Development and evaluation of a nutrition education program for housewives to reduce sodium intake: application of the social cognitive theory and a transtheoretical model / 한국영양학회지

Purpose@#This study was performed to evaluate an education program for housewives to reduce sodium intake based on the social cognitive theory. @*Methods@#Housewives (n = 387) received 2 education sessions focused on food purchase and cooking, and completed a questionnaire on their perceptions of environmental, cognitive, and behavioral factors and the stages of behavioral change to reducing sodium intake both before and after the education program. @*Results@#After the education program, the recognition of social efforts for sodium reduction and sodium labeling and experience with low-sodium products increased. Positive expectancies for the prevention of osteoporosis by the reduction of sodium were enhanced while the main barriers in practicing sodium reduction decreased, especially ‘interrupting social relationships when dining with others’, ‘bad taste’, ‘preference for soup or stew’, and ‘limited knowledge and skills to practice’. In addition, cognition and nutrition knowledge related to reducing sodium intake were improved on all scores, but the effect on self-efficacy and dietary behavior was limited to only a few items. The percentage of participants in the pre-action stage (including pre-contemplation, contemplation, and preparation stages) for reducing sodium intake decreased from 43.2% before education to 21.5% after education, while that in the action stage increased from 19.6% before education to 43.5% after education (p < 0.001). The education program had the most significant impact on participants who were in the pre-action stage and showed improved scores in all sections. @*Conclusion@#These results suggest that a customized education program for housewives could be an effective tool to reduce sodium intake by improving personal expectancies, cognition, and nutrition knowledge regarding sodium reduction and enabling a greater section of the population to move to the action stage of reducing sodium intake.

Psidium guajava L. leaf extract inhibits adipocyte differentiation and improves insulin sensitivity in 3T3-L1 cells

BACKGROUND/OBJECTIVES@#Psidium guajava L. (guava) leaves have been shown to exhibit hypoglycemic and antidiabetic effects in rodents. This study investigated the effects of guava leaf extract on adipogenesis, glucose uptake, and lipolysis of adipocytes to examine whether the antidiabetic properties are mediated through direct effects on adipocytes.MATERIALS/METHODS: 3T3-L1 cells were treated with 25, 50, 100 µg/mL of methanol extract from guava leaf extract (GLE) or 0.1% dimethyl sulfoxide as a control. Lipid accumulation was evaluated with Oil Red O Staining and AdipoRed assay. Immunoblotting was performed to measure the expression of adipogenic transcription factors, fatty acid synthase (FAS), and AMP-activated protein kinase (AMPK). Glucose uptake under basal or insulin-stimulated condition was measured using a glucose analog 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl) amino]-2-deoxy-D-glucose. Lipolysis from fully differentiated adipocytes was measured by free fatty acids release into the culture medium in the presence or absence of epinephrine. @*RESULTS@#Oil Red O staining and AdipoRed assay have shown that GLE treatment reduced lipid accumulation during adipocyte differentiation. Mitotic clonal expansion, an early essential event for adipocyte differentiation, was inhibited by GLE treatment. GLE inhibited the expression of transcription factors involved in adipocyte differentiation, such as peroxisome proliferator-activated receptor γ (PPARγ), CCAAT/enhancer-binding protein α (C/EBPα), and sterol regulatory element-binding protein-1c (SREBP-1c). FAS expression was also decreased while the phosphorylation of AMPK was increased by GLE treatment. In addition, GLE increased insulin-induced glucose uptake into adipocytes. In lipid-filled mature adipocytes, GLE enhanced epinephrine-induced lipolysis but reduced basal lipolysis dose-dependently. @*CONCLUSIONS@#The results show that GLE inhibits adipogenesis and improves adipocyte function by reducing basal lipolysis and increasing insulin-stimulated glucose uptake in adipocytes, which can be partly associated with antidiabetic effects of guava leaves.

