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Differences of sodium consumption pattern hypertension sufferer in coastal and highland communities in Wakatobi islands

La
Ode Alifariki1; Tukatman, Tukatman2;Bangu, Bangu2;
HeriviyatnoJulika Siagian2*
Available from: http://dx.doi.org/10.21931/RB/2021.01.02.12
(registering DOI)
ABSTRACT
Available
data indicate that food sodium (such as salt) is directly related to blood
pressure (BP). The research aims to look at the different sodium consumption
patterns of hypertension sufferers in two different coastal areas and highland
areas in the Wakatobi Islands. The type of research is observational analytic
research using a cross-sectional design. This study has been carried out in the
District of Wangi-Wangi, especially in the MolaSamaturu villages and Waginopo
Village in October 2019. The number of research samples is 100 people (50
respondents in Mola Samaturu Village and 50 people in Waginopo Village). The
results showed the differences between sodium consumption patterns in
hypertensive sufferers in Mola Samaturu Village and Waginopo Village with a p-value
= 0,000 <α 0.05. Sodium consumption
patterns in coastal communities are higher than in highlands community.
Keywords: Hypertension,
sodium consumption pattern, Wakatobi islands
INTRODUCTION
Hypertension
is a significant risk factor for cardiovascular and cerebral vascular disease,
also kidney failure. It is known that the amount of salt intake in meals plays
a role in the pathogenesis of primary hypertension1,2,3. Increased sensitivity
of blood pressure toward excess sodium affects 50% of patients with primary
hypertension4,5. Salt dietary intake
causes enhancement of blood pressure associated with kidney and cardiovascular
diseases, including left ventricular hypertrophy and microalbuminuria6.
Sodium
is the most cation in an extracellular fluid where 35-40% (60 mmol per kg of
body weight) is in the skeleton, and a small portion (about 10-14 mmol / L) is
in the intracellular fluid7. Under normal
circumstances, sodium excretion in the kidneys is regulated to maintain a balance
between intake and output, with extracellular fluid volume remains stable8. More than 90% of the extracellular
fluid's osmotic pressure is determined by salt, specifically in sodium chloride
(NaCl) and sodium bicarbonate (NaHCO3), thereby changing the osmotic pressure
in the extracellular fluid represents changing sodium concentration9.
Increased
sodium intake causes fluid retention of the body, which increases blood volume
by pulling intra-cellular fluid into extracellular so that the heart should
pump forcefully to drive large volumes of blood through narrowing of the
intravascular space, which results in hypertension10,11. This was proven in a
study conducted by Abdurrachim, Hariyawati, and Suryani12that there was a
significant relationship between sodium intake with blood pressure in the elderly
at TresnaWerdhanursing Home and BinaLaras Budi Luhur nursing home, Banjarbaru
City.
Blood
pressure is the bloodstream pressure in blood vessels and circulates in all
tissues of the human body13,14. Blood pressure
consists of 2 parts of systolic pressure and diastolic pressure15,16. Systolic blood
pressure is defined as the pressure during heart contractions, while diastolic
blood pressure is defined as blood pressure when the heart relaxes14.
The
sodium content in foods dramatically varies and depends on the food source (e.g.,
animal foods source naturally contain more sodium) and the level of change that
food itself goes through. Foods that are naturally low in sodium are fruits,
vegetables, oils, and cereals, with the contents range from 20 mg up to 100 g7.
The
Food and Agriculture Organization (FAO) and WHO recommends that the amount of
salt consumption in the community is less than 5 gram a day because of the
adverse effects of excessive salt consumption on health, especially on blood
pressure and cardiovascular disease4,17.Based on data from
National Basic Health Research in 2013, it was found that the prevalence of
risky food consumption patterns, especially salty foods, was 26.2%, and
Southeast Sulawesi was 11.5%18.
Geographically,
the Wangi-Wangi Islands' position is surrounded by the sea of Banda, where
most of the people in the community earn a livelihood as seaweed farmers and
fishers even though there are some villages that quite far from the coast with
livelihoods as land farmers. This geographical position gives a plus and minus
effect on the health of the Wangi-Wangi community, especially those living in
coastal areas exposed to high salt or sodium consumption patterns.
According
to Bustan, more people living in urban areas suffer from hypertension than
people living in villages; furthermore, based on the geographical location
where coastal areas have more hypertension than highland areas19. Research conducted by
Setiawati on the coast of Manado Tua Island obtained a significant relationship
between sodium intake and the incidence of hypertension20.
Based
on the phenomenon, this study aims to determine differences in sodium
consumption patterns of hypertensive patients in coastal and highland
communities in the Wakatobi Islands.
METHODS
The
type of study is observational analytic research using a cross-sectional
design. This research has been conducted in the District of Wangi-Wangi, specifically
atMolaSamaturuvillage and Waginopo Village, in October 2019. The study
population comprises all people with hypertension who live in MolaSamaturu
Village (124 people) and Waginopo Village (116 people), with 240 people in
October 2019. The number of research samples was 100 people (50 respondents in
MolaSamaturu Village and 50 people in Waginopo Village). The blood pressure
variable is obtained by measuring using a blood pressure meter with
hypertension criteria for hypertension sufferers is 140/90 mmHg (first-degree
hypertension, second-degree hypertension, and third-degree hypertension). The
sodium consumption pattern variable is obtained by measuring the consumption
pattern using the Food Frequency Questionnaire (FFQ) then analyzed using a
Nutri survey with a safe sodium consumption pattern standard (<2000 mg/day).
The statistical test uses an independent t-test with a value of α = 0.05.
RESULTS

