relationship between hypertension and salt intake in Turkish population: SALTURK study. Blood Pressure 19, 313–318 (2010). Erdem, Y. et al. Dietary Sources of High Sodium Intake in Turkey: SALTURK II. Nutrients 9, 933 (2017). Imamoto, M., Takada, T., Sasaki, S., Kato, K. & Onishi, Y. Salt intake per dish in the Japanese diet: a clue to help establish dietary goals at home. J Nutr Sci 10, e107 (2021). Anderson, C. A. M. et al. Dietary Sources of Sodium in China, Japan, the United Kingdom, and the United States, Women and Men Aged 40 to 59 Years: The INTERMAP Study. Journal of the American Dietetic Association 110, 736–745 (2010). Reyhani, P., Azabdaftari, F., Ebrahimi-Mamagani, M., Asghari-Jafarabadi, M. & Shokrvash, B. The Predictors of High Dietary Salt Intake among Hypertensive Patients in Iran. International Journal of Hypertension 2020, 1–8 (2020). Leyvraz, M. et al. Food Consumption, Knowledge, Attitudes, and Practices Related to Salt in Urban Areas in Five Sub-Saharan African Countries. Nutrients 10, 1028 (2018). Johnson, C. et al. MEAN POPULATION SALT CONSUMPTION IN INDIA – A SYSTEMATIC REVIEW. Layeghiasl, M., Malekzadeh, J., Shams, M. & Maleki, M. Using Social Marketing to Reduce Salt Intake in Iran. Front. Public Health 8, 207 (2020). Amerzadeh, M., Takian, A., Pouraram, H., Sari, A. A. & Ostovar, A. Policy analysis of socio-cultural determinants of salt, sugar and fat consumption in Iran. BMC Nutr 8, 26 (2022). Breda, J. et al. Estimating the impact of achieving Turkey’s non-communicable disease policy targets: A macro-simulation modelling study. The Lancet Regional Health - Europe 1, 100018 (2021). Jin, A., Xie, W. & Wu, Y. Effect of salt reduction interventions in lowering blood pressure in Chinese populations: a systematic review and meta-­analysis of randomised controlled trials. Open access . Brand, A., Visser, M. E., Schoonees, A. & Naude, C. E. Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women. The Cochrane Database of Systematic Reviews 2022, (2022). Jawaldeh, A. A., Rafii, B. & Nasreddine, L. Salt intake reduction strategies in the Eastern Mediterranean Region. 24, (2018). Webster, J. L., Dunford, E. K., Hawkes, C. & Neal, B. C. Salt reduction initiatives around the world. Journal of Hypertension 29, 1043–1050 (2011). Trieu, K. et al. Salt Reduction Initiatives around the World – A Systematic Review of Progress towards the Global Target. PLOS ONE (2015). Ghimire, K. et al. Salt intake and salt-reduction strategies in South Asia: From evidence to action. J Clin Hypertens 23, 1815–1829 (2021). SHAKE the salt habit. https://www.who.int/publications-detail-redirect/WHO-NMH-PND-16.4 . World Health Organization & Food and Agriculture Organization of the United Nations. Strengthening nutrition action: a resource guide for countries based on the policy recommendations of the Second International Conference on Nutrition (ICN2) . (World Health Organization, 2018). Land, M.-A. et al. Effects of a community-based salt reduction program in a regional Australian population. BMC Public Health 16, 388 (2016). Shao, S. et al. Salt reduction in China: a state-of-the-art review. Risk Manag Healthc Policy 10, 17–28 (2017). Reyes, M. et al. Development of the Chilean front-of-package food warning label. BMC Public Health 19, 906 (2019). Alhamad, N., Almalt, E., Alamir, N. & Subhakaran, M. An overview of salt intake reduction efforts in the Gulf Cooperation Council countries. Cardiovasc Diagn Ther 5, 172–177 (2015). Salt Awareness Week: March 14–20, 2022 - LINKS. https://linkscommunity.org/news/salt-awareness-week-march-14-20-2022 . Tables Tables 5 and 6 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table5.docx Table6.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3869388","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":268617535,"identity":"7db27252-dedd-4d59-86af-dd0a2831c653","order_by":0,"name":"Nasim Nosratinia","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Nasim","middleName":"","lastName":"Nosratinia","suffix":""},{"id":268617536,"identity":"6fb0eb8a-cba1-4c1b-b7cd-3b306a8651ab","order_by":1,"name":"Sina Azadnajafabad","email":"","orcid":"","institution":"Tehran University of Medical 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Sciences","correspondingAuthor":true,"prefix":"","firstName":"Farshad","middleName":"","lastName":"Farzadfar","suffix":""}],"badges":[],"createdAt":"2024-01-16 09:51:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3869388/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3869388/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50115431,"identity":"17893d46-5e0c-4739-b503-58e971beccb1","added_by":"auto","created_at":"2024-01-24 18:42:48","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":250743,"visible":true,"origin":"","legend":"\u003cp\u003eHigh salt consumption prevalence in different provinces of Iran\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3869388/v1/57a22a1c7e8de4fb0e25cd5e.jpg"},{"id":50115433,"identity":"f342f155-9cff-48ec-bbf8-abcf46c3543f","added_by":"auto","created_at":"2024-01-24 18:42:48","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":138008,"visible":true,"origin":"","legend":"\u003cp\u003eMean and 95% confidence interval of salt intake (g/day) in all provinces of Iran\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3869388/v1/73c3aa42466becaa0ef4c592.jpg"},{"id":50908577,"identity":"8304d9e6-254f-4a09-b766-d2a614bb72a7","added_by":"auto","created_at":"2024-02-09 11:29:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":733098,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3869388/v1/b39fda65-0d2e-4ea1-8656-dbebbf70aef9.pdf"},{"id":50115432,"identity":"5bbafe93-1734-44c5-8aac-9540481114b2","added_by":"auto","created_at":"2024-01-24 18:42:48","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26282,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.docx","url":"https://assets-eu.researchsquare.com/files/rs-3869388/v1/7d6a2f3740957a1a4bd6fd2c.docx"},{"id":50115430,"identity":"98cd4b38-7925-4160-b1df-309a2e8e9034","added_by":"auto","created_at":"2024-01-24 18:42:48","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":39908,"visible":true,"origin":"","legend":"","description":"","filename":"Table6.docx","url":"https://assets-eu.researchsquare.com/files/rs-3869388/v1/ed375e6aa84d8e0f3791a2bd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Salt intake among Iranian population: national and subnational report from STEPS 2021","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSalt intake and diet high in sodium contribute to non-communicable diseases particularly high systolic blood pressure, and this notion has been excessively investigated\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Globally, high intake of salt contributed to 1.89\u0026nbsp;million deaths and 44.87\u0026nbsp;million disability-adjusted life-years (DALYs) in 2019, which leads to the fact that high salt intake was the leading dietary risk factor for deaths and DALYs, worldwide\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. World Health Organization (WHO) has estimated that the reduction of salt intake for the amounts of less than 5 grams per day would vehemently prevent 2.5\u0026nbsp;million deaths, annually\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. In this regard, the 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, provides Sustainable Development Goals targeted a 30% reduction in mean salt intake by 2025, compared with that of 2010 as a baseline year\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough high salt intake exacts a massive toll on healthcare systems through a surge in non-communicable diseases burden, some studies demonstrated the gaps in nationally representative individual-level data on intake of key nutritional elements including salt\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Highlighting the paramount significance of establishing national surveillance services for non-communicable diseases through addressing its risk factors, the WHO recommended the stepwise approach for non-communicable disease surveillance (STEPS) as a cardinal framework for periodically evaluating the non-communicable diseases status in countries and territories \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe first national survey of salt intake in Iran using the STEPS method was done in 2016. The mean salt intake was 9.5 grams per day among the Iranian adult population \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Iran as a developing country faces a major socioeconomic transition during the past century including population growth, an increase in the number of elderly people, and rapid and unplanned urbanization, which has led to a reduction in the burden of communicable diseases and shift to non-communicable diseases epidemic in the recent decades\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Nevertheless, the healthcare system has not yet been aligned commensurate with such dramatic changes\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Therefore, intermittently monitoring of non-communicable diseases situation and its risk factors would empower the policy makers to capture the clearer picture from the situation.\u003c/p\u003e \u003cp\u003eThe objective of this study was to investigate the salt intake among Iranian population along with their attitudes and practices about high sodium consumption in various provinces, age groups and socioeconomic status in 2021.