Screening tool for identifying adults with excessive salt intake among community-dwelling adults: a population-based cohort study

Am J Clin Nutr. 2020 Apr 1;111(4):814-820. doi: 10.1093/ajcn/nqaa003.


Background: Excessive salt intake is widely known to be a cause of hypertension, cardiovascular events, and so on. However, simple tools for screening excessive salt intake are lacking.

Objective: We aimed to develop a simple screening tool to identify community-dwelling adults with excessive salt intake.

Methods: The present study involved participants who received health check-ups in Fukushima, Japan, in 2016 and 2017. We defined data from the 2016 check-up as the derivation set, and data from those who received check-ups in 2017 but not 2016 as the validation set. The outcome measure was excessive salt intake, defined as the estimated daily salt intake of 1 SD or more. Candidate predictors associated with the outcome were extracted using the Delphi method by an expert panel and narrowed down with clinical expertise and stepwise backward selection. The screening tool was developed using a coefficient-based multivariable scoring method and externally validated.

Results: A total of 1101 participants were included in the derivation set and 249 in the validation set. At the conclusion of the deviation process, 8 predictors were selected and scored. The areas under the receiver operating characteristic curve for derivation and external validation were 0.70 (95% CI: 0.67, 0.74) and 0.71 (95% CI: 0.62, 0.80), respectively. The calibration slope and intercept for external validation were 1.16 and -0.03, respectively.

Conclusion: We developed a screening tool to identify adults with excessive salt intake. By extracting groups with excessive salt intake, target populations needing intervention for salt reduction can be highlighted efficiently.

Keywords: epidemiology; excess salt; population-based study; questionnaire; screening tool.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Independent Living / statistics & numerical data
  • Japan
  • Male
  • Mass Screening
  • Middle Aged
  • ROC Curve
  • Sodium Chloride, Dietary / analysis
  • Sodium Chloride, Dietary / metabolism*


  • Sodium Chloride, Dietary