Comparison of Measured 24-hour Salt Excretion with Spot Urine and 24-hour Dietary Recall Estimates among Adolescents and Parents: A Cross-Sectional Study from North India
1
Cancer and Surgery, Imperial College London, London, United Kingdom
2
Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurgaon, India
3
HEAL Foundation, Chandigarh, India
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Hypertension, a leading cause of cardiovascular disease, is a significant public health challenge, with urban India reporting prevalence rates up to 40%. Excessive salt intake, averaging 8–11 g/day in India, far exceeds the WHO-recommended limit of 5 g/day and is a key modifiable risk factor. While 24-hour urine collection is the gold standard for measuring salt intake, its practicality in large-scale studies is limited, necessitating alternative methods like spot urine sampling and dietary recall. This study aims to evaluate salt intake among adolescents and their parents in Chandigarh, India, and compare the accuracy of different estimation methods.
METHODS:
A cross-sectional survey was conducted among 462 adolescents and 395 parents from public schools in Chandigarh, part of a cluster-randomized controlled trial focused on reducing chronic disease risk factors. Salt intake was measured via 24-hour urine collection, spot urine samples analyzed with the Kawasaki, Tanaka, and INTERSALT equations, and two non-consecutive 24-hour dietary recalls. Bland-Altman plots were used to assess agreement between methods.
RESULTS:
The mean salt intake measured via 24-hour urine samples was 6.95 g/day (95% CI, 6.48–7.42) for adolescents and 7.73 g/day (95% CI, 7.18–8.28) for parents. Spot urine estimates showed variability, with the INTERSALT equation with potassium yielding the closest results to 24-hour measurements for parents (8.12 g/day; 95% CI, 7.36–8.95). Dietary recall underestimated salt intake for both groups. The INTERSALT equation with potassium demonstrated the smallest mean difference from the 24-hour collection for parents.
CONCLUSIONS:
Spot urine sampling, particularly the INTERSALT with Potassium equation, offers a feasible alternative to 24-hour urine collection for estimating population-level salt intake among adults in resource-limited settings. Dietary recall alone significantly underestimates intake and should be supplemented with objective measures. These findings support the use of tailored estimation methods based on age for improved hypertension management strategies in India.
Hypertension, a leading cause of cardiovascular disease, is a significant public health challenge, with urban India reporting prevalence rates up to 40%. Excessive salt intake, averaging 8–11 g/day in India, far exceeds the WHO-recommended limit of 5 g/day and is a key modifiable risk factor. While 24-hour urine collection is the gold standard for measuring salt intake, its practicality in large-scale studies is limited, necessitating alternative methods like spot urine sampling and dietary recall. This study aims to evaluate salt intake among adolescents and their parents in Chandigarh, India, and compare the accuracy of different estimation methods.
METHODS:
A cross-sectional survey was conducted among 462 adolescents and 395 parents from public schools in Chandigarh, part of a cluster-randomized controlled trial focused on reducing chronic disease risk factors. Salt intake was measured via 24-hour urine collection, spot urine samples analyzed with the Kawasaki, Tanaka, and INTERSALT equations, and two non-consecutive 24-hour dietary recalls. Bland-Altman plots were used to assess agreement between methods.
RESULTS:
The mean salt intake measured via 24-hour urine samples was 6.95 g/day (95% CI, 6.48–7.42) for adolescents and 7.73 g/day (95% CI, 7.18–8.28) for parents. Spot urine estimates showed variability, with the INTERSALT equation with potassium yielding the closest results to 24-hour measurements for parents (8.12 g/day; 95% CI, 7.36–8.95). Dietary recall underestimated salt intake for both groups. The INTERSALT equation with potassium demonstrated the smallest mean difference from the 24-hour collection for parents.
CONCLUSIONS:
Spot urine sampling, particularly the INTERSALT with Potassium equation, offers a feasible alternative to 24-hour urine collection for estimating population-level salt intake among adults in resource-limited settings. Dietary recall alone significantly underestimates intake and should be supplemented with objective measures. These findings support the use of tailored estimation methods based on age for improved hypertension management strategies in India.
| eISSN: | 2654-1459 |
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