Open Access Open Badges Research

The association of knowledge, attitudes and behaviours related to salt with 24-hour urinary sodium excretion

Mary-Anne Land1*, Jacqui Webster1, Anthea Christoforou1, Claire Johnson1, Helen Trevena1, Frances Hodgins1, John Chalmers1, Mark Woodward1, Federica Barzi1, Wayne Smith3, Victoria Flood4, Paul Jeffery5, Caryl Nowson5 and Bruce Neal12

Author Affiliations

1 The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO BOX M201, Missenden Road, Camperdown, Sydney, NSW, Australia

2 Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

3 New South Wales Health, Sydney, Australia

4 The Sydney University of Sydney and St Vincent’s Hospital, Sydney, Australia

5 Deakin University, Melbourne, Australia

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International Journal of Behavioral Nutrition and Physical Activity 2014, 11:47  doi:10.1186/1479-5868-11-47

Published: 4 April 2014



Salt reduction efforts usually have a strong focus on consumer education. Understanding the association between salt consumption levels and knowledge, attitudes and behaviours towards salt should provide insight into the likely effectiveness of education-based programs.


A single 24-hour urine sample and a questionnaire describing knowledge, attitudes and behaviours was obtained from 306 randomly selected participants and 113 volunteers from a regional town in Australia.


Mean age of all participants was 55 years (range 20–88), 55% were women and mean 24-hour urinary salt excretion was 8.8(3.6) g/d. There was no difference in salt excretion between the randomly selected and volunteer sample. Virtually all participants (95%) identified that a diet high in salt can cause serious health problems with the majority of participants (81%) linking a high salt diet to raised blood pressure. There was no difference in salt excretion between those who did 8.7(2.1) g/d and did not 7.5(3.3) g/d identify that a diet high in salt causes high blood pressure (p = 0.1). Nor was there a difference between individuals who believed they consumed “too much” 8.9(3.3) g/d “just the right amount” 8.4(2.6) g/d or “too little salt” 9.1(3.7) g/d (p = 0.2). Likewise, individuals who indicated that lowering their salt intake was important 8.5(2.9) g/d vs. not important 8.8(2.4) g/d did not have different consumption levels (p = 0.4).


The absence of a clear association between knowledge, attitudes and behaviours towards salt and actual salt consumption suggests that interventions focused on knowledge, attitudes and behaviours alone may be of limited efficacy.

Salt; Urinary sodium excretion; Knowledge; Attitude; Behaviour