The World Health Organization recommended reducing one’s salt intake below 5 g/day to prevent disability and death from cardiovascular and other chronic diseases. This review aimed to identify salt estimation at the population level in South Asian countries, namely Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. We searched electronic databases and government websites for the literature and reports published between January 2011 and October 2021 and also consulted key informants for unpublished reports. We included studies that assessed salt intake from urinary sodium excretion, either spot urine or a 24 h urine sample, on a minimum of 100 samples in South Asian countries. We included 12 studies meeting the criteria after screening 2043 studies, out of which five followed nationally representative methods. This review revealed that salt intake in South Asian countries ranges from 6.7–13.3 g/day. The reported lowest level of salt intake was in Bangladesh and India, and the highest one was in Nepal. The estimated salt intake reported in the nationally representative studies were ranging from 8 g/day (in India) to 12.1 g/day (in Afghanistan). Salt consumption in men (8.9–12.5 g/day) was reported higher than in women (7.1–12.5 g/day). Despite the global target of population salt intake reduction, people in South Asian countries consume a much higher amount of salt than the WHO-recommended level.

Background/Objectives: Front-of-package labeling (FOPL) policies are a useful strategy to inform consumers about foods high in nutrients of concern, but little is known about what type of label works best in Bangladesh, a country with increasing levels of unhealthy food intake and diet-related diseases. Methods: We conducted 10 focus groups with men and women in rural and urban Bangladesh (n = 76). Using a semi-structured discussion guide, we asked consumers for their perceptions of the healthfulness of nutrients and foods, two common FOPLs (a color-coded guideline daily allowance [GDA] label and a warning label), and different visual elements of the warning label (e.g., shape, icon, text). Results: Participants understood the health harms of sugar and salt consumption but were less clear on saturated fat. Both FOPLs were perceived as helpful for identifying unhealthy foods, but the warning labels were perceived as easier to understand and more likely to influence behaviors than the GDA. Regarding the design of warning labels, participants perceived warning devices, holding straps, and octagonal shapes as effective but had mixed reactions to which icons or textual statements were most effective. Conclusions: FOPLs are likely to facilitate Bangladeshi consumers’ ability to identify unhealthy products. Further research is needed to understand the impact on food choices as well as the most effective design in this population.

Visit non-attendance is a common barrier to hypertension control in low and middle-income countries (LMICs). We aimed to evaluate the effectiveness of mobile text messaging in improving visit attendance among patients with hypertension in primary healthcare facilities in Bangladesh. A randomized A/B testing study was conducted with two patient groups: (1) patients regularly attending visits (regular patients) and (2) patients overdue for their follow-up clinic visit (overdue patients). Regular patients were randomized into three groups: a cascade of three text reminders, a single text reminder, or no text reminder. Overdue patients were randomized into two groups: a single text reminder or no text reminder. 20,072 regular patients and 12,708 overdue patients were enrolled. Among regular patients, visit attendance was significantly higher in the cascade reminder group and the single reminder group compared to the no reminder group (78.2% and 76.6% vs. 74.8%, p < 0.001 and 0.027, respectively). Among overdue patients, the single reminder group had a 5.8% higher visit attendance compared to the no reminder group (26.5% vs. 20.7%, p < 0.001). The results remained consistent in multivariable analysis; adjusted prevalence ratio (PR) was 1.04 (95% CI 1.02–1.06) for the cascade reminder group and 1.02 (95% CI 1.00–1.05) for the single reminder group among regular patients. The adjusted PR for the single reminder group vs. the no reminder group among overdue patients was 1.23 (95% CI 1.15–1.33). Text message reminders are an effective strategy for improving retention of patients in hypertension treatment in LMICs, especially for patients overdue to care.

According to WHO, reducing salt intake to less than 5 g/day means less death, disability, and suffering from heart disease and stroke, with around 1.89 million lives saved every year. In this scoping review, we have reviewed the salt consumption pattern of South Asia. For this purpose, we searched online databases and websites and consulted key informants to address relevant unpublished reports. The inclusion criteria are English-language publications between January 2011 and October 2021, as well as research that evaluated salt intake in the South Asian region and reported salt/sodium 24-hr urine or spot urine samples involving at least 100 participants. A total of 2043 studies were screened, out of which 12 studies fulfilled all the criteria. Our review revealed that reported salt intake in the South Asian region ranges from 6.7-13.3 g/day, which was higher than the WHO-recommended maximum level of 5 g/day in all countries. Men consumed more salt than women. This review demonstrates the critical importance of implementing a salt reduction program in South Asian countries.

Introduction: The high burden of blood pressure-related cardiovascular diseases in Bangladesh is potentially caused by excessive dietary sodium and insufficient potassium intake. Our objective is to estimate dietary salt and potassium intake among Bangladesh rural and urban adults from urinary excretion of sodium and potassium. Methods: We conducted a cross-sectional study between December 2017 and June 2018, including participants aged 30–59 years from three urban and three rural sites in Bangladesh. Data included urinary excretion of sodium and potassium estimated from one 24-hr urine collection and blood pressure measurements. Results: Among 840 enrolled participants, complete data was available in 509 individuals. Mean age was 43.0 (SD ±7.9) years; 20.9% had hypertension, 50.9% were women, and 50.9% resided in urban areas. Mean systolic and diastolic blood pressure were 118.6 (SD ± 16.6) mmHg and 76.3 (SD ± 11.3) mmHg, respectively. Overall, the mean urinary sodium excretion was 3.9 g/day (95% CI = 3.8 to 4.0), corresponding to a mean salt intake of 9.7 g/day (95% CI = 9.4–10.1). Mean urinary potassium excretion was 1.4 g/day (95% CI = 1.3–1.4), corresponding to an estimated mean dietary potassium intake of 2.0 g/day. Men and urban residents had slightly but non-significantly higher sodium and potassium excretion than women and rural residents. Conclusion: In Bangladesh, salt intake exceeded WHO’s recommended <5g/day limit, while potassium intake was substantially lower than the recommended intake of ≥ 3.5g/day for adults. Promoting low-sodium and potassium-rich diets through nationwide campaigns and policies, including advocating for accessible low-sodium and potassium-enriched salt substitutes, is recommended to mitigate cardiovascular disease risks.