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Ghanaians Might Be at Risk of Excess Dietary Intake of Potassium Based on
Food Supply Data
Article  in  Journal of nutrition and metabolism · October 2018
DOI: 10.1155/2018/5989307
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Journal of Nutrition and Metabolism
Volume 2018, Article ID 5989307, 9 pages
https://doi.org/10.1155/2018/5989307
Research Article
Ghanaians Might Be at Risk of Excess Dietary Intake of
Potassium Based on Food Supply Data
David Oscar Yawson ,1 Michael Osei Adu ,2 Benjamin Ason,3 Frederick Ato Armah ,4
Emmanuel Boateng,1 and Reggie Quansah5
1Department of Soil Science, School of Agriculture, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
2Department of Crop Science, School of Agriculture, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
3Soil Research Institute, Council for Scientific and Industrial Research, Accra, Ghana
4Department of Environmental Science, School of Biological Science, College of Agriculture and Natural Sciences,
University of Cape Coast, Ghana
5Department of Biological, Environmental & Occupational Health Sciences, School of Public Health, College of Health Sciences,
University of Ghana, Accra, Ghana
Correspondence should be addressed to David Oscar Yawson; oscaryawson@gmail.com
Received 20 June 2018; Accepted 20 September 2018; Published 17 October 2018
Academic Editor: Christopher L. Gentile
Copyright © 2018 David Oscar Yawson et al. )is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
)eWorld Health Organization (WHO) has highlighted the beneficial role of adequate intake of potassium (K) in combating the
global burden of noncommunicable diseases (NCDs), mainly hypertension and cardiovascular diseases. Diets are the main source
of K supply to humans and can contribute to both K deficiency (hypokalemia) and excess (hyperkalemia). While global attention
is currently devoted to K deficiency, K excess can be even more dangerous and deserves equal attention. )e objectives of this
paper were to (i) estimate the K intake of Ghanaian population using food supply and food composition data and (ii) compare this
estimate with theWHO-recommended requirement for K in order to assess if there is a risk of inadequate or excess K intake. Food
supply data (1961–2011) were obtained from the Food Balance Sheet (FBS) of the Food and Agriculture Organization of the
United Nations to derive trends in food and K supply. )e average food supply in the FBS for 2010 and 2011 was used in assessing
the risk of inadequate or excess dietary intake of K. )e K content of the food items was obtained from food composition
databases. Based on 2010-2011 average data, the K supply per capita per day was approximately 9,086mg, about 2.6-fold larger
than the WHO-recommended level (3,510mg). )e assessment suggests a potentially large risk of excess dietary K supply at both
individual and population levels. )e results suggest the need for assessing options for managing K excess as part of food security
and public health strategies. )e results further underscore a need for assessment of the K status of staple food crops and mixed
diets, as well as K management in food crop production systems in Ghana.
1. Introduction maintenance of water balance, osmotic pressure, and acid-
base balance, activation of enzymes, and mediation of
Adequate mineral nutrition is a major component of food carbohydrate and protein metabolism. More importantly,
security strategies. Potassium (K) is an essential element potassium plays a crucial role in the regulation of neuro-
which plays crucial roles in the nutrition and health of muscular activity and heartbeat [4, 5].
plants, animals, and humans. Potassium is known to activate Globally, the adverse health outcomes of inadequate
over 60 enzymes in plants, promotes photosynthesis, and intake of vitamins and mineral elements (known as the
plays a role in stomata opening, use of nitrogen, transport of “hidden hunger”) have received tremendous attention [6].