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eOverview\u003c/h2\u003e \u003cp\u003eThis study is designed based on the WHO recommended STEPwise Approach to NCD Risk Factor Surveillance (STEPS) 2021 \u003csup\u003e11\u003c/sup\u003e. In this study, we used the data from the STEPs 2021 and reported the mean salt consumption in the Iranian adult population in 2021. The details about data collection and the method of the study has been explained in detail in another paper \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The study aimed to determine the amount of salt intake in Iranian adult population and give practical information to policy makers in order to make plans to reduce salt consumption as an important risk factor for NCDs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eThis study was part of a population-based survey in 2021, recruiting 27,874 individuals older than 18 years old for the assessment of major risk factors for non-communicable diseases from 31 provinces of Iran. The study protocol was published previously\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Briefly, data were gathered through the methodology of systematic cluster classification, considering the required sample size for evaluating risk factors of NCDs in each province in the Non-communicable Diseases Research Center (NCDRC) in early 2020 based on the WHO recommended STEPwise approach to conduct nationwide surveillance for non-communicable diseases and their risk factors. A systemic proportional size cluster sampling scheme was applied to randomly select a representative sample of Iranian adults. The survey included three phases including completing a questionnaire, anthropometric measurements, and laboratory assessments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSalt intake measurement and variable definition\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eQuestionnaire\u003c/h2\u003e \u003cp\u003e Participants were asked to complete the questionnaire, regarding their salt intake habits. The questions included using saltshakers, adding salt to the food just before the consumption, frequency of consuming salty foods, and their attitudes regarding salt consumption, including whether they had been advised regarding lowering salt consumption within the past 12 months. After the completion of the questionnaire, each participant was assessed by anthropometric and physical measurements.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSalt intake measurement and method selection\u003c/h2\u003e \u003cp\u003e Spot urine samples from all participants (who completed the questionnaire and were assessed by anthropometric and physical measurements) aged at least 25 years, a total of 18,119 individuals underwent urine sodium measurement. The urine samples were collected in the morning and transferred to the central laboratory of the Non-Communicable Diseases Research Center considering the optimal condition criteria defined in the protocol \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. In addition to urine sodium, the kinetic colorimetric assay was applied to assess the spot urine creatinine based on the Jaffe method \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. 24-hour (24-h) urine sodium estimation was mainly determined by applying three known equations namely Kawasaki, Tanaka, and INTERSALT methods \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. To choose the most appropriate model among the abovementioned validated methods, 24-h urine samples were collected from a subsample of 609 participants. Root means square error was calculated for all equations. The root means square error for Tanaka, Kawasaki, and INTERSALT equations is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Finally, due to the lower mean root square error value and no negative values in the confidence intervals, the Tanaka method was chosen for this study. Considering the 10% excretion of sodium through sweating, the value was added to the selected equation results.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEstimated mean salt intake and 24-h urine sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethod\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN of participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRoot mean square error (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKawasaki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.2 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e195.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.11 (1.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTanaka\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.82 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e81.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.83 (1.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINTERSALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.14 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.53 (1.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24h urine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.94 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eVariable definition\u003c/h2\u003e \u003cp\u003eThe WHO recommended amount of salt consumption is less than 5g/day\u003csup\u003e3\u003c/sup\u003e. Body weight, height, and body mass index (BMI) were measured according to the World Health Organization's data-gathering protocol. BMI was defined as underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e), normal weight (18.5\u0026thinsp;\u0026lt;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e), overweight (25\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e), and obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e) for adults. A calibrated digital sphygmomanometer was used to measure sitting blood pressure. Participants were asked to rest in a sitting position for 15 minutes. Then the blood pressure was measured in three rounds with at least three minute intervals and the mean of the second and third time was reported as the participant\u0026rsquo;s BP. Hypertension was diagnosed when the systolic or diastolic BP was \u0026ge;\u0026thinsp;140 and/or \u0026ge;\u0026thinsp;90 mmHg respectively, or the participant had been diagnosed with hypertension by a health professional or was on anti-hypertensive medications. Diabetes was defined as a fasting plasma glucose value\u0026thinsp;\u0026ge;\u0026thinsp;7.0 mmol/L (126 mg/dl) or being on medication for raised blood glucose. National Cholesterol Education Program ATP III guideline was applied to assess the total cholesterol (TC), which was classified as desirable (less than 200 mg/dl), borderline high (200\u0026ndash; 239 mg/dl), and high (greater than 240 mg/dl)\u003csup\u003e15\u003c/sup\u003e. Physical activity was assessed using Global Physical Activity Questionnaire (having at least 150 minutes of moderate-intensity physical activity OR 75 minutes of vigorous-intensity physical activity OR an equivalent combination of moderate- and vigorous-intensity physical activity achieving at least 600 MET-minutes in a week is considered active).\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Ever or current daily cigarette smoking was considered as a positive smoking history. Consuming at least two servings of fruit and three servings of vegetables was considered appropriate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe used the National Population and Housing Census 2016 conducted by Iran's Statistical Center as the standard population for direct age standardization in order to compare provinces. Weighted frequency, proportion, mean, and standard deviation (SD) were used to describe the data. 95% confidence interval (95% CI) for each quantitative variable was reported. Categorical variables were analyzed by Chi-Square test. For analyzing the differences among means of two groups and three groups or more, an independent-sample t-test and one-way analysis of variance (ANOVA) test was used, respectively. Regarding the handling of missing data, if the response to the primary question in each part of the questionnaire, typically the first question in each section, was not provided, the entire section was considered as missing data. Multiple logistic regression was applied to calculate the adjusted odds ratio (OR) and 95% CI for high salt intake. In models 1 to 5, we included different types of covariates based on previous studies \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, and a stepwise approach was utilized for model 6 to identify the relevant covariates, including variables with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 and missing data\u0026thinsp;\u0026lt;\u0026thinsp;30%. All data analyses were conducted using R statistical package version 4.3.1.P-value less than 0.05 was considered as statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eThe study methodology conformed to Helsinki Declaration standards as revised in 1989. The study was approved by National Institute for Health Research under the reference code of IR.TUMS.NIHR.REC.1398.006. Participation in this study was voluntary and each participant could leave the study at any time. The aim of study and the process were explained to all participants and all provided informed consent prior to participation in study in written form. Also, study design, data collection, data analysis and paper submission were not affected by the funding source of the study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eSociodemographic