Psidium guajava L. leaf extract inhibits adipocyte differentiation and improves insulin sensitivity in 3T3-L1 cells

BACKGROUND/OBJECTIVES@#Psidium guajava L. (guava) leaves have been shown to exhibit hypoglycemic and antidiabetic effects in rodents. This study investigated the effects of guava leaf extract on adipogenesis, glucose uptake, and lipolysis of adipocytes to examine whether the antidiabetic properties are mediated through direct effects on adipocytes.MATERIALS/METHODS: 3T3-L1 cells were treated with 25, 50, 100 µg/mL of methanol extract from guava leaf extract (GLE) or 0.1% dimethyl sulfoxide as a control. Lipid accumulation was evaluated with Oil Red O Staining and AdipoRed assay. Immunoblotting was performed to measure the expression of adipogenic transcription factors, fatty acid synthase (FAS), and AMP-activated protein kinase (AMPK). Glucose uptake under basal or insulin-stimulated condition was measured using a glucose analog 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl) amino]-2-deoxy-D-glucose. Lipolysis from fully differentiated adipocytes was measured by free fatty acids release into the culture medium in the presence or absence of epinephrine. @*RESULTS@#Oil Red O staining and AdipoRed assay have shown that GLE treatment reduced lipid accumulation during adipocyte differentiation. Mitotic clonal expansion, an early essential event for adipocyte differentiation, was inhibited by GLE treatment. GLE inhibited the expression of transcription factors involved in adipocyte differentiation, such as peroxisome proliferator-activated receptor γ (PPARγ), CCAAT/enhancer-binding protein α (C/EBPα), and sterol regulatory element-binding protein-1c (SREBP-1c). FAS expression was also decreased while the phosphorylation of AMPK was increased by GLE treatment. In addition, GLE increased insulin-induced glucose uptake into adipocytes. In lipid-filled mature adipocytes, GLE enhanced epinephrine-induced lipolysis but reduced basal lipolysis dose-dependently. @*CONCLUSIONS@#The results show that GLE inhibits adipogenesis and improves adipocyte function by reducing basal lipolysis and increasing insulin-stimulated glucose uptake in adipocytes, which can be partly associated with antidiabetic effects of guava leaves.

Regional disparities in the associations of cardiometabolic risk factors and healthy dietary factors in Korean adults

BACKGROUND/OBJECTIVES@#Regional disparities in dietary factors might be related to regional disparities in cardiometabolic health. Therefore, this study investigated the associations of cardiometabolic risk factors and dietary factors with regional types in Korean adults. @*SUBJECTS/METHODS@#Based on data from the 2007–2017 Korea National Health and Nutrition Examination Survey, the study included 39,781 adults aged ≥ 19 years who completed the dietary survey and a health examination. Healthy and unhealthy dietary factors (fat, sodium, fruit, and vegetable intakes) were evaluated using 1-day 24-h dietary recall method, as well as the use of nutrition labels with a questionnaire. @*RESULTS@#Of the participants, 48.7%, 36.0%, and 15.2% lived in metropolitan, urban, and rural areas, respectively. Adults living in urban and rural had higher odds ratios (ORs) for obesity (OR for urban, 1.07; 95% confidence interval (CI), 1.01–1.14; OR for rural, 1.14; 95% CI, 1.05–1.24) than adults living in metropolitan areas; these associations were significantly observed in middle-aged adults. Compared to metropolitan residents, rural residents had lower ORs for hypertension in middle-aged (OR, 0.86; 95% CI, 0.76–0.96) and metabolic syndrome in older adults (OR, 0.78; 95% CI, 0.67–0.91). Regarding urban residents, a lower OR for diabetes in middle-aged adults (OR, 0.85; 95% CI, 0.74–0.97) and a higher OR for hypertension in older adults (OR, 1.19; 95% CI, 1.02–1.39) were observed. Overall rural residents had higher ORs of excessive carbohydrate, low fruit, and high salted-vegetable intakes than metropolitan residents. Low fruit intake was positively associated with obesity, metabolic syndrome, and hypertension, after adjustment for regional type and other confounders in total participants. @*CONCLUSIONS@#These findings indicate that cardiometabolic risk and unhealthy dietary factors differ among regional types and age groups within Korea. Nutritional policy and interventions should consider regional types for prevention and management of cardiometabolic risk factors.