assimilates, and microbial population in the rhizosphere Similarly, the global burden of noncommunicable diseases
[1–3]. Major roles of K in humans and animals include (NCDs) has directed attention to the role of K in these
2 Journal of Nutrition and Metabolism
diseases [7, 8]. )ere is a strong evidence of association total supply is the sum of total domestic production and
between low K intake and increased risk of a number of imports, adjusted to changes in stocks that might have
NCDs, including hypertension, cardiovascular disease, occurred since the beginning of the reference period. On the
chronic kidney stone formation, and low bone-mineral utilization side, the total supply of the given food item is
density [5, 9–13]. Low dietary intake of K can result in low decomposed into quantities exported, used for animal feed
serum K concentration, a situation referred to as hypoka- and seed, processed for food and nonfood uses, losses, and
lemia. Conversely, high serum K concentration the fraction available for human consumption [23, 24]. )e
(>5.5mmol/L) or hyperkalemia [14] can result from high fraction of supply of the food item available for human
dietary supply, problems with K excretion, and imbalance consumption is divided by the total population of a given
between intracellular and extracellular concentrations [15]. country to obtain the per capita supply. )us, the FBS does
Compared to hypokalemia, hyperkalemia is quite rare but not directly provide information on food consumption but
generally more serious and less well tolerated [15–17]. on food availability, which was used as a proxy for con-
Hyperkalemia can result in a feeling of tiredness or weak- sumption in the current study.
ness, numbness or tingling, breathing difficulties, chest )e average food supply per person for the latest years
pains, and palpitations or irregular heartbeats. In extreme (2010 and 2011) in the FBS was computed. )is was done to
cases, paralysis or heart failure can occur [14, 15]. Because capture the minimum interannual variation in food avail-
the reported average K intake from diets in several countries ability or consumption. Food items were selected from the
is below the recommended threshold, the need for increased FBS based on the kg food supply per person. )e dietary K
dietary intake of K-rich diets has been highlighted and ef- supply per person was estimated as the product of per capita
forts are being promoted globally [12, 18]. food supply (based on the FBS) and the K content of the food
While the instrumental role of adequate K intake, items [6, 25]. )e K content or supply of each food com-
through food, and its cost-effectiveness in combating the ponent was calculated using the corresponding conversion
global burden of NCDs are attracting priority attention [12], factors for the edible fraction provided in the food compo-
the risk of excess K intake from diets and its associated sition table. )e K contents of the food components (except
adverse health outcomes are not being given comparable for cocoa and products, oats, crustaceans, cephalopods, and
priority considerations because this condition is thought to other molluscs) were obtained from the West African Food
be rare compared to K deficiency [15]. Diets are the main Composition Table [26].)e K contents of the food items that
source of K supply in humans. )e K content of food were not found in the West African Food Composition Table
components largely derives from the soils on which feed and [26], such as cocoa and products, were obtained from the
food crops are grown and the capacity of crops for K uptake. United States Department of Agriculture-Agricultural Re-
Yet, the K status of soils, K uptake, and fertilizer manage- search Service (USDA-ARS) Nutrient Database for Standard
ment in most agroecosystems continue to receive less at- Reference [27]. )is method has been applied previously in
tention, and this is particularly so in Ghana [3, 4]. )e studies that estimated the adequacy or otherwise of minerals
objective of this paper was, therefore, to estimate the dietary in the diets of populations in some countries [6, 21, 25, 28].
supply of K and the risk of inadequate or excess dietary To build the final database of K contents of selected food
supply of K in adult Ghanaian population using food supply items, food items were excluded if the product of supply
and composition data. and K content was zero or if that particular food component
is not known to be widely or commonly consumed in Ghana
2. Methods according to local knowledge. In the food composition
databases, effort was made to identify the categories of food
2.1. K Supply from Foods. Prevalence of K deficiency can be items that best matched those in the FBS [6]. Where two or
assessed directly via the analysis of urine or blood samples. more categories of the same food items are consumed in
In the absence of such analysis and for larger population size, Ghana according to local knowledge, an average K content
the deficiency of K can be quantified via food surveys or was computed to represent that food item.)e total K supply
dietary analysis using food composition data [19] even (or intake) per person was calculated as the sum of the
though food surveys data can be biased by systematic products of food supply and K composition of all the food
misreporting and behavioural change [20]. Where there is items as described earlier. All K contents or concentration
paucity of data on representative food surveys or food data are expressed as mg 100 g−1 fresh weight edible portion.