and health characteristics of participants\u003c/h2\u003e\n \u003cp\u003eAmong 27,874 participants with age 18 years old and above, 25,202 participants aged 25 and more were included in the study: 13,990 (55.5%) women and 11,212 (44.5%) men. The mean (SD) age of participants was 48.2 (0.1). The number of rural residents was more than twice the number of urban residents (73.2% vs 26.8%). The majority of the participants had basic and complementary health insurance 22,692 (90.7%) and 17,759 (71.3%) respectively. Other socioeconomic status of participants is presented in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSocio-demographic status of participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge groups, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,243 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6,178 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026ndash;54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,412 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u0026ndash;64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4,520 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u0026ndash;70 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,704 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,145 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResidential area, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6,576 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18,446 (73.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYears of schooling, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZero\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,988 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026ndash;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6,576 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u0026ndash;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4,661 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9,798 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,284 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20,675 (82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e544 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,699 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic sector employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,597 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic sector labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e245 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate Sector Employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e713 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate Sector labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e974 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFreelance job or self-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,885 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnpaid work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11,840 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,531 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed due to disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e441 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed seeker job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e558 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed Not seeking work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e239 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBasic health insurance, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22,692 (90.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,331 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplementary insurance, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17,759 (71.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7,162 (28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWealth index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4,835 (20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4,788 (20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4,777 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4,788 (20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4,684 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eSalt intake\u003c/h2\u003e\n \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\n \u003ch2\u003eSalt consumption\u003c/h2\u003e\n \u003cp\u003eThe mean of urine sodium and creatinine was 134.35 mmol/l (95% CI: 133.10-135.59, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 146.34 mg/dl (95% CI: 144.70-147.98, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). After using the Tanaka method, the mean of salt intake among the Iranian population was 9.71g (95% CI: 9.66\u0026ndash;9.76, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in 2021. As many as 17,538 (98.0%) of participants consumed more than 5g of salt daily. Considering the sociodemographic features of participants, male participants (mean(95% CI): 9.95g(9.87g-10.3g)), residents of rural regions (mean(95% CI): 10.2g (9.96g-10.07g)), people with lower years of schooling (mean(95% CI): 9.99g (9.88g-10.01g)) and married ones (mean(95% CI): 9.99g (9.88g-10.1g) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)consumed higher levels of salt per day. Participants aged 25\u0026ndash;34 years and 65\u0026ndash;70 years showed the lowest and the highest levels of salt intake among various age groups (mean (95% CI): 9.36g (9.24g-9.47g) vs 9.92g (9.76g-10.08g), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Smokers consumed lower amounts of salt than non-smokers (mean (95% CI): 9.45g (9.35g-9.54g) vs 9.75g (9.71g-9.79g), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no statistically significant differences in salt intake among participants with different employment status, basic health insurance coverage and wealth index level. Also, participants\u0026rsquo; condition regarding diabetes mellitus or total cholesterol level, did not make statistically significant impact on their salt consumption (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eParticipant\u0026rsquo;s laboratory data\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(Mean, 95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003cp\u003e(Mean, 95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003cp\u003e(Mean, 95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpot urine sodium (mmol/l)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134.35,\u003c/p\u003e\n \u003cp\u003e(133.1-135.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e142.15,\u003c/p\u003e\n \u003cp\u003e(140.28-144.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128.12,\u003c/p\u003e\n \u003cp\u003e(126.47-129.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpot urine creatinine (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146.34,\u003c/p\u003e\n \u003cp\u003e(144.7-147.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e161.18,\u003c/p\u003e\n \u003cp\u003e(158.69-163.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134.49,\u003c/p\u003e\n \u003cp\u003e(132.41-136.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSalt intake attitudes and practices among women and men of various age-groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eSalt intake\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of participants consuming\u0026thinsp;\u0026ge;\u0026thinsp;5g/day\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.44\u0026ndash;9.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9923 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.87\u0026ndash;10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7615 (98.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.24\u0026ndash;9.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3425 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.54\u0026ndash;9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4338 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026ndash;54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.77\u0026ndash;10.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3975 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u0026ndash;64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.73\u0026ndash;9.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3216 (97.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u0026ndash;70 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.76\u0026ndash;10.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1182 (98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 70 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.58\u0026ndash;10.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1402 (97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eResidency\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.56\u0026ndash;9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11861 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.96\u0026ndash;10.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5677 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eYears of schooling\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZero\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.88\u0026ndash;10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3069 (98.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026ndash;7 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.89\u0026ndash;10.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4908 (98.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u0026ndash;12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.66\u0026ndash;9.