Sodium, Potassium and Iodine Intake, in a National Adult Population Sample of the Republic of Moldova
Authors: D’Elia Lanfranco , Obreja Galina , Ciobanu Angela , Breda Joao , Jewell Jo , Cappuccio Francesco Paolo 
Published: October 2019

In the Republic of Moldova, nearly 90% of all deaths are due to noncommunicable diseases (NCDs), tha majority of which (58%) are caused by cardiovascular disease (CVD). Excess salt (sodium) and inadequate potassium intakes are associated with high CVD. Moreover, salt iodisation is the preferred policy to prevent iodine deficiency and associated disorders. However, there is no survey that has directly measured sodium, potassium and iodine consumption in adults in the Republic of Moldova. The aim is to estimate population sodium, potassium and iodine intakes and explore knowledge, attitudes and behaviour (KAB) towards the use of salt, amongst the adult population in the Republic of Moldova. Proportional random samples of adults were obtained from 28 of the 37 Districts and Municipalities and one Administrative Territorial Unit of Moldova. Participants attended a screening including demographic, anthropometric and physical measurements. Dietary sodium, potassium and iodine intakes were assessed by 24h urinary sodium (UNa), potassium (UK) and iodine (UI) excretions. Creatinine was measured. KAB was collected by questionnaire. Eight hundred and fifty-eight participants (326 men and 532 women, 18&ndash;69 years) were included in the analysis (response rate 66%). Mean age was 48.5 yrs (SD 13.8). Mean UNa was 172.7 (79.3) mmoL/day, equivalent to 10.8 g of salt/day and potassium excretion 72.7 (31.5) mmoL/day, equivalent to 3.26 g/day. Men ate more sodium and potassium than women. Only 11.3% of the sample had a salt intake below the World Health Organization (WHO) recommended target of 5 g/day and approximately 39% met WHO targets for potassium excretion (&gt;90 mmoL/day). Whilst 81.7% declared limiting their consumption of processed food and over 70% declared not adding salt at the table, only 8.8% looked at sodium content of food, 31% still added salt when cooking and less than 1% took other measures to control salt consumption. Measures of awareness were significantly more common in urban compared to rural areas. Mean urinary iodine was 225 (SD: 152; median 196) mcg/24h, with no difference between sexes. According to WHO criteria, 41.0% had adequate iodine intake, 28.6% had intake below requirements and 17.8% and 12.6% had above requirement or excessive levels, respectively. Iodine content of salt table was 21.0 (SD: 18.6) mg/kg, with no difference between men and women. However, the content was lower in rural than urban areas (16.7 [SD: 18.6] vs 28.1 [SD: 16.5] mg/kg, p&lt;0.001). There were weak or no correlations between urinary sodium and iodine excretions, and between urinary iodine excretion and iodine concentration in the table salt used in the participants&rsquo; households, indicating that in most cases participants were not using iodised salt as their main source of salt, more so in rural areas. In the Republic of Moldova, salt consumption is unequivocally high, potassium consumption is lower than recommended, both in men and in women, whilst iodine intake is still inadequate in 1 in 3 people, although severe iodine deficiency is rare. Salt consumed is often not iodised, with less iodised salt being used in rural areas.