composition tables, as is the case for Ghana, alternative To be consistent with the FBS units, the K contents were
sources of data such as the Food Balance Sheet (FBS) multiplied by 10 to obtain K supply in mg·kg−1 food intake.
provided by the Food and Agriculture Organization (FAO) )e per capita food supply and associated K supply for the
can be used to indirectly quantify the adequacy of K intake as period 1961–2011 were computed using the FBS and the
has been done in similar studies (e.g., [21, 22]). Hence, the food composition table, with a similar approach as described
current study used the FBS data to indirectly quantify the earlier, to obtain the trends.
risk of inadequate K intake in Ghana. A FBS provides
a snapshot of the supply and uses of about 92 food items/
groups for each of the FAO member countries during 2.2. Adequacy of K Supply from Food. )e likely risk of in-
a given reference period [23]. )e FBS has supply and adequate dietary supply of K was assessed at the individual
utilization sides. For a given reference period and food item, level, and then the prevalence of deficiency at the population
Journal of Nutrition and Metabolism 3
level was estimated using the EAR cut-point approach Ghana (Table 1). )e food item coffee and products (mainly
[6, 25, 29]. A detailed description of this approach and its instant powder coffee) had the largest K content (3640mg),
strengths and assumptions are provided in the Food and followed by mixed ground spices with the K content of
Nutrition Board [29]. Due to paucity of information, the 1040mg. “Meat, other” (mainly game meat) had the third
recommended K intake for adults of 3510mg·K per person largest K content (923mg), while “sugar (raw equivalent)”
per day [12] was used in the current study as the reference had the least (2mg). )e top three food items with the
nutrient intake (RNI). )e RNI represents the intake level of largest K content (i.e., instant powder coffee, mixed ground
a mineral which meets the nutrient requirements of 97.5% spices, and game meat) were consumed in very low quan-
apparently healthy individuals in a population group for tities in Ghana between 2010 and 2011 according to the FBS.
a given age and sex [6]. Again, due to paucity of information, Hence, these contributed less to the overall dietary K supply.
we used a standard conversion of RNI 1.2∗EAR (as [6] used Total K intake from food supply per person was estimated
for Mg and explained by [30] to convert the RNI to an at 9,086mg per day (Table 1). )e top five food items con-
estimated average requirement (EAR) of 2925mg). sumed in large quantities were (in order of importance)
To assess the risk of inadequacy at the individual level, cassava and products, yams, plantains, roots (other), and rice
the EAR value was used to represent the “required mean K (milled equivalent). )e K supply from these food items was
intake” (r), while the total K supply (based on the FBS and 2641.6, 2775.9, 1884.8, 317.6, and 17.8mg per capita per day,
food composition data) represented the “observed mean respectively (Table 1). )ese top five food items contributed
intake” (y). )e difference between y and r,D, gives an initial approximately 89% of total dietary K supply. Of the total
impression of the adequacy or otherwise of K intake per dietary K supply, starchy roots contributed 84%, while veg-
person. To allow a probability of correct conclusion on the etables contributed only 5% (Figure 1(a)). )e rest contributed
adequacy of intake, the magnitude and direction (positive or approximately 2% or less. Oranges and mandarines contrib-
negative) of the ratio of D and its standard deviation (SDD) uted 50% of the total contribution of fruits (Figure 1(b)). Of
was estimated [29].)e SDD represents the daily variation in the starchy roots, yams and cassava contributed the largest
individual intake of K. To calculate the SDD, the standard (Figure 1(c)). Wheat and products contributed the largest
deviation of the required intake (SDr) was estimated at 10% among the cereals (Figure 1(d)), while tomato and prod-
and 15% [29], while the pooled standard deviation of the ucts contributed 82% of the total contribution from vege-
observed intake (SDi) for adult males and females was tables (Figure 1(e)). “Game meat, other” contributed 55%
obtained from reference tables [29] due to lack of national- of the total contribution of meat, fishes, and seafood.