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3273 (98.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.31\u0026ndash;9.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6174 (97.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.31\u0026ndash;9.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2896 (97.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.73\u0026ndash;9.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14642 (98.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.55\u0026ndash;9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2552 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.68\u0026ndash;9.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14872 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eBasic health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.67\u0026ndash;9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15996 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.56\u0026ndash;9.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1428 (98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eComplementary health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.55\u0026ndash;9.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4712 (97.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.70\u0026ndash;9.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12647 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eWealth index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.66\u0026ndash;9.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3545 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.295\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.49\u0026ndash;9.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3220 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.82\u0026ndash;10.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3574 (98.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.56\u0026ndash;9.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3373 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClass V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.47\u0026ndash;9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2896 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eHypertension (BP\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;140/90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.77\u0026ndash;9.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6412 (97.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.59\u0026ndash;9.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11121 (98.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eEver had diabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69\u0026ndash;9.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2062 (97.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.63\u0026ndash;9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9154 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eEver had myocardial infarction or stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.55\u0026ndash;9.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1443 (96.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.67\u0026ndash;9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16081 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eBody Mass Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.5\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.43\u0026ndash;9.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e447 (95.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnder 18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.18\u0026ndash;9.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5433 (97.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71\u0026ndash;9.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6874 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.06\u0026ndash;10.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4763 (98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eLow physical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.57\u0026ndash;9.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7799 (97.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.66\u0026ndash;9.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8125 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eSmoker\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.35\u0026ndash;9.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2384 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71\u0026ndash;9.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15138 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eTotal cholesterol level\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDesirable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.61\u0026ndash;9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13811 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBorderline high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.7\u0026ndash;9.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2949 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.56\u0026ndash;10.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e758 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eUsing saltshaker\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.85\u0026ndash;9.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6585 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.54\u0026ndash;9.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10942 (97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eHow often do you add salt to your food right before starting or while eating your meal?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.75\u0026ndash;10.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2297 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71\u0026ndash;10.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1769 (98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.58\u0026ndash;9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3437 (98.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.56\u0026ndash;9.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4001 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.54\u0026ndash;9.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6023 (97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eHow often do you add salt while preparing/cooking meals?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69\u0026ndash;9.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8907 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.64\u0026ndash;9.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2741 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.46\u0026ndash;9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2741 (97.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.4\u0026ndash;9.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2094 (97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.59\u0026ndash;10.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1044 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eHow often do you eat salty processed food? (pickled cucumbers, popcorn, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.75\u0026ndash;10.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e791 (99.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.66\u0026ndash;9.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1643 (98.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.65\u0026ndash;9.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5597 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.59\u0026ndash;9.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5650 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.49\u0026ndash;9.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3846 (96.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eHow much salt do you think you use?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExcessive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.41-10.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e587 (97.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.86\u0026ndash;10.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1651 (98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppropriate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.67\u0026ndash;9.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9147 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.55\u0026ndash;9.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4250 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.25\u0026ndash;9.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1892 (96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eDo you think eating excessive amounts of salt or salty food cause any health problems?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.68\u0026ndash;9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16210 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.581\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.50\u0026ndash;9.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1317 (97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eHow important is it to you to reduce the amount of food salt?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.57\u0026ndash;9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14766 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSlightly important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.70\u0026ndash;9.