Drinking water salinity (sodium) and blood pressure Water-related crises are not a new problem in Bangladesh.

About 53% of the coastal area is affected by different degrees of salinity (Islam !!"#. $he coastal area in Bangladesh constitutes !% of the country% the population li&ing in this area relies hea&ily on ri&ers' ponds and groundwater' for washing' bathing' and obtaining drin(ing water. )onds in these areas are primarily rain fed' but the water often mi*es with saline water from ri&ers' soil runoff' and shallow groundwater (+ahman and +a&enscroft !!3#. Appro*imately ! million people who li&e along the coast are affected by &arying degrees of salinity in drin(ing water obtained from &arious natural sources ,-inistry of .n&ironment and /orest (-0./# !!12. $his salinity is mo&ing further inland' and o&er time the population at ris( is on the increase. As the salinity increases it can be e*pected that the li(elihood health conse3uences would increase if such water is used for drin(ing and coo(ing. $he salt' 4a5l accounts for almost 65.7% of the dissol&ed salts that causes salinity of water. $he other ma8or components of seawater are magnesium (-g#' calcium (5a#' potassium (9# and sulfate (:0 "#. $herefore any effects of salinity of drin(ing water on blood pressure could be result of ingested sodium through drin(ing water. A technical report produced by W;0 and the /A0 recommended ingestion of less than 5 g sodium chloride (or g sodium# per day as a population inta(e permissible limit' while ensuring that the salt is iodi<ed (W;0' !!3#. $his e*pert consultation stressed that dietary inta(e of sodium from all sources influences blood pressure le&els in the population and should be limited so as to reduce the ris( of coronary heart disease and stro(e. A strong e&idence of the lin( between e*cessi&e salt consumption and se&eral chronic diseases (W;0' !!1# has been established. 0bser&ational studies and clinical trials performed in general populations pro&ide o&erwhelming e&idence that higher salt inta(e is associated with raised blood pressure (Alderman !!!% ;e and -ac=regor !!7% >aw et al. ?@@?% -idgley et al. ?@@1#. Intersalt study demonstrated an association between salt inta(e and ele&ated blood pressure (Intersalt 5ooperati&e +esearch =roup ?@66# and reported that sodium inta(e A ?.6 gBday was associated with a 3-mm;g increase in systolic blood pressure and !.? mm;g increase in diastolic blood pressure (.lliott et al. ?@@1#. $he relationship between ele&ated sodium inta(e and hypertension has been the sub8ect of considerable scientific contro&ersy. Although short-term studies ha&e suggested that such a relationship does e*ist (>uft /5 et al. ?@7@#' most people in western .urope and 4orth America ingest a high salt diet from infancy yet do not e*hibit persistent hypertension until the fourth decade (W;0 ?@7@#.

Whereas reducing the sodium inta(e can reduce the blood pressure of some indi&iduals with hypertension' this is not effecti&e in all cases (>aragh C;' )ec(er -:. ?@63#. In case of children' se&eral studies suggest that high le&els of sodium in drin(ing-water are associated with increased blood pressure in children ($uthill +W' 5alabrese .C. ?@6?% #' in other studies no such association has been found ()omrehn )+ et al. ?@63% Armstrong B9 et al. ?@6 #. $he sodium ion is ubi3uitous in water and is naturally present in all foods and may be added during food processing. /ood is the main source of daily e*posure to sodium' primarily as sodium chloride. In Western .urope and 4orth America' the estimated o&erall consumption of dietary sodium chloride is 5D ! gBday ( D6 g of sodium per day#' the a&erage being ?! gBday (" g of sodium# (W;0 ?@7@#. )eople on a low sodium diet need to restrict their sodium inta(e to less than :ciences ?@77#. $he consumption of drin(ing-water containing ! mg of sodium per litre would lead to a daily inta(e of about "! mg of sodium. +esults from a recent study in Bangladesh (9han et al' !??# has re&ealed that a&erage per capita estimated sodium inta(es from drin(ing water could be in the range of 5 to ?1 gBday in the dry season' compared to !.1D?. gBday in the rainy season. :odium salts are found in &irtually all food (the main source of daily e*posure# and drin(ing water. 0n the basis of e*isting data' no firm conclusions ha&e been drawn concerning the possible association between sodium in drin(ing-water and the occurrence of hypertension. $herefore there e*ists need for e&idence that would allow us either to show or re8ect the notion of association between sodiumBsalinity in drin(ing-water and the occurrence of ele&ated blood pressure or hypertension. Is blood pressure higher among populationBindi&iduals ha&ing high sodiumBsalinity in drin(ing-waterE Fependent &ariableG :B)' FB)' -A) Independent &ariableG :alinityB sodium in drin(ing water. 5onfoundersG Age' se*' body mass inde*' social class' room temperature' ta(ing anti-hypertensi&e medication and smo(ing status 5ross sectional study with reference group. )opulatuionG :chool children B AdeloscentsB All age group .*tensi&e baseline inter&iews will be conducted to collect information on history of drin(ing water sources' demographics' and lifestyle characteristics. Fietary inta(es of salt will be assessed through gBday (4ational Academy of

