Parental knowledge, attitudes, and discretionary practices regarding children's dietary salt intake in Saudi Arabia:...

To assess salt-related knowledge, attitudes, and practices (KAP) among parents and caregivers in Saudi Arabia and examine associations between parental awareness and child-directed salt-reduction behaviors.

This cross-sectional analysis included 655 parents or caregivers of children under 18 years of age from a broader online convenience sample surveyed between December 2022 and May 2023. A 37-item questionnaire adapted from established instruments and translated into Arabic using a forward-backward process assessed salt-related KAP. Analyses included descriptive statistics, exploratory chi-square tests with Cramér's V, and multivariable binomial logistic regression. Benjamini-Hochberg false-discovery-rate (FDR) correction was applied across the 16 primary KAP regression coefficients.

Among participants, 78.8% recognized excessive salt intake among Saudi adults, compared with 54.2% for Saudi children, and 95.7% recognized the general health risks of high salt intake. Most (89.5%) considered limiting their child's salt intake important, yet 82.6% reported adding salt to foods prepared for their children. After multivariable adjustment and FDR correction, support for more action to reduce salt in foods targeted at children was independently associated with not placing a salt shaker on the table at mealtimes (aOR = 3.80, 95% CI 1.65-8.79, raw p = 0.002, q = 0.032); the wide confidence interval indicates limited precision. The inverse association between recognizing excessive salt intake among Saudi children and requesting meals prepared without salt when dining out (raw p = 0.035) did not remain significant after FDR correction (q = 0.280). Other adjusted associations were not significant, and unadjusted chi-square findings were considered exploratory.

Parents and caregivers in Saudi Arabia showed high general awareness of salt-related health risks but lower recognition of excessive salt intake among children. The findings also suggest a knowledge-behavior gap, with frequent discretionary salt use despite favorable attitudes toward limiting children's salt intake. Adjusted analyses provided limited evidence of independent associations between parental KAP and selected behaviors, with only one association surviving FDR correction. These findings support culturally appropriate, structurally supportive sodium-reduction strategies for children and families in Saudi Arabia.