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8722 (35.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.70\u0026ndash;10.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1392 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eHave you been advised to reduce your salt intake?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69\u0026ndash;9.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12606 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.57\u0026ndash;9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4853 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eFruit consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppropriate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.59\u0026ndash;9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6488 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInappropriate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69\u0026ndash;9.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11039 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eFast food consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69\u0026ndash;9.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14401 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.652\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.55\u0026ndash;9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3126 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eVegetable consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppropriate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.31\u0026ndash;9.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1607 (96.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInappropriate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.7\u0026ndash;9.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15920 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eConsidering the health status of participants, the salt intake was higher among participants with obesity, and hypertension. People who had normal BMI had the lowest and the obese ones had the highest amount of salt intake. (8.72g (95% CI: 8.43\u0026ndash;9.01) vs 10.16g (95% CI: 10.06\u0026ndash;10.26), p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) Salt consumption was higher in hypertensive participants in comparison to the normotensive ones. (9.84g (95% CI: 9.77\u0026ndash;9.91) vs 9.63g (95% CI: 9.59\u0026ndash;9.68), p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) Although the difference in salt intake was not statistically significant, the mean salt consumption was slightly lower among patients having a history of myocardial infarction or stroke. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n \u003cp\u003eIn an age-standardized model for the sub-national level, Markazi had the highest salt consumption prevalence (99.47%, SE:0.28) and Bushehr had the lowest salt consumption (94.92%, SE:0.94) in both sexes (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eAlthough salt consumption in all provinces was higher than the WHO recommended amount, some variations were observable, from 10.34g/day in Kurdistan, the province with the highest, to 8.73g/day in Bushehr, the province with the lowest amount of salt consumption. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eAttitudes toward salt consumption\u003c/h2\u003e\n \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\n \u003ch2\u003eAttitudes and practices\u003c/h2\u003e\n \u003cp\u003eMore than 70% of the participants had received advice (from a medical doctor, a health care worker, etc.) in order to reduce their salt consumption within the past 12 months before answering the questionnaires (71.6%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). People who lived in the city received more recommendations than rural residents in order to decrease the salt addition to the food. (76.0% compared to 70.1%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The higher the level of education, the less advice people received on reducing their salt intake (68.9% compared to 76.3%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). About 94.6% of the participants thought that it is important to reduce the amount of daily salt usage (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Between men and women, women cared more about decreasing salt intake (96.0% compared to 92.8%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The salt intake attitude and practices among participants are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eThe majority of participants (men and women) thought that the extreme usage of salt causes health problems (92.0% vs 7.92%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When the participants were asked about mean salt usage, men said greater amounts than women (14.1% compared to 11.0%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). More than half of women (54.3%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) always added salt while cooking or preparing a meal. Among all participants more than one-third (37.9%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) added salt to their food while eating or just before starting their meal. This amount was higher in men than women (42.1% compared to 34.6%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). People living in urban areas added more salt than people in rural areas (39.2% compared to 37.5%, p-value\u0026thinsp;=\u0026thinsp;0.024). There was no significant difference between married and single people in adding extra salt to their food (p-value\u0026thinsp;=\u0026thinsp;0.056). While there was a significant difference in adding salt to food and processed food consumption in different wealth indexes, there was no observable gradual increase in salt addition to food and eating processed food with increasing wealth index (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The same pattern applied to processed food consumption and wealth index. Single people used processed food more than married people (13.3% versus 1184 13.1%, p-value\u0026thinsp;=\u0026thinsp;0.05) and this amount was higher in unemployed compared to the employed ones (13.9% versus 9.5%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003eAfter including different variables for socio-demographic characteristics, lifestyle, anthropometry, and laboratory measurements variables using a stepwise approach in a multiple logistic regression model (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e), high salt intake was 88% higher in men than women (adjusted OR\u0026thinsp;=\u0026thinsp;1.883, 95% CI: 1.322\u0026ndash;2.68, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Increasing age was associated with higher salt intake, and the age group 65\u0026ndash;70 exhibited the strongest association with an adjusted odds ratio (OR) of 3.35. (95% CI: 1.658\u0026ndash;6.77, p-value\u0026thinsp;=\u0026thinsp;0.001). There was no association between high salt intake and area of residency. High salt consumption was 40% lower in smokers than nonsmokers (adjusted OR\u0026thinsp;=\u0026thinsp;0.6, 95% CI: 0.382\u0026ndash;0.943, p-value\u0026thinsp;=\u0026thinsp;0.027). Hypertensive participants had 54% lower amounts of high salt intake than normotensive participants (adjusted OR\u0026thinsp;=\u0026thinsp;0.467, 95% CI: 0.345\u0026ndash;0.631, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as well as hypertensive patients who were aware of having hypertension (adjusted OR\u0026thinsp;=\u0026thinsp;0.338, 95% CI: 0.190\u0026ndash;0.603, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (based on model 1)). High salt intake was 4.5 times higher in obese people than people who had normal BMI (adjusted OR\u0026thinsp;=\u0026thinsp;4.576, 95% CI: 2.361\u0026ndash;8.869, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Adding salt to last meal increased high salt intake by 56% (adjusted OR\u0026thinsp;=\u0026thinsp;1.564, 95% CI: 1.147\u0026ndash;2.131, p-value\u0026thinsp;=\u0026thinsp;0.005).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eSalt intake among the Iranian adult population exceeded WHO recommendations by nearly double. Salt consumption varied based on sociodemographic factors, with men, rural residents, and married individuals consuming higher amounts. Among different age groups, those aged 65\u0026ndash;70 had the highest salt intake, while those aged 25\u0026ndash;34 had the lowest. Participants with obesity and the ones with hypertension consumed higher amounts of salt. There was no significant difference in salt consumption between those who received advice to reduce salt in their diet and those who didn't. Participants with unhealthy lifestyle habits, like using salt shakers, adding salt during meals, inadequate vegetable consumption, and low physical activity, had higher salt intake.\u003c/p\u003e \u003cp\u003eThe mean salt intake among the Iranian population increased from 9.52 g/day (9.48\u0026ndash;9.56, CI: 95%) in 2016 to 9.71 (9.66\u0026ndash;9.76, CI: 95%) in 2021\u003csup\u003e8\u003c/sup\u003e. In our study, high salt consumption was 56% higher in people who had added salt to their last meal. In 2016, Iranian participants who used salt shakers had higher salt intake, but there was not a significant association between high salt consumption and using a salt shaker\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Five-holed salt shakers instead of 17-holed ones led to lower salt consumption per meal in England\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. These findings suggest that avoiding saltshakers or employing reduced-holed ones may be effective strategies to reduce overall salt intake.