level data. )e SDD was then calculated using the procedure
in [29]: 3.2. Trends in K Intake. Between 1974 and 1983, dietary
2 2 1/2SD � 􏽨SDi /n + SDr 􏽩 , (1) supply of K declined sharply from around 6000mg toD
around 4500mg per capita per day (Figure 2). )ereafter, K
where n is the number of days of observed intake data. intake from food supply increased substantially and reached
Subsequently, the ratio of D to SDD was computed for a plateau around 1989. However, from 1991, K intake from
each case (at 10 and 15% for adult males and females) to food supply increased sharply and consistently with food
obtain the probability of correct conclusion regarding the supply up to 2011.
adequacy or otherwise of individual intake (based on the
interpretation table in [29]).
)e EAR cut-point method was used to estimate the 3.3. Risk of Excess K Intake. )e average dietary K supply
likely prevalence of inadequate intake at the population level. per person for 2010 and 2011 was estimated at 9,086mg per
In the EAR cut-point method, a normal distribution of daily day. )e estimated variations in individual daily intake
intake among the population was expected. )e proportion (SDD at both 10% and 15%) were large for the different sex
of the population at risk of inadequate intake is assumed to and age categories considered (Table 2). Similarly, the
be equivalent to the proportion with intake below the EAR D/SDD ratios (at both 10% and 15%) were large and positive.
[29]. Because we only had a point estimate of dietary K According to the interpretation tables provided by the Food
supply and following an approach used in some previous and Nutrition Board [29], these large, positive ratios suggest
studies (e.g., [6, 25]), daily K intake in the population was a 98% probability that the usual dietary K intake of the in-
assumed to have a normal distribution, centred on the mean dividual is far in excess of the recommended level, indicat-
dietary supply and with a coefficient of variation (CV) of ing risk of excess. )is potentially large risk of K excess at
25% or 30%. Based on this, the prevalence of inadequate K the individual level suggests a potentially large probability of
intake was estimated using the average of 2010 and 2011 excess supply at the population level. Using the EAR cut-point
population provided in the FBS which was used to calculate method with a CV of 25% and 30% (based on a population of
the per capita food supply. 24,542million) resulted in a risk of deficiency for only 104,000
and 348,000 people, respectively.
3. Results 4. Discussion
3.1. Contribution of Food Components. )e current study Potassium (K) is largely supplied to humans from diets and
included 46 food items in the Food Balance Sheet (FBS) for is highly absorbable (about 85–90%). Based on food supply
4 Journal of Nutrition and Metabolism
Table 1: Estimated 2010-2011 average food and K supply per person of 46 edible food items based on the Food Balance Sheet (FBS) and food
composition data for Ghana.
