ASSOCIATION BETWEEN SALT INTAKE AND BLOOD PRESSURE AMONG CHILDREN

Introduction Objectives Literature Review Materials and Methods Result & Discussion Conclusion

References

Survey by World Health Organization in 2002 said that the evidence of association between dietary salt intakes and blood pressure has increased since 1994.
Although rare in children but research found that individuals, who have high blood pressure at a young age, are likely to have hypertension when they grow up (Nelson et al., 1992). Excessive dietary salt intake contributes to the increase in blood pressure in children (He et al., 2006)

 To

determine the association between salt intake and blood pressure among children age 7-12 years in Selangor To study the association between salt intake and blood pressure in children according to gender. To study the association between salt intake and blood pressure in children according to area.

Salt: composed of sodium and chloride (Vijay, 2003).

It is the sodium, and not the chloride that is potentially harmful to the heart (Vijay, 2003). Although sodium is an essential mineral, diets that contain high amounts of sodium are associated with increased risk of hypertension (Schiff et al., 2009) According to the Malaysia Diet Guidelines 2010, the salt intake should not exceed one teaspoon, which is equivalent to 2,000 mg a day.

Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels.
Blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure during one heartbeat (Klabunde & Richard, 2005). In children, the child's gender, age, and height determine the normal range for blood pressure.

 Place

: Primary school in Selangor Malay:Chinese:Indian = 6:3:1 Children age 7-12 years old 393 of respondents We were using the food diary which the dietary record of all food and drink consumed.

 The

schools lists were obtained from Department of Education consisting of 633 schools in Selangor. The schools were divided into urban and rural. Type of schools:

6 Sekolah Kebangsaan (SK) 2 Sekolah Jenis Kebangsaan Cina (SJK(C)) 2 Sekolah Jenis Kebangsaan Tamil (SJK(T))

 Measuring

tape (SECA)

measure height

Digital

bathroom scale (TANITA)

Measure weight

Omron

HEM-7111 Automatic Blood Pressure Monitor

 Food

diary
Instruction were given on the food diary keeping. All the basic information such as age, gender, height, weight, BMI, races were filled out.

Food diary were given to respondents for 3 days food intake ( 2 weekdays and 1 day weekend).

All the data were recorded.

The food diary were collected after 3 days and blood pressure were taken.

 Blood

pressure measurement
Sub arm and sphygmomanometer were placed at heart level. Upper forearm was wrapped with cuff.

Respondent s were rested for 5 minutes.

Reading on the monitor were recorded after it stop constantly.

Let the cuff pressure act automatically.

The button start at the monitor was pressed.

 Nutritionist

Pro software Statistical package for social science (SPSS)

one way ANOVA paired sample t-test Chi-square test

Table 1.1: Description of respondent by gender, school area, and blood pressure classification
Description
Gender Male Female School area Rural Urban Blood pressure classification Normal Pre-hypertension Hypertension

% (n)

41.0 (161) 59.0 (232)

52.9 (208) 47.1 (185)

52.7 (207) 18.0 ( 71) 29.3 (115)

140

Number of respondents

120 100 80 60 40 20 0

Urban Rural

Male 72 85

Female 113 123

Figure 1.1: Number of respondents by male and female

60
52.7%

50 40 30 20
18.0% 29.3%

10
0 Normal
Normal

Pre-hypertension
Pre-hypertension Hypertension

Hypertension

Figure 1.2: Percentage of respondents by classification of blood pressure

Table 1.2: Distribution of salt (sodium) intake (mg) by gender, school area, and blood pressure classification
Description Gender
Male Female School area Rural Urban Blood pressure classification Normal Pre-hypertension Hypertension 207(52.7) 71(18.0) 115 (29.3) 2372.62 + 759.37 2297.65 + 787.17 2473.52 + 792.82 208 (52.9) 185(47.1) 2424.82 + 759.89 2347.88 + 791.18

n (%)
161(41.0) 232(59.0)

Mean + SD
2410.52 + 751.67 2373.38 + 791.61

Table 1.3: Distribution of gender and school areas by blood pressure classification, % (n)
Description Gender Male Female 55.9% (90) 50.4%(117) 16.1% (26) 19.4% (45) 28.0% (45) 30.2% (70) Normal Pre-hypertension Hypertension

School area Rural Urban 43.8% (91) 62.7% (116) 23.1% (48) 12.4% (23) 33.2% (69) 24.9% (46)

60 50 40 30 20 10 0

55.9% 50.4%

28% 16.1% 19.4%

30.2%

normal

pre-hypertension
male female

hypertension

Figure 1.3: Percentage of respondent by gender

70 60 50 43.8%

62.7%

40
30 20 10 0 normal pre-hypertension
rural urban

33.2% 23.1% 12.4% 24.9%

hypertension

Figure 1.4: Percentage of respondent by area

Table 1.4: Distribution of systolic blood pressure (mmHg) by gender, school area, and blood pressure classification
Description Gender Male Female
School area Rural Urban Blood pressure classification* Normal Pre-hypertension Hypertension
*Significant difference at p<0.05

n (%)
161(41.0) 232 (59.0)