\u003c/p\u003e \u003cp\u003eMen consumed more salt than women, possibly due to childhood habits. This aligns with a 2015 study in Shahroud, focusing on 6 to 12-year-old school children, which showed similar gender-based differences. Also, even among children, the salt intake patterns between rural and urban residents mirrored our findings\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. In Isfahan, four cross-sectional studies in 1998, 2001, 2007, and 2013 showed salt consumption increased steadily in men during that time but in women, decreased from 2001 to 2007, probably influenced by salt reduction programs\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. This trend is consistent with a 2016 Australian study that reported higher daily salt intake in men.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. These global patterns emphasize the need to consider gender differences in salt reduction initiatives.\u003c/p\u003e \u003cp\u003eTraditional bread is a significant source of salt in the Iranian diet, with nearly half of the WHO's recommended salt limit obtainable from it. Efforts to reduce salt in bread production, such as salt substitutes and improving flour quality, have faced challenges, including limited competition in the use of flour or bread.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Enhancing bakery supervision, especially for traditional bakeries, in terms of flour quality and controlled salt content, and imposing penalties for non-compliance may advance salt reduction initiatives. There might be a relationship between low-quality flour used in rural areas and higher amount of salt intake in residents of rural regions. However, further investigations are needed.\u003c/p\u003e \u003cp\u003eIn a 2018 study on 13 countries, the salt intake from 2011 to 2018 ranged from 6.75 g/d (95% CI: 6.32-7.17) in Barbados to 10.66 g/d (95% CI: 10.52‐10.81) in Portugal. While some countries like Italy, England, Canada, and Barbados showed reduced salt intake since 2010, the reasons remain unclear\u0026mdash;whether due to population salt reduction, measurement methods, or sampling techniques\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. In 2005, Turkish people had the world's highest salt consumption (18.01 g/day). Obese individuals, rural residents, and hypertensive participants had higher salt intake\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRecent data in 2017 confirmed high sodium intake in Turkey (about 14.8 g/day), primarily from bread and added salt while cooking\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Promoting salt avoidance while cooking and encouraging salt reduction strategies in bakeries, may be initial steps to lower salt intake, similar to Iran.\u003c/p\u003e \u003cp\u003eAnother study in Japan reported that the mean salt intake was 9.2 g/d in 2021, with the majority of extra salt coming from fish/meat and vegetable dishes\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. In a study the main sources of dietary salt were reported: Japan: soy sauce, China: salt added to food while cooking or at the table, the UK and the US: bread, cereal, grain, and commercially processed food products\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. This emphasizes the importance of measuring salt content in food products to plan salt reduction strategies. On the other hand, many individuals are unaware of the high salt content in certain foods, but with proper information they may consider cutting off on that food.\u003c/p\u003e \u003cp\u003e Obese and hypertensive participants used higher amounts of salt according to our results. A 2016 study in Tabriz found that well-informed hypertensive patients significantly changed their salt consumption habits upon learning about the negative effects of excess salt.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Unfortunately, most of the patients got this information after they were diagnosed with hypertension\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCompatible with this article, our study suggests that hypertensive participants have lower salt intake, underscoring the importance of promoting healthy eating habits and education. The allowed amount of daily salt should be clearly explained to people in order to make them understand whether they are using too much salt. For example, in a study, conducted in Urban Areas in Five Sub-Saharan African Countries, most participants knew that using excessive amount of salt was unhealthy, but only few of them thought that they used too much salt\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn a 2015 systematic review in India, the mean salt intake was 10.98 g/day (95% CI: 8.57 to 13.40), with no significant gender or urban/rural differences, but higher salt consumption in hypertensive individuals.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe high amount of salt intake is a worldwide problem. Therefore, lots of countries are trying to come up with methods to reduce extra salt intake. Informing people about the total amount of salt in different food products is one of the main steps toward salt reduction. In our country, a study in Yasuj indicated that most people underestimate the amount of salt they use every day. The main idea was to educate people and give them information about different salt substitutes, which resulted in a 3g/day reduction in salt consumption\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn a survey in 2018\u0026ndash;2019 in Iran, the main reasons for high sodium, fat, and sugar intake were as following: cultural factors, lack of awareness, global trends (which advertise fast food and junk food), and not taking benefit of media to inform people\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Modifying lifestyle can reduce deaths associated with non-communicable diseases. Data in a study in Turkey 2020, also comes in agreement with this statement. In this particular study, if the salt consumption was reduced by the amount of what WHO recommends, lots of deaths could be averted\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBetween different ways of salt reduction, one appeared to be the most effective according to a systematic review in China in 2019. This included using a substitute for salt\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. According to a systematic review in 2021, using low-sodium salt substitutes (LSSS) instead of regular salt, LSSS will probably slightly reduce blood pressure and cardiovascular mortality in adults. However, the side effects of these substitutes like increased levels of blood potassium may be unsafe, especially in people who have problems with potassium regulation and children\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the Eastern Mediterranean Region progress has been made in reducing salt intake. Kuwait and Qatar managed to reduce salt in 2013 and 2014 respectively. Iran, Oman, Egypt, and some other countries are working on salt reduction. Strategies include setting standards for high-salt foods, planning salt reduction activities, informing bakers, and educating consumers\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. A systematic review in 2011 in 28 countries, including Finland, Japan, France, the UK, and Ireland found that reducing salt intake involved educating healthcare providers and consumers, food labeling, and reducing salt in food products\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Another report on 75 countries in 2015, highlighted strategies like food reformulation, consumer education, food front labeling, public institution interventions, and taxation that resulted in lowering daily salt consumption and sodium in food products and behavioral change\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. In eight Asian countries including Afghanistan, Bangladesh, India and Pakistan in 2021, the main salt reduction strategies included: consumer awareness, product reformulation, and environmental change\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe WHO recommends limiting daily salt intake to less than 5g/day for adults and less for children. To achieve this goal, WHO introduced the SHAKE package, which stands for Surveillance, Harness Industry, Adopt Standards for Labeling and Marketing, Knowledge, and Environment\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. According to this package, every country should take five steps. First, gather information about salt consumption, behavior, and public opinion regarding salt sources. Second, produce salt-limited food products, reformulate existing products, and introduce taxes on high-salt items. Third, label food products correctly. Forth, raise public awareness regarding disadvantages of excessive salt. Fifth, reduce salt in schools, workplaces and hospitals\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eResolve to Save Lives (RTSL) has elaborated on strategies within the SHAKE package, emphasizing the need for government support, industry cooperation, and social media engagement. These strategies come in six steps. 1) Educate the public about the benefits of behavioral changes. This approach, implemented successfully in Australia, resulting in 10% reduction in salt intake \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. 