Food category Commonly eaten K content Food supply K supply K supplyfood/product in Ghana (mg/100 g) (kg/yr) (mg/yr) (mg/day)
Wheat and products Bread, wheat, white 117.00 17.64 2063.30 56.5
Rice (milled equivalent) Rice, white, polished, boiled∗ (without salt) 20.10 32.40 651.01 17.8
Maize and products Maize, white, stiff porridge∗ (without salt) 40.00 27.11 1084.20 29.7
Oats, regular and quick, unenriched,
Oats∗ cooked with water (includes boiling and 70.00 0.16 10.85 0.3
microwaving), without salt
Millet and products Millet, whole grain, boiled∗ (without salt) 124.00 6.11 757.02 20.7
Sorghum and products Sorghum, whole grain, boiled
∗ (without
salt) 122.00 8.24 1004.67 27.5
Cassava and products a 418.58 230.35 96417.12 2641.6
Potatoes and products Snack, potato chips, made from driedpotatoes, plain 637.00 0.21 130.59 3.6
Sweet potatoes Sweet potato, yellow, boiled∗ (without salt) 369.04 5.10 1880.25 51.5
Yams Yam tuber, boiled∗ (without salt) 687.00 147.48 101318.76 2775.9
Roots, other b 313.43 36.99 11593.86 317.6
Sugar (raw equivalent) Sugar 2.00 11.60 23.19 0.6
Beans/Peas∗ c 300.49 0.72 215.60 5.9
Soyabeans∗ d 573.26 0.02 8.60 0.2
Groundnuts (shelled e
equivalent)∗ 723.74 5.97 4317.13 118.3
Coconuts including copra f 379.88 5.86 2224.17 60.9
Tomatoes and products g 616.00 22.66 13955.48 382.3
Onions∗ h 133.95 6.23 834.49 22.9
Vegetables, other∗ i 241.43 8.65 2088.33 57.2
Oranges, mandarines Orange, raw 121.18 21.46 2599.92 71.2
Lemons, limes, and j
products∗ 114.34 1.67 190.95 5.2
Grapefruit and products∗ k 96.18 0.03 2.89 0.1
Bananas∗ l 238.40 1.99 474.42 13
Plantains∗ m 524.20 131.24 68793.39 1884.8
Apples and products∗ n 101.00 1.03 103.53 2.8
Pineapples and products∗ Pineapple, pulp, raw 104.65 0.99 103.61 2.8
Fruits, other o 151.06 12.89 1946.39 53.3
Coffee and products∗ Coffee, instant, powder 3640.00 0.06 200.20 5.5
Cocoa beans and products∗ Beverages, cocoa mix, powder 712.00 3.68 2616.60 71.7
Tea (including mate)∗ Tea, infusion 18.00 0.05 0.90 0.00
Spices, other∗ Spices, mix, ground 1040.00 0.05 52.00 1.4
Beer p 31.33 4.31 135.05 3.7
Beverages, fermented Ovaltine beverage with skimmed milk(without sugar, fortified) 204.00 14.05 2866.20 78.5
Pig meat Pork, meat, approximately 40% fat, boiled
∗
(without salt) 230.77 1.04 240.00 6.6
Bovine meat Beef, meat, 15–20% fat, boiled
∗ (without
salt) 254.00 1.23 312.42 8.6
Mutton and goat meat Goat, meat, boiled∗ (without salt) 316.04 1.75 553.08 15.2
Poultry meat Chicken, light meat, flesh and skin, boiled
∗
(without salt) 128.00 7.09 906.88 24.8
Meat, other Game meat, dried 923.00 4.86 4481.17 122.8
Cream∗ q 114.50 0.02 2.29 0.1
Butter, ghee Cheddar 82.30 0.10 7.82 0.2
Fats, animals, raw Margarine, fortified 18.00 0.20 3.60 0.1
Eggs r 133.64 1.17 156.36 4.3
Milk excluding butter Milk, cow, canned, evaporated 303.00 8.67 2627.01 72
Fishes s 258.05 6.28 1619.89 44.4
Journal of Nutrition and Metabolism 5
Table 1: Continued.
Food category Commonly eaten K content Food supply K supply K supplyfood/product in Ghana (mg/100 g) (kg/yr) (mg/yr) (mg/day)
Crustaceans∗ t 204.00 0.08 16.32 0.4
Cephalopods∗ u 454.50 0.10 43.18 1.2
Total 9,086
aCassava, tuber, boiled (without salt), and cassava, tuber, dried. bCocoyam, tuber, boiled (without salt), and taro, tuber, boiled (without salt). cBeans, liquid
from stewed kidney beans; beans, baked, home prepared; peas, edible-podded, boiled, drained, without salt; peas, edible-podded, frozen, cooked, boiled,
drained, with salt; peas, green, raw; and cowpea, boiled (without salt). dSoyabean, boiled (without salt), and soyabean, combined varieties, boiled (Ghana)
(without salt). eGroundnut, shelled, dried, raw, and groundnut paste. fCoconut, mature kernel, fresh, raw; coconut, immature kernel, fresh, raw; coconut,
kernel, dried, raw; and coconut water. gTomato, red, ripe, boiled (without salt), and tomato paste, concentrated. hOnion, raw, and onion, boiled (without salt).
