Salt Intake Among the Iranian Population and Public Attitudes Toward Salt Consumption: National and Subnational Report From STEPS 2021.

High salt intake is a significant risk factor for non-communicable diseases globally. This study aimed to assess salt intake and attitude to salt consumption in Iran in 2021 using STEPS data. Data were analyzed from a population-based survey with a nationally and sub-nationally representative sample of Iranian adults. A systematic cluster sampling approach was employed. In total, 17,910 participants were included in the salt intake analyses, and 27,838 participants were included in the attitude and practice analyses. Spot urine samples were collected to estimate 24-h urine sodium and daily sodium intake. Participants also completed questionnaires, and anthropometric and physical measurements were taken. The mean daily salt intake in Iran in 2021 was 9.71 g/day, with 97.98% of participants exceeding the WHO-recommended limit of 5 g/day. Salt intake was higher in men than in women (9.95 vs. 9.51 g/day), and higher among rural compared to urban residents (10.02 vs. 9.6 g/day). Married and obese individuals had elevated salt intake. Participants with hypertension consumed more salt than those without (9.83 vs. 9.64 g/day). However, among hypertensive individuals, those aware of their condition consumed less salt. 91.96% of participants thought that excessive dietary salt could cause health problems and 57.93% considered reducing salt intake "very important." Participants who added salt in their last meal had 1.77 times higher odds of excessive salt intake. Men (OR = 1.48) and those with higher BMI (OR = 1.67 for overweight, 2.26 for obesity) were more likely to exceed recommended salt levels. Our results underscore an urgent public health challenge, as salt intake among Iranian adults is nearly twice the recommended threshold. Habits such as using salt shakers, adding salt during cooking, and consuming salty processed foods were more common among individuals with higher estimated intake. These associations underscore the need for continued national attention to salt reduction efforts.