Sodium and potassium intakes in the Kazakhstan population estimated using 24-h urinary excretion: evidence for national action.

PURPOSE: There is strong scientific evidence for reducing sodium and increasing potassium intake to the recommended levels to lower blood pressure and cardiovascular risk, but consumption levels in Kazakhstan are unknown. This study sought to estimate mean sodium and potassium intake using 24-h urine samples and describe dietary knowledge and behavior among adults in Kazakhstan. METHODS: In two cross-sectional surveys, the same multi-stage cluster sampling method was used to randomly select participants aged 25-64 years from Almaty City in 2015 and Kyzylorda in 2016. Complete 24-h urine samples were available for 478 participants; 294 in Almaty City and 184 in Kyzylorda (response rates 86% and 54%, respectively) and were weighted for the age and sex distribution of the two regions. RESULTS: Weighted mean 24-h urinary sodium excretion was 6782 mg/day (17.2 g salt) (95% CI 6507-7058) in both regions combined, and not significantly different between the regions (P = 0.660). 99% of adults in the two regions combined consumed above the World Health Organization's (WHO) recommended sodium maximum of 2000 mg/day; however, only 15% of adults perceived that they consumed excess sodium. Weighted mean 24-h urinary potassium excretion was 2271 mg/day (95% CI 2151-2391) for the regions combined. CONCLUSION: Mean sodium consumption in Kazakhstan was more than triple the WHO's recommended maximum, and mean potassium consumption was below the recommended minimum. National efforts to lower sodium intake and increase potassium intake are needed and would likely prevent ample premature deaths and disease burden.

Evaluation of the potential effectiveness of wheat flour and salt fortification programs in five Central Asian countries and Mongolia, 2002-2007.

BACKGROUND: A project for universal salt iodation with potassium iodate and wheat flour fortification with a vitamin-mineral premix was implemented in Azerbaijan, Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan, and Uzbekistan between 2002 and 2007. OBJECTIVE: To determine the potential effectiveness of the food fortification programs in improving the micronutrient status of selected families in a sentinel population in each country. METHODS: An area was selected in each country in a sentinel population expected to have early access to iodated salt and fortified wheat flour. Within this area, an average of 40 families with a woman of reproductive age and two children between 2 and 15 years old were sampled at baseline. All the rounds of the study were carried out in women and children in the same households. Hemoglobin, serum ferritin, folic acid, and urinary iodine excretion were analyzed at baseline, one year, and three years later. RESULTS: In the third round in 2007 significant increases were observed in the average levels of blood hemoglobin, serum ferritin and folic acid, and urinary iodine. Corresponding decreases in the prevalence of anemia and increases in serum ferritin levels, folic acid, and iodine were found. CONCLUSIONS: Salt and wheat flour fortification resulted in a significant improvement in the micronutrient status of children and women living in sentinel households in the countries participating in the Asian Development Bank project. Sentinel studies were a cost-effective way of determining potential national effectiveness.