iCocoyam, leaves, boiled∗ (without salt); amaranth leaves, boiled (without salt); cabbage, raw; carrot, raw; eggplant, boiled (without salt); garlic, raw; lettuce,
raw; okra fruit, boiled (without salt); peppers, chilli, raw; pepper, sweet, red, raw; pepper, sweet, red, boiled (without salt); pepper, sweet, green, raw; and
pepper, sweet, green, boiled (without salt). jLemon, raw, and juice, lemon, unsweetened. kJuice, grapefruit, canned, unsweetened, and grapefruit, pulp, raw.
lBanana, white flesh, raw, and banana, yellow flesh, raw. mPlantains, cooked; plantains, green, fried; snacks, plantain chips, salted; plantain, ripe, boiled
(without salt); and plantains, ripe, fried. nSweet apple, fruit, raw; juice, apple, canned or bottled; apple, with skin, raw; and apple, without skin, raw. oAvocado,
pulp, raw; mango, deep orange flesh; mango, orange flesh, raw; papaya, fruit, ripe, raw; and watermelon, fruit, raw. pBeer European (4.4% alcohol); beer, millet
(est. 3% alcohol); and beer, sorghum (est. 3% alcohol). qCream, whipping, 38% fat, and cream, 13% fat. rEgg, chicken, boiled (without salt), and egg, chicken,
fried. sAnchovy, fillet, steamed (without salt); mackerel, grilled (without salt and fat); mudfish, grilled (without salt and fat); sardine, steamed (without salt);
tilapia, grilled (without salt and fat); and tuna, grilled (without salt and fat). tSpiny lobster, mixed species, cooked, moist heat, and crab, queen, cooked, moist
heat. uOctopus, common, cooked, moist heat, and squid, mixed species, cooked, fried. ∗K composition was sourced from the USDA National Nutrient
Database for Standard Reference Software v.2.6.1, and the rest were from the FAOWest African Food Composition Table. )e K composition (mg per 100 g
edible portion) was converted to mg per kg food intake by multiplying by 10.
and composition data, average dietary K intake at both concentration by about 1mEq·L−1 [17]. )is disproportionate
individual and population levels in Ghana was about 2.6-fold increase in the serum K concentration indicates that high
larger than the level recommended by WHO [12]. )is dietary supply of K can have rapid and potentially fatal or
suggests a potentially large risk of excess dietary supply of K health-threatening hyperkalemia [15], especially in those
amongst adult Ghanaian population for the years under with underlying health conditions. Excretion is a major
consideration. )e large, positive D/SDD ratios suggest pathway for controlling high serum K concentration [5]. )us,
a 98% probability that the usual dietary K intake of the those with impaired K excretion and high dietary K intake can
individual is far in excess of the recommended level [29].)e rapidly suffer the adverse consequences of hyperkalemia.
EAR cut-point method also suggested that only a few people )e dietary source of potassium largely depends on the
might have inadequate dietary K supply. )e results in the type of food consumed in large quantities and widely by the
current study rectify those reported earlier in Yawson et al. population and the K status and fertilizer management of the
[31]. On the contrary, the K intake in several countries has soils on which crop plants for human and animal feed are
been found to be below recommended levels [12]. )is grown. )e results in the current study show that yams, cas-
realization, together with the potential role of K deficiency sava, and plantains constituted the bulk of diets and K supply.