Table 1. Respondents characteristics
Table
1 shows respondents' characteristics with hypertension based on age range
mostly in the MolaSamaturu village as 30% with age range 30-35 years old. In
the Waginopo village, mostly in the age range 42-47 years old is 44%. By gender
characteristics, mostly in MolaSamaturu Village with a percentage of 46% men
and Waginopo Village the most were 44% men. By type of occupation, in
MolaSamaturu village, 62% of respondents are fishermen, and Waginopo Village,
most of the respondents, are farmers as much as 50%. Characteristics of
respondents based on BMI show the most respondents in the MolaSamaturu village
is in normal BMI (18.5-25.0) as much as 74%, either in the Waginopo village,
most of the respondents is in the normal BMI with the percentage of 74%.

Table 2. Distribution of variables
Based
on table 2, respondents' characteristics in the category of hypertension in the
MolaSamaturu village mostly in the stage I category with percentage is 50%, the
same in Waginopo village that mostly is in the stage I as many as 66%. For the
sodium consumption pattern variable, MolaSamaturu village with 68% is in ≥ 2000
mg/day category, while in Waginopo village mostly in < 2000 mg/day category
with 76% of respondents (Table 2).

Table 3. Distribution of mean
score, minimum-maximum blood pressure, and sodium consumption pattern
hypertension sufferer
Table 3 shows that the mean systolic and
diastolic blood pressure values of respondents in Mola Samaturu were higher
than respondents in Waginopo Village, as well as sodium consumption, higher in
Mola Samaturu Village, higher than respondents in Waginopo Village.

