Early adulthood: an overlooked age group in national sodium reduction initiatives in South Korea

Factors Affecting Salt Reduction Measure Adoption among Chinese Residents

China has the highest mortality rate caused by diseases and conditions associated with its high-salt diet. Since 2016, China has initiated a national salt reduction campaign that aims at promoting the usage of salt information on food labels and salt-restriction spoons and reducing condiment and pickled food intake. However, factors affecting individuals’ decisions to adopt these salt reduction measures remain largely unknown. By comparing the performances of logistic regression, stepwise logistic regression, lasso logistic regression and adaptive lasso logistic regression, this study aims to fill this gap by analyzing the adoption behaviour of 1610 individuals from a nationally representative online survey. It was found that the practices were far from adopted and only 26.40%, 22.98%, 33.54% and 37.20% reported the adoption of labelled salt information, salt-restriction spoons, reduced condiment use in home cooking and reduced pickled food intake, respectively. Knowledge on salt, the perceived benefits of salt reduction, participation in nutrition education and training programs on sodium reduction were positively associated with using salt information labels. Adoption of the other measures was largely explained by people’s awareness of hypertension risks and taste preferences. It is therefore recommended that policy interventions should enhance Chinese individuals’ knowledge of salt, raise the awareness of the benefits associated with a low-salt diet and the risks associated with consuming excessive salt and reshape their taste choices.

Effects of Intensive Individualized Nutrition Counseling on Nutritional Status and Kidney Function in Patients With Stage 3 and 4 Chronic Kidney Disease

OBJECTIVE

Although dietary modification is a critical component of chronic kidney disease (CKD) management, compliance with dietary recommendations is often suboptimal. This prospective intervention study was conducted to evaluate the effects and adherence of intensive, individualized nutrition counseling in CKD patients from a single nation Asian ethnic group.

METHODS

Patients with Stages 3 and 4 CKD were recruited from a tertiary hospital outpatient clinic in Korea. The intensive group received 3 monthly sessions of individualized intensive nutrition counseling. The control group received a one-time group program. The intensive group was compared with the control group at 3 months.

RESULTS

A total of 59 patients were enrolled, and 42 (71.2%) completed the study (23/32 of the intensive group; 19/27 of the control group). The mean age of the patients was 64.7 ± 12.5 years, and 81% were male. The most common nutritional diagnosis was an excessive intake of sodium (Na, 97.6%), followed by potassium (K, 78.6%), protein (52.4%), and phosphorus (P, 31.0%). After 3 months of nutrition counseling, K and P intakes decreased significantly in both the intensive group (K, 2,760.9 ± 677.4 vs. 1,500.7 ± 398.5 mg/d, P < .001; P, 1,010.5 ± 247.4 vs. 631.3 ± 178.1 mg/d, P < .001) and the control group (K, 2,090.8 ± 765.3 vs. 1,703.9 ± 490.0 mg/d, P = .036; P, 807.2 ± 163.8 vs. 679.1 ± 175.9 mg/d, P = .044). Meanwhile, protein (68.3 ± 21.8 vs. 45.4 ± 10.1 g/d, P = .001), Na (4,009.8 ± 1,418.2 vs. 2,224.6 ± 759.8 mg/d, P < .001), and energy intakes (1,857.1 ± 411.5 vs. 1,273.7 ± 231.5 kcal, P < .001) decreased in the intensive group, but were comparable in the control group. Notably, BMI decreased (BMI, 25.4 ± 2.5 vs. 24.9 ± 2.9 kg/m2, P = .014) while eGFR (43.1 ± 11.8 vs. 48.9 ± 13.7 mL/min/1.73m2, P = .002) improved significantly in the intensive group only.

CONCLUSION

Intensive individualized nutrition counseling results in better adherence to dietary recommendations and improvement in kidney function in CKD patients.

