Sodium and nutrient levels in selected street food, consumer awareness towards salt intake, vendor attitudes towards salt usage and reduction strategies in Malaysia

Abstract

The scenario of street food and nutrition in Malaysia has yet to be explored in depth. This study aims to determine the sodium and nutrient levels in selected street food, the awareness of consumers towards salt intake, and vendors towards salt usage and salt reduction strategy in Malaysia. This cross-sectional and multimethod study consisted of three phases. Phase I started with a field survey involving 10 520 foods, in which there were 820 different types of foods that comprise 42.6% main meals, 35% snacks, and 22.4% desserts. Subsequently, 210 samples were selected and analyzed for sodium, proximate, and individual sugar content. 63 and 70 samples were selected and analyzed for monosodium glutamate (MSG) and fatty acid composition, respectively. Except for maltose, saturated fatty acids (FAs), monounsaturated FAs, and polyunsaturated FAs, significant differences between the categories were found for the contents of sodium (p<0.05), moisture (p<.001), protein (p<.001), fat (p<.001), energy (p<0.05), carbohydrate (p<.001), ash (p<.001), MSG (p<0.05), total sugar (p<.001), sucrose (p<.001), fructose (p<0.05), and glucose (p<0.05). Lactose and trans fatty acids (FAs) were not detected in any of the foods. Phase II involved the assessment of the agreement level towards ten influencing factors of street food purchasing and the knowledge, attitude, and practice (KAP) on salt intake among consumers aged ≥18 years (n=1434) through a validated online questionnaire. Cleanliness (4.10±0.88), food attributes (3.68±0.86), price (3.64±0.89), practice and tradition (3.64±0.89), quantity (3.53±0.88), and time (3.50±0.91) were the mainly agreed influencing factors compared to high energy content (3.20±0.94), environment (3.14±0.94), high sugar content (2.53±0.99), and high fat content (2.47±0.93). 37.5% of the consumers had good knowledge, 87.5% had positive attitudes, and 74.0% had inadequate practice on salt intake. Phase III started with the assessment of KAP on salt usage among vendors (n=389) through a validated questionnaire. Most of the vendors had unsatisfactory knowledge (82.8%), positive attitudes (57.3%), and inadequate practice (69.2%) on salt usage. In a qualitative part of this study, 22 focus group discussions and six in-depth interviews were conducted to explore the perspectives of salt reduction in the Malaysian out-of-home (OH) sector among another group of vendors (n=25), caterers (n=25), and consumers of the OH sector (n=76). They perceived a high salt intake within the sector and emphasized the need for a comprehensive salt reduction policy. Barriers faced included the limited awareness and knowledge among consumers, counterproductive practices among food operators and consumers, challenges in accessing affordable lowsodium food products, lack of standardized guidelines and effective enforcement mechanisms, food quality, and the price of salt. They advocated for awareness and knowledge enhancement, enhanced regulation of manufactured food products, stricter enforcement targeting vendors, promotion and recognition of health-conscious food premises, strategies for gaining consumers’ acceptance, and maintaining food quality. In conclusion, street foods in Malaysia exist in a wide range of varieties with varied nutrient contents and amounts. To facilitate the availability of a healthy street food environment, a properly planned nutrition policy that considers the awareness state and perceptions of consumers and vendors towards street food and nutrition is needed.