Current Status of Sanitary and Nutritional Food Service in Elderly Day Care Center / 대한지역사회영양학회지

Objectives@#This study was conducted to examine the status of foodservice management, with special interest on sanitary and nutritional food service in elderly day care centers. @*Methods@#A total of 79 employees who managed foodservice facilities in elderly day care centers were included in the survey. The contents of the questionnaire consisted of general characteristics, importance and performance of sanitary and nutrition management, the reasons for poor performance, factors necessary for improvement, and the employee's demand for support. Data analysis was conducted using the SPSS v25.0. @*Results@#Sanitary management showed an average importance score of 4.84 ± 0.40 and a performance score of 4.70 ± 0.61 (t-value: 8.260). The item with the lowest performance score was personal sanitary management (4.58 ± 0.71). In nutrition management, the average importance score was 4.52 ± 0.68, and the performance score was 4.20 ± 1.00 (t-value: 9.609). There were significant differences between the average score of importance and performance in both areas. As a result of an Importance-Performance Analysis, items that were recognized as important but had relatively low performance was “personal hygiene”, “ventilation” and “food storage”. Also in the nutritional management area, “menu planning for disease management” and “checking the saltiness in the soup” etc. had very low performance with low importance recognition. The items shown in the “low priority” quadrant were those that required professional management skills. In the areas that demanded support in foodservice management, education about sanitary and safe institutional food service had the highest score (4.42 ± 0.74), and all other items showed a demand of 4 points or more. @*Conclusions@#Foodservice managers recognize the importance of foodservice facility management but performance is relatively low. Institutional support is, therefore, needed to improve performance. For items with low importance, it seems necessary to improve awareness of the necessity of these items and to provide education in this regard. To gradually improve foodservice management, continuous provision of education and training in these areas are of great importance.

Current status, perception and practicability of restaurant staffs related to reducing sodium use in Seongnam, Korea / 한국영양학회지

PURPOSE: With the increase of going out to eat, reducing the sodium in restaurant foods has a crucial impact on reducing sodium intake. This study aimed to assess the current status and perceptions of restaurant staffs related to reducing sodium use in restaurants. METHODS: Restaurant managers and chefs (n = 312) in Seongnam area completed a questionnaire on the current status related to sodium use, the barriers to practice for reducing sodium use, support needs, and the practicability of methods for reducing sodium use in restaurants. RESULTS: The percentage of restaurants in the preaction stage (including the precontemplation, contemplation, and preparation stages) for reducing sodium use was 79.7%. Logistic regression analysis showed that measuring salinity while cooking was associated with measuring seasoning (OR, 4.761; 95% CI, 2.325 ~ 9.751), action/maintenance stages of behavior change (OR, 2.829; 95% CI, 1.449 ~ 5.525) and providing salinity information of restaurant foods (OR, 6.314; 95% CI, 2.964 ~ 13.45). Maintaining taste and hindering the cooking process were the main barriers to reduce sodium use. The total practicability of actions for reducing sodium was higher in staffs who worked in restaurants that measured seasoning and salinity while cooking (p < 0.05 and p < 0.01, respectively). The hardest item to practice was ‘purchase foods after comparing sodium content in the nutrition labeling’. ‘Avoid serving salt-fermented foods as side dishes’, ‘serve small portions of kimchi and less salty kimchi’, and ‘put up promotional materials for reducing sodium intake’ were selected as easy items to perform. The majority (82%) was willing to reduce sodium in restaurant foods under the support of local government and they desired the promotion of participating restaurants and education on cooking skills to reduce sodium. CONCLUSION: Measuring seasoning and salinity while cooking is a meaningful practice that is associated with stages of behavior change and the practicability of actions for reducing sodium. It is necessary to provide support and education with a gradual approach to staffs for reducing sodium in restaurant foods.