in NCDs, has directed attention to the urgent need to assess )is suggests that, in jurisdictions where starchy roots and
and manage dietary supplies of K in human populations tubers constitute the bulk of diets, the population could be at
[12]. )e current study shows that the risk of excess K risk of excess K supply. )is, in turn, directs attention to K
intake and its associated health outcomes, although rare, management in food crop production, as well as the quality of
need to be given similar attention, especially in jurisdic- diets. Fufu and gari are the cassava-based diets commonly
tions where starchy roots and tubers constitute the bulk consumed in Ghana, while yams and plantains are commonly
of diets. Hyperkalemia, just like hypokalemia, affects the consumed in their cooked form without further processing
cardiac, neuromuscular, and gastrointestinal organs and (locally known as “ampesi”). While cassava is more widely
is less tolerated than hypokalemia [15]. In extreme situa- consumed in larger quantities than yams in Ghana and is
tions, hyperkalemia can result in sudden death from im- a good source of K, cassava is largely grown on marginal lands
paired cardiac conduction [14, 15]. by smallholder farmers, with almost zero fertilizer input.
In humans, the bulk of K (about 98%) is stored in in- However, cassava might benefit from K supply from NPK
tracellular spaces, largely in muscles [17]. Maintenance of fertilizers applied to other crops in mixed cropping systems.
a normal intracellular-extracellular ratio is crucial for the While external K input has a lower priority inGhana, especially
healthy functional roles of K. Imbalance in intracellular and in sole roots and tuber production systems, roots and tubers are
extracellular K concentrations results from high K supply, heavy K feeders and can rapidly reduce the K supply of even K-
transcellular shifting, and poor K excretion [15]. While severe rich soils after a few years of continuous cultivation [3].
symptoms of high serum K concentration might occur only at Furthermore, even though the food composition table used in
or above 7mmol·L−1, the rapid rate of rise in extracellular K the current study was produced in the 70s, cassava and yam
concentration is more dangerous than the slow rate of rise [32]. seem to have the ability to mobilize and concentrate K even
It has been estimated that while a loss of 200–400mEq K from when grown on marginal soils. )ere is the need for national
the body would reduce serum K concentration by about assessment of the current K status of these roots and tubers and
1mEq·L−1, 100–200mEq excess supply would increase serum the soils on which they are grown, as well as K in mixed diets.
6 Journal of Nutrition and Metabolism
0% 0% Lemons, limes, and Grapefruit and
2% 0% 1% products, 0.52, products, 0.01,0%
2% 0%
1% 2% 2%
3%
1% Bananas,5%
0% 1.30, 9%
Oranges,
mandarines,
7.12, 48%
Fruits, other,
5.33, 36%
84%
Pineapples Apples and
and products, products, 0.28,
Cereals excluding beer Stimulants 0.28, 2% 2%
Starchy roots Alcoholic beverages
Sugar and sweeteners Meat
Bean/pulses/nuts Animal fats
Oilcrops Eggs
Vegetables/spices Milk excluding butter
Fruits excluding wine Fishes, seafood
(a) (b)
Sorghum and
products, 2.75,
Plantains, 188.48, Cassava and 18%
25% products, 264.16, Wheat and
34% products, 5.65,
Millet and 37%
Roots, other, products, 2.07,
31.76, 4% 14%
Potatoes and Oats, 0.03, 0%
products, 0.36, Maize and Rice (milled
0%
Yams, 277.59, products, 2.97, equivalent),
36% Sweet potato, 19% 1.78, 12%5.15, 1%
(c) (d)
Pepper, 0.09, 0% Spices, other, Bovine meat,
0.14, 0% 0.86, 4%
Mutton and goat
meat, 1.52, 7%
Vegetables, Pig meat, 0.66,
other, 5.72, 13% 3%
Onions, 2.29, 5% Fishes, seafood,
4.6, 20%
Poultry meat,
2.48, 11%
Tomatoes and Game meat,
Products, 38.23, other, 12.28,
82% 55%
(e) (f )
Figure 1: Percentage contribution of main food items to total K supply for Ghana based on 2010-2011 average food supply data: (a) main
food items; (b) subcomponents of the food item “fruits”; (c) subcomponents of the food item “starchy roots”; (d) subcomponents of the food
item “cereals”; (e) subcomponents of the food item “vegetables”; (f ) subcomponents of the food item “meat, shes, and seafood.” All
absolute values of daily per capita K shown are in ×10mg.
