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Ethnic differences in knowledge, attitudes, and practices related to dietary salt intake and association with hypertension in Malaysia: a multi-centre cross-sectional study

Hypertension Research volume 48, pages 131–147 (2025)Cite this article

Abstract

The association between high salt intake and elevated blood pressure levels has been well-documented. However, studies on how effectively this knowledge translates into actionable practices, particularly across different ethnic groups, remain limited. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) towards dietary salt intake across ethnicities and determine its association with hypertension. 5128 Malaysian adults recruited from a national blood pressure screening study completed questionnaires on demographics, and KAP related to dietary salt intake. There were 57.4% Malay, 23.5% Chinese, 10.4% Indian, and 8.7% individuals of other ethnic groups. Overall, more than 90% of the participants knew that a high salt intake causes serious health problems, but only around one-third knew the relationship between high salt intake and strokes and heart failure. Participants of different ethnic groups displayed significant differences in the KAP domains, where Indians generally exhibited better knowledge, attitudes, and reported better practices such as reading salt labels and using spices. Those who were unaware of the difference between salt and sodium and who reported not reading salt labels had higher odds of having elevated blood pressure. These findings demonstrate that while there is a suboptimal translation of salt knowledge into practice in Malaysia, with significant differences in KAP observed between ethnic groups, the potential of improving health outcomes by improving the clarity and awareness of salt labels is substantial. Tailored education promoting salt-label reading, minimizing processed foods intake and discretionary salt use should be ethnic-specific to better curb this escalating hypertension epidemic.

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Data availability

The data that support the findings of this study are available from the corresponding author, YCC, upon reasonable request.

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Acknowledgements

We would like to thank the MMM 2018 at the International Society of Hypertension (ISH), Malaysian Society of Hypertension (MSH), Malaysian Society of Hypertension-Sunway University Young Investigator Network (MSH-SU YIN), and the Malaysian Society for World Action on Salt, Sugar and Health (MyWASSH) for their support in this study. We would also like to thank the following individuals who contributed to the data collection activities for MMM 2018, Abdul Hafiz Mohamad Gani, Dalyana Hamid, Tay Chai Li, Wong Ping Foo, Haslinda Hassan, Noor Marzlin Marzukhi, Kong Sie Zin, Sunita Bavanandan, Nadratulmazlyna Mansor, Ng Wei Leik, Christine Shamla Selvaraj, Ahmad Fithri Azam Abdul Rahman, Hanisah Shafie, Dr Zeti, Ding Ai Lee, Syariza Radzi, Hanis Saadah Husin, Azli Shahril Othman, Pei San Kang.

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Authors and Affiliations

  1. Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Selangor Darul Ehsan, Malaysia

    Yook Chin Chia, Siew Mooi Ching, Pei Boon Ooi, Maong Hui Cheng & Felicia Fei-Lei Chung

  2. Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia

    Yook Chin Chia, Hooi Min Lim, Mohazmi Mohamed & Hooi Chin Beh

  3. Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia Serdang, Selangor Darul Ehsan, Malaysia

    Siew Mooi Ching & Navin Kumar Devaraj

  4. Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia

    Siew Mooi Ching

  5. Research Centre of Excellence Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia

    Siew Mooi Ching

  6. Research Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Selangor Darul Ehsan, Malaysia

    Ming Tsuey Chew

  7. Hospital Shah Alam Persiaran Kayangan, Selangor Darul Ehsan, Malaysia

    Jethro Ee Keat Oui

  8. Department of Primary Care Medicine, Student and Staff Health Unit, University of Malaya Medical Centre, Jalan Universiti, Lembah Pantai, Kuala Lumpur, Malaysia

    Bee Nah Chew

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  1. Yook Chin Chia
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Contributions

YCC conceived and devised the concept of examining the KAP of salt intake in this sub-study. YCC, SMC, NKD, PBO, and MTC developed the KAP questionnaire on salt. All other authors contributed to data collection. YCC, NKD, JEKO, SMC, FCFL, MTC analysed the data. YCC SMC and MTC wrote the manuscript. All other authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Yook Chin Chia.

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Ethics approval

Ethics approval was obtained from the Malaysian National Medical Research Register (NMRR-18-876-40691) and Universiti Malaya Medical Center (MREC ID NO: 2018320-6146).

Conflict of interest

YCC received on behalf of the Malaysian Society on Salt, Sugar and Health (MyWASSH), an unrestricted educational grant from Medtronic.

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Chia, Y.C., Ching, S.M., Chew, M.T. et al. Ethnic differences in knowledge, attitudes, and practices related to dietary salt intake and association with hypertension in Malaysia: a multi-centre cross-sectional study. Hypertens Res 48, 131–147 (2025). https://doi.org/10.1038/s41440-024-01851-z

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