Effect of a public health center-based nutrition education program for hypertension in women older than 50 years of age / 한국영양학회지

PURPOSE: The health risk of women increases after menopause. This study evaluated the effectiveness of a public health center-based nutrition education program for hypertension in women older than 50 years of age. METHODS: The program included 8-week nutrition education and 8-week follow-up with keeping a health diary and nutrition counseling. The program was evaluated three times: before and after the nutrition education, and after the follow-up. The subjects were classified into hypertensives (n = 44) or normotensives (n = 71). RESULTS: The rate of taking antihypertensive drugs in the hypertensive group was 86.4%. The systolic blood pressure decreased in the hypertensive and normotensive groups after nutrition education (p < 0.05). The body weight (p < 0.001), BMI (p < 0.001), waist circumference (p < 0.001), and percent body fat (p < 0.01) were also decreased after nutrition education in both groups. The hypertensive group showed an increase in HDL-cholesterol level (p < 0.001) and decreases in triglycerides (p < 0.01) and LDL-cholesterol (p < 0.05) levels after completion of the program. The normotensive group also displayed significant changes in HDL-cholesterol (p < 0.001) and triglycerides (p < 0.01). The dietary habits and nutrition knowledge on sodium and hypertension were improved in both groups (p < 0.001). The total score of dietary behavior related to the sodium intake was improved in the normotensive group (p < 0.001). The total score of the high sodium dish frequency questionnaire decreased in both groups after nutrition education and completion of the program compared to that before the program. Decreases in the consumption frequencies of noodles, pot stews and stews, Kimchi, and beverages were significant. The total self-efficacy score was increased in both groups by the program (p < 0.001). In particular, the hypertensive group showed improvement in all items. CONCLUSION: This public health center-based nutrition education program may contribute to the prevention and management of hypertension and chronic diseases in women over 50 years of age.

Effect of Active Nutrition Care on Underweight Elderly Patients Receiving Long-term Enteral Tube Feeding / 대한지역사회영양학회지

OBJECTIVES: This study was performed to investigate the effect of active nutrition care on feeding and nutritional status of elderly patients receiving long-term enteral tube feeding. METHODS: Subjects included 77 elderly patients who had received enteral nutrition more than one week before admission. Nutrition care was provided to patients supplied less calories than required. Feeding intolerance was examined and managed every day and formula was adjusted to meet nutritional requirement during the first 3 months after admission. Patients were classified into under or over 80% of percent ideal body weight (PIBW) and medical records were used to compare changes in weight,, biochemical indices, and nutritional status during the study. RESULTS: Weight, BMI, triglyceride and total cholesterol in blood, hemoglobin, and hematocrit levels were significantly lower in patients under 80% of the PIBW than in those over 80% of the PIBW at admission. The percentage of supply to required calories was also lower in patients under 80% of the PIBW. After 1 month of nutritional care, supplied volume of formula was significantly increased in patients under 80% of the PIBW. Weight, BMI, and PIBW were increased and there were no differences between groups after 6 months. In addition, the concentrations of triglyceride and total cholesterol in blood, hemoglobin, and hematocrit tended to increase in patients under 80% of the PIBW, leading to no difference between groups after 3 months. CONCLUSIONS: Personalized active nutrition care is effective to increase weight and improve feeding and nutritional status in underweight elderly patients receiving longterm enteral nutrition.

Effect of Active Nutrition Care on Underweight Elderly Patients Receiving Long-term Enteral Tube Feeding / 대한지역사회영양학회지

OBJECTIVES: This study was performed to investigate the effect of active nutrition care on feeding and nutritional status of elderly patients receiving long-term enteral tube feeding. METHODS: Subjects included 77 elderly patients who had received enteral nutrition more than one week before admission. Nutrition care was provided to patients supplied less calories than required. Feeding intolerance was examined and managed every day and formula was adjusted to meet nutritional requirement during the first 3 months after admission. Patients were classified into under or over 80% of percent ideal body weight (PIBW) and medical records were used to compare changes in weight,, biochemical indices, and nutritional status during the study. RESULTS: Weight, BMI, triglyceride and total cholesterol in blood, hemoglobin, and hematocrit levels were significantly lower in patients under 80% of the PIBW than in those over 80% of the PIBW at admission. The percentage of supply to required calories was also lower in patients under 80% of the PIBW. After 1 month of nutritional care, supplied volume of formula was significantly increased in patients under 80% of the PIBW. Weight, BMI, and PIBW were increased and there were no differences between groups after 6 months. In addition, the concentrations of triglyceride and total cholesterol in blood, hemoglobin, and hematocrit tended to increase in patients under 80% of the PIBW, leading to no difference between groups after 3 months. CONCLUSIONS: Personalized active nutrition care is effective to increase weight and improve feeding and nutritional status in underweight elderly patients receiving longterm enteral nutrition.