The Science of Salt: A focused review on salt-related knowledge, attitudes and behaviors, and gender differences

The aim of the current review was to examine the scope of studies published in the Science of Salt Weekly that contained a measure of self-reported knowledge, attitudes, and behavior (KAB) concerning salt. Specific objectives were to examine how KAB measures are used to evaluate salt reduction intervention studies, the questionnaires used, and whether any gender differences exist in self-reported KAB. Studies were reviewed from the commencement of Science of Salt Weekly, June 2013 to the end of August 2017. Seventy-five studies had relevant measures of KAB and were included in this review, 13 of these were salt-reduction intervention-evaluation studies, with the remainder (62) being descriptive KAB studies. The KAB questionnaires used were specific to the populations studied, without evidence of a best practice measure. 40% of studies used KAB alone as the primary outcome measure; the remaining studies used more quantitative measures of salt intake such as 24-hour urine. Only half of the descriptive studies showed KAB outcomes disaggregated by gender, and of those, 73% showed women had more favorable KAB related to salt. None of the salt intervention-evaluation studies showed disaggregated KAB data. Therefore, it is likely important that evaluation studies disaggregate, and are appropriately powered to disaggregate all outcomes by gender to address potential disparities.

'When operating a cafeteria, sales come before nutrition' - finding barriers and facilitators to serving reduced-sodium meals in worksite cafeterias

OBJECTIVE

The present study was conducted to examine barriers to and facilitators of serving reduced-sodium meals (RSM) in worksite cafeterias.

DESIGN

We conducted in-depth interviews with key stakeholders in food catering companies.

SETTING

Food catering companies at various customer sites in South Korea.

SUBJECTS

A total of nineteen interviews with twenty-five participants from ten catering companies were conducted. Sixteen on-site dietitians and nine managers from the catering companies' headquarters participated in the interviews.

RESULTS

Four main themes emerged from the interviews. First, key stakeholders' psychosocial characteristics (perception, intention and knowledge) are important in serving RSM in worksite cafeterias. Second, skills and techniques related to measuring sodium content and preparing RSM were emphasized by the interviewees. Third, the lack of various delicious low-sodium menus is a barrier to serving RSM. Lastly, a number of environmental factors were addressed, which include social support for reduced-sodium diets (a facilitator) and pressure to maintain profit margins (a barrier), that contribute to serving meals with less salt. Based on these factors, various recommendations for future sodium reduction policies and programmes were suggested.

CONCLUSIONS

It is important to implement population-wide sodium reduction as a means of preventing CVD and stroke. The study provided important facilitators of and barriers to serving RSM in worksite cafeterias, which could be helpful in developing environmental interventions that promote low-sodium diets.

Consumer attitudes, barriers, and meal satisfaction associated with sodium-reduced meal intake at worksite cafeterias

BACKGROUND/OBJECTIVES

Targeting consumers who consume lunches at their worksite cafeterias would be a valuable approach to reduce sodium intake in South Korea. To assess the relationships between socio-demographic factors, consumer satisfaction, attitudes, barriers and the frequency of sodium-reduced meal intake.

SUBJECTS/METHODS

We implemented a cross-sectional research, analyzing data from 738 consumers aged 18 years or older (327 males and 411 females) at 17 worksite cafeterias in South Korea. We used the ordinary least squares regression analysis to determine the factors related to overall satisfaction with sodium-reduced meal. General linear models with LSD tests were employed to examine the variables that differed by the frequency of sodium-reduced meal intake.

RESULTS

Most subjects always or usually consumed the sodium-reduced meal (49%), followed by sometimes (34%) and rarely or never (18%). Diverse menus, taste and belief in the helpfulness of the sodium-reduced meal significantly increased overall satisfaction with the sodium-reduced diet (P < 0.05). We found importance of needs in the following order: 1) 'menu diversity' (4.01 points), 2) 'active promotion' (3.97 points), 3) 'display of nutrition labels in a visible location' (3.96 points), 4) 'improvement of taste' (3.88 points), and 5) 'education of sodium-reduction self-care behaviors' (3.82 points).

CONCLUSION

Dietitians could lead consumers to choose sodium-reduced meals by improving their taste and providing diverse menus for the sodium-reduced meals at worksite cafeterias.