2) Encourage the use of low-sodium salt, which contains potassium chloride as a sodium chloride substitute. This technique was effectively used in China\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. 3) Implement labeling on the front of food packages to highlight high-salt content. In Chile, mandatory front pack labeling program resulted in prevention of schools from buying products with one or more warning labels\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. 4) Forcing food industries to meet specific salt reduction targets, as demonstrated in Kuwait, where a major bread manufacturer achieved a 20% reduction in salt content. \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. 5) Establish salt reduction standards in hospitals, worksites, and schools, following the successful models in the UK, Australia, and the U.S. 6) Reduce salt contents in foods prepared outside of the home, specially, in restaurants. This method was used in some of the chain restaurants in the US, forcing them to put all nutrition information, including salt content in the menu.\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis study has several strengths. First one is the large sample size. Men and women were included in a proper ratio. The sample is nationally and sub-nationally representative, covering a wide range of geographical areas in Iran (all 31 provinces) and a reasonable sample of population in each province. The next strength is the precise method of salt intake measurement. We used spot urine sample for every participant and validated our method of choice (Tanaka) with 24-hour urine samples.\u003c/p\u003e \u003cp\u003eDuring the data collection, we used electronic tools to gather participants\u0026rsquo; data, thus there was a minimum of missing data.\u003c/p\u003e \u003cp\u003eOur study has some limitations. Firstly, we included adults aged 25 years old and more. So, we didn\u0026rsquo;t have any data from children, teenagers and younger adults and the previously mentioned groups. The second limitation is that we used spot urine samples instead of 24-h urine sample, which is the gold standard method, and necessary equation methods were used to estimate daily salt intake. To validate these methods, we collected 24-h urine sample of 609 participants and the difference of the final reports were negligible. Finally, the questionnaires were completed self-reportedly and there might be some misleading data due to the recall-bias of the participants.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study showed that the amount of salt intake in Iranian adult population is nearly twice as the WHO recommended amount. Having some unhealthy habits like using a salt shaker, added salt during cooking a meal or while eating it and eating salty processed food are some of the main reasons why salt intake levels are so high in Iran. Focusing on better educating people on the adverse effects of salt of individuals health, advocating proper physical activity, reaching a normal weight and modifying unhealthy habits should be the main priorities. For this purpose, health authorities, food producers and legislators should come to an understanding and take measures for accomplishing this goal in their country.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003eThe study was approved by National Institute for Health Research under the reference code of IR.TUMS.NIHR.REC.1398.006. Participation in this study was voluntary and each participant could leave the study at any time. The aim of study and the process were explained to all participants and all provided informed consent prior to participation in study in written form. Also, study design, data collection, data analysis and paper submission were not affected by the funding source of the study.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors have no conflict of interest to disclose.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: F.F., S.D., Ne.R.; Data curation: F.F., S.D., Ne.R., Na.R., Y.F., E.G., M.Y., E.F.M., S.M.F., R.H., A.K., M.M., M-M.R., N.A., M.Ma.; Formal Analysis: A.G., M.Ma., S.K., N.A., E.G., M.N.; Funding acquisition: F.F.; Investigation: F.F., S.D., Ne.R.; Methodology: F.F., S.D., Ne.R., E.G., S.R., N.A., M.Ma.; Project administration: F.F., Ne.R.; Resources: F.F., Ne.R., Na.R.; Supervision: F.F., S.D., Ne.R.; Validation: F.F., Ne.R., S.A., S-H.G., A.G., M.Ma., N.A., E.G., M.A.-K.; Visualisation: M.Ma., N.A., E.G., A.G., S.K. S-H.G.; Writing-original draft: N.N., S-H.G., A.G., S.A., M.A.-K.; Writing-review \u0026amp; editing: N.N., S.A., M.M., A.G., S-H.G., M-A.K., Ne.R., S.K., S.R., N.A., A.K., E.G., Y.F., M-M.R., M.Y., Na.R., M.N., R.H., S.M.F., M.K., M.M., E.F.M., A.M.N.R.,S.D., F.F.\u003c/p\u003e\u003ch2\u003eData availability statement\u003c/h2\u003e \u003cp\u003eThe datasets used and analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGlobal burden attributable to high sodium intake from 1990 to 2019 - PubMed. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/34627699/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/34627699/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBreda, J. \u003cem\u003eet al.\u003c/em\u003e Estimating the impact of achieving Turkey\u0026rsquo;s non-communicable disease policy targets: A macro-simulation modelling study. The Lancet Regional Health \u0026ndash; Europe 1, (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eGuideline: Sodium Intake for Adults and Children\u003c/em\u003e. (World Health Organization, 2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Assembly, 66. \u003cem\u003eDraft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases: formal meeting of the Member States to conclude the work on the comprehensive global monitoring framework, including indicators, and a set of voluntary global targets for the prevention and control of noncommunicable diseases: report by the Director-General\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://apps.who.int/iris/handle/10665/105633\u003c/span\u003e\u003cspan address=\"https://apps.who.int/iris/handle/10665/105633\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth effects of dietary risks in 195 countries, 1990\u0026ndash;2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 393, 1958\u0026ndash;1972 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1223\u0026ndash;1249 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSTEPwise approach to NCD risk factor surveillance (STEPS). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRezaei, S. \u003cem\u003eet al.\u003c/em\u003e Salt intake among Iranian population: the first national report on salt intake in Iran. Journal of Hypertension 36, 2380\u0026ndash;2389 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDanaei, G. \u003cem\u003eet al.\u003c/em\u003e Iran in transition. Lancet 393, 1984\u0026ndash;2005 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 399, 1625\u0026ndash;1645 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManual. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps/manuals\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps/manuals\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProtocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021. Archives of Iranian Medicine 634\u0026ndash;646 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToora, B. D. \u0026amp; Rajagopal, G. Measurement of creatinine by Jaffe\u0026rsquo;s reaction\u0026ndash;determination of concentration of sodium hydroxide required for maximum color development in standard, urine and protein free filtrate of serum. Indian J Exp Biol 40, 352\u0026ndash;354 (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa, W. \u003cem\u003eet al.\u003c/em\u003e Validation and Assessment of Three Methods to Estimate 24-h Urinary Sodium Excretion from Spot Urine Samples in High-Risk Elder Patients of Stroke from the Rural Areas of Shaanxi Province. Int J Environ Res Public Health 14, 1211 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Cholesterol Education Program ATP III guideline - Google Search. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.google.com/search?q=National+Cholesterol+Education+Program+ATP+III+guideline\u0026amp;\u003c/span\u003e\u003cspan address=\"https://www.google.com/search?q=National+Cholesterol+Education+Program+ATP+III+guideline\u0026amp;\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e oq=National+Cholesterol+Education+Program+ATP+III+guideline\u0026amp;gs_lcrp=EgZjaHJvbWUyBggAEEUYOdIBCDIyMTFqMGo3qAIAsAIA\u0026amp;sourceid=chrome\u0026amp;ie=UTF-8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlobal physical activity questionnaire (GPAQ). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/m/item/global-physical-activity-questionnaire\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/m/item/global-physical-activity-questionnaire\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoffe, L. \u003cem\u003eet al.\u003c/em\u003e Comparison of sodium content of meals served by independent takeaways using standard versus reduced holed salt shakers: cross-sectional study. Int J Behav Nutr Phys Act 13, 102 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmamian, M. H. Salt intake and blood pressure in Iranian children and adolescents: a population-based study. (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohammadifard, N. Trend of salt intake measured by 24-hour urine collection samples among Iranian adults population between 1998 and 2013: The Isfahan salt study.