Black soybean anthocyanins attenuate inflammatory responses by suppressing reactive oxygen species production and mitogen activated protein kinases signaling in lipopolysaccharide-stimulated macrophages

BACKGROUND/OBJECTIVES: Oxidative stress is closely related with inflammation and development of many diseases. Black soybean seed coat contains high amount of anthocyanins, which are well-known for free radical scavenging activities. This study investigated inflammatory response and action mechanism of black soybean anthocyanins with regard to antioxidant activity in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells. MATERIALS/METHODS: RAW 264.7 cells were treated with anthocyanins extracted from black soybean seed coats in a concentration range of 12.5 to 100 µg/mL. The production of reactive oxygen species (ROS), secretion of pro-inflammatory mediators and cytokines, and the signaling in the mitogen activated protein kinases (MAPKs) pathway were examined. RESULTS: Black soybean anthocyanins significantly decreased LPS-stimulated production of ROS, inflammatory mediators such as nitric oxide (NO) and prostaglandin E₂, and pro-inflammatory cytokines, including tumor necrosis factor α and interleukin-6, in a dose-dependent manner without cytotoxicity (P < 0.001). Black soybean anthocyanins downregulated the expression of inducible NO synthase and cyclooxygenase-2 in LPS-stimulated RAW 264.7 cells (P < 0.001). Moreover, black soybean anthocyanins inhibited LPS-induced phosphorylation of MAPKs, including extracellular signal-regulated kinase, c-Jun N-terminal kinase, and p38 (P < 0.001). CONCLUSION: These results suggest that black soybean anthocyanins exert anti-inflammatory activity by inhibiting ROS generation and subsequent MAPKs signaling, thereby inhibiting inflammatory responses.

Evaluation of Consumer Nutrition Education Program to Reduce Sodium Intake Based on Social Cognitive Theory / 대한지역사회영양학회지

OBJECTIVES: This study was performed to evaluate the consumer education program for reducing sodium intake based on social cognitive theory (SCT) and investigate consumer perceptions of environmental, cognitive and behavioral factors. METHODS: Consumers (n=4,439) were recruited nationwide in Korea to participate in a nutrition education program for reducing sodium intake which was targeted on senior housewives (SH), parents (P), and office workers (OW). Questions regarding main factors of SCT were asked both before and after the education program. RESULTS: SH and P recognized external social efforts and information to reduce sodium including nutrition labeling more than OW. The main barriers to practice reducing sodium intake were limited choice of low sodium food and menu, interference with social relationship when dining with others, and limited information, knowledge and skills. SH had lower barriers to practice reducing sodium intake and OW perceived 'preference to soup or stew' and 'preference to Kimchi, salted fish and fermented sauces' as barriers more than other groups at the baseline. Less than 50% of participants knew the relationship between sodium and salt, sodium in nutrition labeling, and recommended sodium intake. In addition, OW had little knowledge for capability to reduce sodium intake and lower self-efficacy to practice compared with SH and P. After education, positive outcome expectations such as lowering blood pressure, prevention of cardiovascular disease and osteoporosis were increased and barriers to practice reducing sodium intake were decreased in all groups (p < 0.05). The knowledge for behavioral capability and self-efficacy to reduce sodium intake were also improved but OW had still lower scores compared with other groups. CONCLUSIONS: These results suggested that nutrition education programs could be an effective tool to impact general population by facilitating awareness and increased capability to reduce sodium intake.

Effect of a 12-week weight management program on the clinical characteristics and dietary intake of the young obese and the contributing factors to the successful weight loss