Mean + SD
112 + 14 110 + 13

208(52.9) 185(47.1)

113 + 13 108+ 14

207(52.7) 71(18.0) 115(29.3)

102 + 9 112 + 6 125+ 11

Table 1.5: Distribution of diastolic blood pressure (mmHg) by gender, school area, and blood pressure classification
Description Gender Male Female School area Rural Urban Blood pressure classification* Normal Pre-hypertension Hypertension
*Significant difference at p<0.05

n (%) 161(41.0) 232(59.0)

Mean + SD 72 + 10 71 + 9

208(52.9) 185(49.1)

73 + 10 69+ 9

207(52.7) 71(18.0) 115(29.3)

65 + 6 74 + 5 80+ 9

Table 1.6: Association between salt intake with SBP and DBP

Item Systolic blood pressure (SBP) Diastolic blood pressure (DBP)

N
393

r
0.121*

p-value
0.016

393

0.059

0.241

*. Correlation is significant at the 0.05 level (2-tailed). **. Correlation is significant at the 0.01 level (2-tailed).

Positive correlation between salt intake and blood pressure in term of SBP and DBP The blood pressure was high when the sodium intake was high, thus the children with high sodium intake were likely to have greater chance to get hypertension. This is due to:

when the sodium content in blood goes down, blood volume and blood pressure decrease as well. Then, baroreceptors (sense pressure) and osmoreceptors (sense fluid levels) in kidneys and brain will sense lower blood pressure and the body reacts to it by activating mechanisms that will increase blood pressure (Lago, 2008).

 Mean

for sodium intake is the highest for hypertension followed by normal, and prehypertension.
is due to the:-

This

High sodium levels can only increase blood pressure if kidneys are not working properly (Lago, 2008). Kidney of children in good health able to consume higher sodium without increasing their blood pressure and give the reading of sodium intake for normal blood pressure a bit higher than pre-hypertension.

p>0.05 : there was no significant different between salt intake and gender.
The sodium intake was also higher in male compared to female. From the food diary: male consume or eat more compared to female. When huge amount of food were consumed, the tendency to consume more sodium is higher.

Salt intake in urban area was less compared to rural area.

From this result, we can say that children from rural area consumed more foods that were high in sodium compared to urban area. Most of children in rural area had coconut milk rice and fried rice for their breakfast. Most of children in urban area took bread and milk for their breakfast.

There was positive correlation between salt intake and blood pressure but not statistically significant.
There was linear relationship between salt intake and blood pressure means blood pressure will increase with the increase of sodium intake. According to gender, sodium intake was higher in male compared to female but female had higher prevalence of hypertension compared to male.

The blood pressure in children was non-significantly (P>0.05) toward the gender.
According to area, rural area gave higher salt intake compared to urban area due to their difference in diets. The blood pressure in children was non-significantly (P>0.05) toward the area.

 To

obtain a good result, we should using large population of respondent. The bigger the sample study, the more accurate data that can be obtained (He et al., 2006).

Berenson, G.S., Srinivasan, S.R., Bao, W., Newman, W.P., Tracy, R.E. and W.A. Wattingney. 1998. Association between multiple cardiovascular risk factor and artherosclerosis in children and young adult. New England Journal of Medicine. 338: 1650-1656. He F.J., MacGregor GA. Importance of salt in determining blood pressure in children: of controlled trials. Hypertension 2006; 48: 861869. meta-analysis

Klabunde, Richard (2005). Cardiovascular Physiology Concepts. Lippincott Williams & Wilkins. pp. 934. ISBN 978-0781750301. Lago R.M., 2008. Blood Sodium Level Does Not Affect Blood Pressure. Available from http://www.innovations-report.com Nelson MJ, Ragland DR, Syme SL. Longitudinal prediction of adult blood pressure from juvenile blood pressure levels. Am J Epidemiol 1992; 136: 633645. Rampal, L., Rampal, S., Azhar, M.Z. and A.R. Rahman. 2008. Prevalence, awareness, and control of hypertension in Malaysia: A national study of 16,440 Public Health, 122: 11-18. Vijay, G. Padama. 2003. The healthy heart diet book. New Delhi: Orient Paperbacks. World Health Organization. World Health Report 2002: Reducing Risks, Promoting Healthy Life. World Health Organization: Geneva, Switzerland, 2002. Available at http://www.who.int/whr/2002 treatment, subjects.

Schiff W. J., M. S., R. D. 2009. Nutrition for Healthy Living. McGraw-Hill Higher Education