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLand, M.-A., Neal, B., Johnson, C., Nowson, C. \u0026amp; Margerison, C. SALT CONSUMPTION OF AUSTRALIAN ADULTS: A SYSTEMATIC REVIEW AND META- ANALYSIS.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoloei, S. \u003cem\u003eet al.\u003c/em\u003e Policy analysis of salt reduction in bread in Iran. AIMS Public Health 6, 534\u0026ndash;545 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHadian, Z., Fatemeh, S., Reihani, S., Mirmoghtadaie, L. \u0026amp; Tan, T. C. Survey of the salt (NaCl) Contents of Traditional Breads in Tehran, 2016\u0026ndash;2018: Implication for Public Health. Int J Prev Med 13, 91 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThout, S. R. \u003cem\u003eet al.\u003c/em\u003e The Science of Salt: Updating the evidence on global estimates of salt intake. J Clin Hypertens 21, 710\u0026ndash;721 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErdem, Y. \u003cem\u003eet al.\u003c/em\u003e The relationship between hypertension and salt intake in Turkish population: SALTURK study. Blood Pressure 19, 313\u0026ndash;318 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErdem, Y. \u003cem\u003eet al.\u003c/em\u003e Dietary Sources of High Sodium Intake in Turkey: SALTURK II. Nutrients 9, 933 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImamoto, M., Takada, T., Sasaki, S., Kato, K. \u0026amp; Onishi, Y. Salt intake per dish in the Japanese diet: a clue to help establish dietary goals at home. J Nutr Sci 10, e107 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson, C. A. M. \u003cem\u003eet al.\u003c/em\u003e Dietary Sources of Sodium in China, Japan, the United Kingdom, and the United States, Women and Men Aged 40 to 59 Years: The INTERMAP Study. Journal of the American Dietetic Association 110, 736\u0026ndash;745 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReyhani, P., Azabdaftari, F., Ebrahimi-Mamagani, M., Asghari-Jafarabadi, M. \u0026amp; Shokrvash, B. The Predictors of High Dietary Salt Intake among Hypertensive Patients in Iran. International Journal of Hypertension 2020, 1\u0026ndash;8 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeyvraz, M. \u003cem\u003eet al.\u003c/em\u003e Food Consumption, Knowledge, Attitudes, and Practices Related to Salt in Urban Areas in Five Sub-Saharan African Countries. Nutrients 10, 1028 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson, C. \u003cem\u003eet al.\u003c/em\u003e MEAN POPULATION SALT CONSUMPTION IN INDIA \u0026ndash; A SYSTEMATIC REVIEW.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLayeghiasl, M., Malekzadeh, J., Shams, M. \u0026amp; Maleki, M. Using Social Marketing to Reduce Salt Intake in Iran. Front. Public Health 8, 207 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerzadeh, M., Takian, A., Pouraram, H., Sari, A. A. \u0026amp; Ostovar, A. Policy analysis of socio-cultural determinants of salt, sugar and fat consumption in Iran. BMC Nutr 8, 26 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBreda, J. \u003cem\u003eet al.\u003c/em\u003e Estimating the impact of achieving Turkey\u0026rsquo;s non-communicable disease policy targets: A macro-simulation modelling study. The Lancet Regional Health - Europe 1, 100018 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin, A., Xie, W. \u0026amp; Wu, Y. Effect of salt reduction interventions in lowering blood pressure in Chinese populations: a systematic review and meta-\u0026shy;analysis of randomised controlled trials. \u003cem\u003eOpen access\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrand, A., Visser, M. E., Schoonees, A. \u0026amp; Naude, C. E. Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women. \u003cem\u003eThe Cochrane Database of Systematic Reviews\u003c/em\u003e 2022, (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJawaldeh, A. A., Rafii, B. \u0026amp; Nasreddine, L. Salt intake reduction strategies in the Eastern Mediterranean Region. 24, (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWebster, J. L., Dunford, E. K., Hawkes, C. \u0026amp; Neal, B. C. Salt reduction initiatives around the world. Journal of Hypertension 29, 1043\u0026ndash;1050 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrieu, K. \u003cem\u003eet al.\u003c/em\u003e Salt Reduction Initiatives around the World \u0026ndash; A Systematic Review of Progress towards the Global Target. PLOS ONE (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhimire, K. \u003cem\u003eet al.\u003c/em\u003e Salt intake and salt-reduction strategies in South Asia: From evidence to action. J Clin Hypertens 23, 1815\u0026ndash;1829 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSHAKE the salt habit. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications-detail-redirect/WHO-NMH-PND-16.4\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications-detail-redirect/WHO-NMH-PND-16.4\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization \u0026amp; Food and Agriculture Organization of the United Nations. \u003cem\u003eStrengthening nutrition action: a resource guide for countries based on the policy recommendations of the Second International Conference on Nutrition (ICN2)\u003c/em\u003e. (World Health Organization, 2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLand, M.-A. \u003cem\u003eet al.\u003c/em\u003e Effects of a community-based salt reduction program in a regional Australian population. BMC Public Health 16, 388 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShao, S. \u003cem\u003eet al.\u003c/em\u003e Salt reduction in China: a state-of-the-art review. Risk Manag Healthc Policy 10, 17\u0026ndash;28 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReyes, M. \u003cem\u003eet al.\u003c/em\u003e Development of the Chilean front-of-package food warning label. BMC Public Health 19, 906 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlhamad, N., Almalt, E., Alamir, N. \u0026amp; Subhakaran, M. An overview of salt intake reduction efforts in the Gulf Cooperation Council countries. Cardiovasc Diagn Ther 5, 172\u0026ndash;177 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalt Awareness Week: March 14\u0026ndash;20, 2022 - LINKS. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://linkscommunity.org/news/salt-awareness-week-march-14-20-2022\u003c/span\u003e\u003cspan address=\"https://linkscommunity.org/news/salt-awareness-week-march-14-20-2022\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 5 and 6 are available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3869388/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3869388/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHigh salt intake is a major risk factor for non-communicable diseases, resulting in numerous deaths and disability-adjusted life-years worldwide. The study aimed to analyze data from a 2021 nationwide survey of 25,202 Iranian adults, investigating daily salt intake. Participants were randomly chosen by a systematic proportional size cluster sampling. All of them completed questionnaires and their anthropometric and physical measurements were taken. Using Tanaka method and necessary equations, spot urine samples were taken to estimate 24-hour urine sodium and evaluate daily sodium intake in grams. The mean amount of salt intake was 9.71g (95% CI: 9.66\u0026ndash;9.76) in 2021. Furthermore, 98.0% of participants consumed more than 5g of salt daily. Salt intake in men was higher than in women (9.95g (95% CI: 9.87\u0026ndash;10.3) vs 9.51g (9.44\u0026ndash;9.58) daily. Rural areas\u0026rsquo; residents and people with lower years of schooling consumed higher levels of salt per day, 10.02g (9.96\u0026ndash;10.07) and 9.99g (9.88\u0026ndash;10.1), respectively. Mean salt consumption in married people was higher than in single individuals by 0.37g per day. Salt consumption was higher in obese participants in comparison to people with normal BMI (10.16g (10.06\u0026ndash;10.26) vs 8.72g (8.43\u0026ndash;9.01)). The risk of high salt consumption was significantly lower in hypertensive participants than normotensive ones (adjusted OR\u0026thinsp;=\u0026thinsp;0.467, 95% CI: 0.345\u0026ndash;0.631), as well as being aware of hypertension in hypertensive patients (adjusted OR\u0026thinsp;=\u0026thinsp;0.338, 95% CI: 0.190\u0026ndash;0.603). Iranians\u0026rsquo; salt intake was nearly double the WHO-recommendation. Approved effective interventions must be considered to lower salt consumption in Iran like food labeling, educating people, and using salt substitutes.\u003c/p\u003e","manuscriptTitle":"Salt intake among Iranian population: national and subnational report from STEPS 2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-24 18:42:43","doi":"10.21203/rs.3.rs-3869388/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6925c294-ad7a-42d7-89df-48954629c29b","owner":[],"postedDate":"January 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28296809,"name":"Health sciences/Medical research"},{"id":28296810,"name":"Health sciences/Risk factors"},{"id":28296811,"name":"Health sciences/Health care/Public health"}],"tags":[],"updatedAt":"2024-02-09T11:29:33+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-24 18:42:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3869388","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3869388","identity":"rs-3869388","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}