BACKGROUND/OBJECTIVES: The objectives were to investigate the effect of a 12-wk intervention with behavioral modification on clinical characteristics and dietary intakes of young and otherwise healthy obese and to identify factors for successful weight loss. The goal was to lose 0.5 kg per week by reducing 300-500 kcal/day and by increasing physical activities. SUBJECTS AND METHODS: Forty four obese subjects (BMI > 25) and 19 normal weight subjects (BMI 18.5-23) finished the 12-week intervention. Obese subjects participated in 5 group educations and 6 individual counseling sessions. Normal weight subjects attended 6 individual counseling sessions for evaluations of dietary intake and exercise pattern. Anthropometric and clinical characteristics and 3-day dietary records were evaluated at baseline and week12. RESULTS: Weight and serum triglyceride and free fatty acid concentrations in obese group decreased significantly with intervention. Intakes of energy, fat, and cholesterol decreased significantly in the obese. Active participation, realistic weight loss goal setting, and weight gain after high school graduation not during childhood were identified as key factors for successful weight loss. CONCLUSIONS: The 12-week intervention with behavioral modification resulted in reduced energy and fat intakes and led to significant weight loss and improvements of clinical characteristics in the obese. The finding that those who became obese during childhood lost less weight indicates the importance of 'early' intervention.

Development of Nutrition Education Program for Consumers to Reduce Sodium Intake Applying the Social Cognitive Theory: Based on Focus Group Interviews / 대한지역사회영양학회지

OBJECTIVES: This study aimed to develop nutrition education program for consumers to reduce sodium intake based on social cognitive theory (SCT). METHODS: The main factors of SCT related to low sodium diet were investigated by using focus group interview (FGI) with 30 women who participated in consumer organizations. RESULTS: The main target groups for the education program were housewives (H), parents (P), and the office workers (OW), for which we considered their influences on other people and the surroundings. According to the results of FGI, in carrying out low sodium diet, 'positive outcome expectation' were prevention of chronic disease and healthy dietary habit, and 'negative outcome expectation' were low palatability of foods, difficulty in cooking meals, and limited choice of foods. The contents of the program and education materials were individualized by each group to raise self-efficacy and behavioral capability, which reflected the results of the FGI. The program included 'salt intake and health' to raise positive outcome expectation. For improving the ability to practice low-sodium diet, the program contained the contents that focused on 'cooking' and 'food purchasing' for H, on 'purchasing and selection of low-sodium food with the children' for P, and on 'way of selecting restaurant menu' for OW. Also the program included 'way of choosing the low-sodium foods when eating out' with suggestions on sodium content of the dishes and snacks. Further, 'dietary guidelines to reduce sodium intake' was also suggested to help self-regulation. CONCLUSIONS: This nutrition education program and education materials could be utilized for the community education and provide the basis for further consumer targeted education program for reducing sodium intake.

The Effects of Low-sodium Diet Education Program on Dietary Habits, Diet Quality and Obesity Index in Overweight and Obese Middle-aged Women / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to investigate the effect of low sodium diet education program on dietary habits, diet quality, and measures of obesity in overweight or obese middle-aged women. METHODS: Subjects were 81 individuals aged 45 years or over, who completed an 8-week nutrition education. The subjects were divided into a normal group (N = 30) and an overweight-obese group (N = 51) according to the BMI. The effects were evaluated by anthropometric measurement, biochemical analysis, questionnaire, and diet records before and after the program. RESULTS: Overweight-obese group showed significant decreases in weight (p < 0.0001), BMI (p < 0.0001), percent of body fat (p = 0.0087), waist circumference (p < 0.0001), systolic (p = 0.0003) and diastolic blood pressure (p = 0.0261). Nutrients intakes were not different between the two groups and only sodium intake was decreased after education. Total score of general dietary habits, dietary behavior related to sodium intake, dietary diversity score (DDS), diet variety score (DVS), and diet quality index-international (DQI-I) were improved in both groups compared to the baseline. Overweight-obese group showed significant improvement in 'having fruits everyday', 'having fish everyday', 'trying to eat many kinds of food', 'eating less broth when eating soup, stew, and noodles', 'eating less kimchi and salt-fermented vegetable', and 'propensity to think that dishes should be pretty seasoned'. In addition, moderation of empty calories food (p = 0.0064) and macronutrient ratio (p = 0.0004) were improved in the overweigh-obese group, but in the normal group, the results did not reach statistical significance. CONCLUSIONS: These results suggested that low sodium diet education program may contribute to obesity management by improving diet quality and dietary habits in middle-aged women.