Figure
1. Sodium consumption pattern in
Molasamaturu Village

Figure 2. Sodium
consumption pattern in WaginopoVillage

Table 4. Hypothesis test for
differences of sodium consumption pattern hypertension sufferer
Table
4 shows a difference between Sodium consumption pattern hypertension sufferers
in MolaSamaturu village and Waginopo village with p value= 0.000< α 0.05
(table 4).
DISCUSSION
Sample
testing is based on the relationship between hypertension as a dependent
variable with seafood consumption as an independent variable along with other
risk factors causing hypertension, such as age, gender, alcohol consumption,
smoking, history of DM, family history of DM, history of dyslipidemia, and
history dyslipidemia in families not examined in this study.
This
research shows that hypertension is more in coastal areas (MolaSamaturu
Village) compared to highland areas (Waginopo Village). Sodium is a mineral
found in the body and many foods source. Sodium is an essential nutrient for
maintaining blood volume, regulating water balance in cells, and maintaining
nerve function. The kidney controls sodium balance by increasing or decreasing the
excretion of sodium in the urine. Another theory states that kidney disorders
cannot correctly excrete sodium (Na) in average amounts; the consequences are sodium
(Na) in intravascular volume increase so that hypertension occurs21.
The
distribution of stage II and III hypertension sufferers shows that higher in
coastal communities than in the highlands; this can be attributed to the
excessive sodium consumption behavior found in seafood. The recommended daily sodium
consumption is around 2400 mg, which can be achieved from salt around 2000 mg
while another 400 mg is found in the food consumed 22.
The
food consumption pattern of highland communities, especially in the Waginopo
area, shows the same thing with coastal communities in frequency. However,
there are significant differences in the types of food that characterize
coastal communities, such as shellfish, crabs, and others that contain high
sodium.This is in line with previous research, which states that the
consumption patterns of coastal communities have a frequency of eating 3 times
a day with staple foods, namely rice, animal consumption patterns are relatively
high, especially seafood and fish ponds, while the pattern of fruit consumption
is still relatively low frequency 0 in a day with a percentage of 75% 23.
In
1904, Ambard and Beaujard revealed salt intake correlates to BP as the first
study on hypertension diet conducted on 6 patients with hypertension for 3
weeks using three types of salt and protein. The amount of salt in the body is
measured by salt in food and urine per day. The amount of salt in the intake is
small, the patient will experience a negative sodium balance, and blood
pressure decreases. Otherwise, if the amount of salt in the intake is high, the
amount of salt will be excreted a little so that sodium balance is achieved,
and blood pressure will increase even though the amount of protein intake is
small. Based on the result, the conclusion was the salt affects blood pressure.
They were conducting the restriction on salt intake and success to reduce blood
pressure 24.
This
study's analysis results indicate that the highest sodium intake is in the
coastal area, where sodium intake is excessive with a percentage of 68%. In
contrast, in the highlands region, the highest sodium intake category is the
sodium intake category, with a percentage of 76%. Factors that influence the
high consumption of salt or sodium in coastal communities in the MolaSamaturu
village are raw eating habits of shellfish, sea urchins, and salted fish. From
the survey results, people in coastal areas consume high sodium foods daily,
especially salted fish in hurricane season becomes the primary alternative for a
food source in the coastal community. Another case is the community in Waginopo
Village, which rarely consumes seafood from shellfish and salted fish. Some
respondents even said that dried fish was not salted but only dried and then
processed and consumed.
Research
on the relationship of seafood with the incidence of hypertension has been done
by Masengi et al. 25, which states a
significant relationship between seafood consumption with the incidence of
hypertension (p = 0.001).
Statistically,
there was a significant difference (p = 0.00) for sodium intake in coastal areas
and highlands areas where sodium intake was higher in coastal areas than in the
highland area. This study is in line with Sundari et al. 26, where sodium intake significantly
affects essential hypertension, p-value—in line with research Rusliafa et al. 27 states that there are
differences in hypertension incidence in coastal and highland areas, namely
eating pattern (sodium intake p = 0.026).
Several
studies have been conducted in some areas worldwide regarding daily salt intake
related to blood pressure. A survey of salt intake in the newfound land area revealed the differences between
the center of the island (inland) and the coastal community, where the typical
salt intake is varying between 6.7 and 7.3 g/day compared to 8.4 and 8.8 g/day 28. Parallel changes in
the incidence of hypertension lead to differences in salt intake in several
regions. The incidence of hypertension in the inland community was 15%, aged
between 55 to 75 years old, lower than the coastal community with a percentage
around 27%. Similar results were found among the Solomon Islanders 29. In those tribes, had a
salt intake below 2 g/day, only 1% of the population having raised in BP which
lived away from the coast. About 3% of the Inland community population experienced
elevating BP with salt intakes around 3 and 8 g/day. While people who lived on
the coastal area had a salt intake between 9 to 15 g/day, indicating an
increase of BP around 8% of the population. Migratory, in his study, found a
relationship between daily salt intake and BP.The similarities in the results
of this study are probably caused by the same characteristics of coastal and
mountainous communities in consuming their daily food.
CONCLUSIONS
There
is a difference between sodium consumption patterns in hypertensive sufferers
in Mola Samaturu Village and Waginopo Village with a p-value = 0,000
<α 0.05. Sodium consumption patterns in coastal communities are higher than
in highlands community. This is due to the ease of getting foods that contain
high sodium compared to highland areas. Further studies may find out the
possibility of food modification that can reduce sodium levels, especially in
coastal areas.
Acknowledgments
The
author would like to thank the parties who have contributed to the
implementation of this research, especially the Dean of the UHO Faculty of
Medicine, Chair of the UHO LPPM.
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Received: 12 December 2020
Accepted: 10 February 2021
La Ode Alifariki1;
Tukatman, Tukatman2;Bangu, Bangu2; HeriviyatnoJulika
Siagian2*
Epidemiology
Department, College of Medicine, Halu Oleo
University,
Kendari,
Indonesia1;
Nursing Department, College of Science and Technology, Sembilanbelas November
University, Kolaka, Indonesia2
Corresponding author: HeriviyatnoJulikaSiagian,
Pemudast., Tahoa, Sembilanbelas
November University, Kolaka regency, South-East Sulawesi, Indonesia 93561, heriviyatno.j.siagian@gmail.com