Salt Intake in Malaysia: A Population-Based Study of Knowledge, Attitudes, and Practices Among Adults.

Excessive salt consumption has remained a critical public health issue in Malaysia where the average daily consumption has far exceeded the recommended limit by the World Health Organization (WHO). Driven by the cultural dietary patterns and limited public knowledge, it poses a significant challenge to attitudes, beliefs, and self-reported salt intake practices among Malaysian adults. This nationwide cross-sectional study was conducted from August to November 2023 using a multistage random sampling method.The study employed the validated MySalt Literacy instrument, designed to suit Malaysia's multicultural context and comprising domains on knowledge, beliefs, attitudes, practices, and salt intake among adults aged 18 years and older. A total of 4400 respondents participated in the study, with the majority being female (64.7%) and the remainder male (35.3%). Most respondents had attained tertiary education (54.2%) and resided in rural or semi-rural areas (55.7%). The study findings revealed only 30.9% of respondents correctly identified the recommended daily limit for salt intake, and 65.7% were unaware of the relationship between salt and sodium. In terms of behavioural practices, only 15.6% respondents reported actively limiting their daily salt intake, while merely 13.9% consistently paid attention to labels indicating "no salt added," "low," or "reduced sodium" when purchasing food. Further analysis indicated a significant correlation between attitudes, beliefs, and label-reading practices with salt intake behaviour. This study reveals that Malaysian adults are generally aware of the health risks due to excessive salt intake and express positive attitudes towards salt reduction, however significant knowledge gaps and cultural barriers impedes the progress. Thus, efforts to reduce salt intake must go beyond raising awareness by addressing cultural beliefs, taste preferences and behavioural habits. Effective interventions should incorporate culturally tailored strategies and relatable messages that consider taste preferences and behavioural norms. A coordinated, multi sectoral approach involving health promotion, nutrition education (including label-reading skills), and food policy reforms such as front of pack labelling and mandatory reformulation is essential for sustainable, population wide salt reduction.