A Survey on the Salt Content of Kindergarten Lunch Meals and Meal Providers' Dietary Attitude to Sodium Intake in Gyeonggi-do Area / 대한지역사회영양학회지

Dietary habit of excess sodium consumption is formed mainly by excessive salt intake from the younger age and this may lead to hypertension, stroke, and stomach cancer. This study was performed to estimate the salt content in kindergarten meals and provide basic data on meal providers' dietary attitude to sodium intake for nutrition education. We collected data on161 food items from 16 institutions in Gyeonggi-do and salt content was calculated from salinity and weight of individual food items. The average salt content from lunch meals was 2.2 g, which was about daily adequate intake of sodium for children aged 3 to 5 years old. Greatest contributor to the salt content in a meal was soup and stew (47.8%). The most salty dishes were sauces and kimchi followed by stir-fried food, deep-fried food, braised food, and grilled food. The salt content was higher in soup and stew despite of low salinity, due to the large quantity per serving. The salt contents of soups and kimchi were 40.6% and 14.3%, respectively of the total salt content in dish groups. Staff members and caregivers at home who prepared food for the child showed preference for one-dish rice meal, dried fish and salted mackerel, and broth when eating soup, stew, and noodles. Caregivers showed higher sodium index score and had higher preference for processed food such as Ramen, canned food, and ham compared with staff members (p < 0.05). These results suggested that monitoring salt content of kindergarten meals and nutrition education for those prepare meals for children are needed to lower sodium intake in childhood.

Salt content of school meals and comparison of perception related to sodium intake in elementary, middle, and high schools

Excessive sodium intake leading to hypertension, stroke, and stomach cancer is mainly caused by excess use of salt in cooking. This study was performed to estimate the salt content in school meals and to compare differences in perceptions related to sodium intake between students and staffs working for school meal service. We collected 382 dishes for food from 24 schools (9 elementary, 7 middle, 8 high schools) in Gyeonggi-do and salt content was calculated from salinity and weight of individual food. The average salt content from elementary, middle, and high school meals were 2.44 g, 3.96 g, and 5.87 g, respectively. The amount of salt provided from the school lunch alone was over 80% of the recommended daily salt intake by WHO. Noodles, stews, sauces, and soups were major sources of salt intake at dish group level, while the most salty dishes were sauces, kimchies, and stir-fried foods. Dietary knowledge and attitude related to sodium intake and consumption frequency of the salty dishes were surveyed with questionnaire in 798 students and 256 staffs working for school meal service. Compared with the staffs, the students perceived school meals salty and the proportions of students who thought school meals were salty increased with going up from elementary to high schools (P < 0.001). Among the students, middle and high school students showed significant propensity for the preference to one-dish meal, processed foods, eating much broth and dipping sauce or seasoning compared with the elementary students, although they had higher nutrition knowledge scores. These results proposed that monitoring salt content of school meals and consideration on the contents and education methods in school are needed to lower sodium intake.

A Study on the Health and Nutritional Characteristics according to Household Income and Obesity in Korean Adults Aged over 50: Based on 2005 KNHANES / 대한지역사회영양학회지

This study investigated the health and nutritional characteristics according to household income level and obesity in Koreans aged over 50 years based on the 2005 National Health and Nutrition Examination Survey. Subjects were classified into 3 groups by average household income with reference to the minimum monthly living expenses (MLE): low (n = 319, or = 200% MLE) and each group was compared by BMI index. With increasing income level, the prevalence of systolic hypertension and hyperlipidemia was increased. In the low income group, serum total cholesterol, triglycerides, and fasting glucose were higher in the obese compared with the normal. In the middle and high income groups, the prevalence of hyperlipidemia and diastolic hypertension were higher in the obese. Subjects had nutritional imbalance, such as inadequate intake of calcium and potassium. With increasing income level, the percentages of protein and fat to total calorie were increased in addition to the intakes and density of nutrients. The obese in the low income group had higher intakes of energy, protein, phosphorus and higher consumption frequency of cereals and potatoes compared with the normal. It was shown that the obese of the middle and high income groups tended to have lower consumption frequency of Korean cabbage and higher frequency of fruits. The obese of high income group also had binge drinking habit. Therefore, this study suggests that specific approaches based on economic status should be considered in developing nutrition education program for the elderly.