appropiate food-fre3uency 3uestionnaire (//H#. In addition' trained physicians administered a comprehensi&e anthropometric assessment and blood pressure measurements would be ta(en.
Alderman -;. !!!. :alt' blood pressure' and human health. ;ypertension 31G6@!D6@3. Armstrong B9 et al. Water sodium and blood pressure in rural school children. Archives of environmental health' ?@6 ' 37G 31- "5. .lliott )' :tamler C' 4ichols +' Fyer A+' :tamler +' 9esteloot ;' et al. ?@@1. Intersalt re&isitedG further analyses of " hour sodium e*cretion and blood pressure within and across populations. Intersalt 5ooperati&e +esearch =roup. B-C 3? G? "@D? 53. ;e /C' -ac=regor =A. !!7. :alt' blood pressure and cardio&ascular disease. 5urr 0pin 5ardiol G @6D3!5. Intersalt 5ooperati&e +esearch =roup. ?@66. IntersaltG an international study of electrolyte e*cretion and blood pressure. +esults for " hour urinary sodium and potassium e*cretion. B-C @7G3?@D3 6. Islam' -.+. (ed.#' !!". Where >and -eets the :eaG A )rofile of the 5oastal Ione of Bangladesh' $he Jni&ersity )ress >imited' Fha(a. InG ;ossain ->' ;ossain -9' :alam -A and +ubaiyat A. :easonal &ariation of soil salinity in coastal areas of Bangladesh. International Cournal of .n&ironmental :cience' -anagement and .ngineering +esearch Kol. ? ("#' pp. ?7 -?76' Cul-Aug.' !? . A&ailable on-line at httpGBB www.i8esmer.com 9han et al.' !??. Frin(ing Water :alinity and -aternal ;ealth in 5oastal BangladeshG Implications of 5limate 5hange. Environmental Health Perspectives. ??@G?3 6D?33 . 9urt< $W' -orris +5 Cr. Fietary chloride as a determinant of Lsodium-dependentL hypertension. Science' ?@63' G??3@-??"?. >aragh C;' )ec(er -:. Fietary sodium and essential hypertensionG some myths' hopes and truths. Annals of internal medicine' ?@63' @6G735-7"3. >aw -+' /rost 5F' Wald 4C. ?@@?. By how much does dietary salt reduction lower blood pressureE IM Analysis of obser&ational data among populations. B-C 3! G6??D6?5. >uft /5 et al. 5ardio&ascular and humoral responses to e*tremes of sodium inta(e in normal blac( and white men. Circulation' ?@7@' 1!G1@7-7!1. -idgley C)' -atthew A=' =reenwood 5-' >ogan A=. ?@@1. .ffect of reduced dietary sodium on blood pressureG a meta-analysis of randomi<ed controlled trials. CA-A 75G?5@!D?5@7 -0./ (-inistry of .n&ironment and /orest#. !!1. Impact of :ea->e&el +ise on >and Jse :uitability and Adaptation 0ptionsG 5oastal >and Ioning in the :outhwest. Fha(a' BangladeshG -inistry of .n&ironment and /orest. -organ $0. $he effect of potassium and bicarbonate ions on the rise in blood pressure caused by sodium chloride. Clinical science' ?@6 ' 13G"!7s. 4ational Academy of :ciences. Drinking water and health. Washington' F5' 4ational Academy )ress' ?@77G"!!-"??. )omrehn )+ et al. 5ommunity differences in blood pressure le&els and drin(ing water sodium. American journal of epidemiology' ?@63' ??6G1!-7?. +ahman AA' +a&enscroft ). !!3. =roundwater +esources and Fe&elopment in Bangladesh. nd ed. BangladeshG 5entre for Ad&anced :tudies' Jni&ersity )ress >td. W;0' ?@7@. Sodium, chlorides and conductivity in drinking water. 5openhagen' W;0 +egional 0ffice for .urope' (.J+0 +eports and :tudies 4o. #. W;0' !!3. Diet, nutrition and the prevention of chronic diseases !eport of a "oint #H$%&A$ E'pert Consultation. W;0 $echnical +eport :eries' 4o. @?1. W;0' !!1. !educing salt intake in populations( report of a #H$ forum and technical meeting, )*+ $cto,er -../, Paris, &rance