Journal of Nutrition and Metabolism 7
1000 900
900 800
800 700
700
600
600
500
500
400
400
300
300
200 200
100 100
0 0
Years
Figure 2: Trend in daily per capita K in food supply and per capita food supply in Ghana for the period 1961–2011. Mean daily capita−1 K
content (primary axis, lled black circles with continuous line); food supply in Ghana (secondary axis, lled grey squares with broken line).
Table 2: Extent of adequacy of individual K intake for di”erent sex and age categories in Ghana based on 2010-2011 average food supply.
Female Male
19–50 years old 51+ years old 19–50 years old 51+ years old
SDD10 295.87 294.94 298.60 296.45
SDD15 441.01 440.38 442.84 441.40
D/SDD10 19.00 19.06 18.83 18.97
D/SDD15 12.75 12.77 12.70 12.74
Note. SDD10 denotes the daily variation in individual intake of K estimated at 10% standard deviation, while SDD15 denotes the estimate at 15%. Values used in
the calculations: required intake 2925mg per day; standard deviations of the required intake at 10 and 15% (SDr10 and SDr15, respectively) 292.5mg per
day and 438.75mg per day, respectively.
With quality of diets, the deliberate consumption of estimate. †e data fed to the FAO FBS might be unreliable
fruits and vegetables is only beginning to increase due to due to Ghana’s poor data collection and aggregation on food
health awareness programmes, but even this is constrained production, import, and export. †ere can also be the issue
by cost, availability, and traditional eating habits. †e of underreporting regarding the scale of consumption of
consistent patterns of food and K supplies (Figure 2) suggest some food items. For example, Ghanaians are known to
stability in the consumption of the main K-supplying foods consume large quantities of game meats (bush meat) and
in large quantities over time. †e gradual increase in the other nontimber forest products (NFTPs) which are rich in
consumption of fruits and vegetables (which have lower K K, yet this is likely underestimated in the FBS. Similarly,
content compared to roots and tubers), together with the Ghanaians are known to consume appreciable amounts of
rising consumption of processed foods and westernized “molluscs, other,” mainly snails and squids, but the FBS does
diets, especially in urban centres, might help lower dietary not report food items that are not commercially declared. In
supply of K even though processed food could increase Ghana, bush meat is the secondmost widely eaten meat after
sodium intake. Moreover, in urban settings, rice (which is chicken [34, 35]. Key examples of bush meat and other
lower in K than starchy roots) is increasingly becoming the NFTPs commonly eaten in Ghana include grasscutters,
dominant staple [33], a situation that might result in large antelopes, rats, bats, snails, mushrooms, and honey [36].
contribution of rice to dietary energy but low contribution In 2014, the Wildlife Division of the Forestry Commission
to K intake in Ghana. †ere is the need for empirical studies of Ghana estimated the annual domestic trade in bush
on K contents of Ghanaian food crops (especially staples) meat alone at US $140 million [37]. While this estimate
and mixed diets and their relationship with adverse health excludes nontraded (commercially undeclared) bush meat,
outcomes of hyperkalemia, especially in those with renal or it suggests that consumption of bush meat can be quite
poor K excretion conditions. high in Ghana. Similarly, coastal communities have access
†e limitations of the approach adopted in the current to a range of shes at di”erent periods that might not be
study have been acknowledged by previous studies (e.g., reported or captured in the FBS. Due to the underreporting
[6, 25]). †e accuracy of data in the FBS and the food of these food items not considered to be “mainstreamed” or
composition databases will a”ect the accuracy of the current obtained from other sources such as subsistence farming or
Daily per capita K in Ghana food supply
(mg capita–1 day–1)
1961
1963
1965
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
Food supply in Ghana (kg capita–1 year–1)
8 Journal of Nutrition and Metabolism
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