Development of Nutrition Education Program for Hypertension Based on Health Belief Model, Applying Focus Group Interview / 대한지역사회영양학회지

Health Belief Model is a socio-psychological theory of decision making to individual health-related behaviors. This study was aimed to develop an effective education program for hypertension based on health belief model. The main factors of health belief model were investigated by focus group interview (FGI) with 23 hypertensive or prehypertensive subjects aged over fifty years. 'Perceived susceptibility' to hypertension was family history, neglect of health care, preference for salty food, broth of soup and stew. Lifelong medication, complications, and medical costs were reported as 'perceived severity' of hypertension. 'Perceived benefits' of hypertension management were decrease of medicinal dose, reduction of medical costs, and healthy eating habits of the family, while 'perceived barriers' were lack of palatability of low salt diet, convenience-oriented dietary habits, and limited choice of foods when eating out. Subjects mentioned TV health programs, public health center programs, and advice from doctors and family as 'cues to action' of hypertension management. These qualitative information provided basis for developing a nutrition education program for hypertension which could be implemented in the public health center. Eight week program was composed of understanding hypertension, risk factor management (eating habits, weight), low salt diet (principles, cooking), advanced management for healthy diet in 2 sessions, and summary. Each session was designed to alert the susceptibility and severity, to emphasize the benefits, and to reduce the barriers by providing dietary monitoring, practical advice, and action tips.

Study on the Eating Habits and Practicability of Guidelines for Reducing Sodium Intake according to the Stage of Change in Housewives / 대한지역사회영양학회지

This study was intended to investigate the sodium-related perception, dietary behavior, and practicability of methods for reducing sodium intake(RSI) according to the stage of change in consumers. The survey was conducted to 770 housewives, among them 553 subjects who answered the key questions for the stage of change were categorized into ''aintenance (M)' stage (maintaining reduced salt intake for more than 6 months; n = 287, 51.90%), 'Action (A)' stage (maintaining reduced salt intake for less than 6 months; n=139, 25.14%), and 'Pre-Action (P)'stage (not starting reduced salt intake; n = 127, 22.97%). The subjects in M and A were significantly older than those in P (p < 0.01). The scores of desirable dietary habit and dietary balance were the highest in M followed by A and P. When eating out, the subjects in P considered 'price' more and 'healthiness of food' less than those in M and A did. Among the guidelines for RSI, 'Avoid Processed Foods', 'Eat enough vegetables and fruits' and 'Add little amount of dipping sauce for fried food' were selected as the three easiest items to perform. With regard to the sodium-related perception, the subjects in M considered eating-out food to be more salty than homemade dishes, read nutrition labels more, avoided table salt or dipping sauce for fried food more, and had 'own low-sodium recipe' than those in P (p < 0.001). It is suggested that practicability of actions for RSI and the stage of change should be considered to develop effective personalized education program and nutrition guidance.

Evaluation of a Nutrition Education Program for 3rd Grade Elementary School Students / 대한지역사회영양학회지

This study examined the effects of a nutrition education program on nutrition-related knowledge, eating habits, and dietary behavior. Subjects were 3rd grade elementary school students in Anyang, Gyeonggi-do. A 5-week nutrition education program was implemented to 28 children and another 26 children were included in the study as a control group. A self-administered questionnaire was used to assess the effects of nutrition education program. Mean nutrition related knowledge score was improved after education (p < 0.001). There was a significant improvement in knowledge of nutrient source (p < 0.05), role of protein (p < 0.05), food tower (p < 0.001), getting information from nutrition labeling (p < 0.05), and proper way of snacking (p < 0.001). Eating habits and self-efficacy also tended to improve by nutrition education, especially eating habit of snack and self-efficacy on balanced diet reached significant improvement (p < 0.05). Food consumption frequency was not changed significantly, only consumption of sea weeds which is considered as a reluctant food among children was increased after education (p < 0.05). In addition, the number of leftover food items and total amount of leftover at school lunch reduced significantly after education when compared with the same 10-day menu prior to education (p < 0.01). This result suggests that unbalanced dietary behavior has been changed with the nutrition education program. In conclusion, the nutrition education program was found to be effective in improving nutrition-related knowledge, eating habits, and dietary behavior.