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.

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.

Study on Energy and Nutrient Intake and Food Preference of the Elderly in Care Facilities / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to assess energy and nutritional intake and investigate the preference for food and cooking methods of the residents in elderly care facilities. METHODS: Data were collected from 72 residents (10 males and 62 females) aged ≥ 70 years in elderly care facilities using questionnaires, food photographs for estimating dietary intake and records for daily physical activity. RESULTS: Average age of the study participants was 85.0 years and 41, 36 and 8 had dementia, hypertension and diabetes mellitus, respectively. 15%, 65% and 19% of subjects were physically mobile, enervated, and immobile, respectively. Daily energy intake was 1360.2 kcal in men and 1378.0 kcal in women, which were 68.0% and 86.1% of the estimated energy requirement (EER) of dietary reference intake for Koreans (KDRI) for ≥ 75 year old individuals, respectively. Estimated energy expenditure (EEE) of subjects calculated using formula from KDRI was 1361.9 kcal and EER calculated using estimated daily physical activity (EDPA) was 1232.9 kcal. Energy intake and EEE from KDRI were higher than EER from EDPA. Dietary intake of dietary fiber, calcium, potassium, zinc, vitamin B2, niacin, vitamin C were lower, and protein, phosphorous, iron, sodium, vitamin A, vitamin B1, vitamin B6, vitamin E were higher than the corresponding ones of KDRI. Subjects liked meats, fishes and shellfish, and fruits, while subjects disliked milk, seaweeds and salted fish and salted vegetables. Cooked rice, soybean paste soup, beef, cooked sliced radish strip, and yogurt were favorite foods, with steam being a favorite cooking method. Subjects considered nutrition as the most important factor for improving food service quality. CONCLUSIONS: Results of this study could be utilized for improving food-service for the residents in elderly care facilities, and provide a basis for setting reference intake of energy and nutrients of the elderly having very low activity levels.

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.

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.

A Study on Dietary Behaviors, Health-Related Lifestyle of Adult Visitors at Public Health Centers in Gyeonggi Urban Area / 대한지역사회영양학회지

The purpose of this study was to investigate dietary behaviors and health-related lifestyles of adult visitors at a public health center in Gyeonggi urban area. A survey using questionnaire was conducted with 949 visitors at Seongnam public health centers from June to August, 2012. The data from 905 respondents were analyzed by gender, consisting of 322 males and 583 females, and age group, consisting of 243 low-age group (LA), 312 middle-age group (MA), 350 high-age group (HA), aged 20 to 30 years, 31 to 50 years, and 51 to 69 years, respectively. Average Body Mass Index was 23.0, which increased with age, and education level was high in LA. 59.0 percent of the subjects had various diseases, and the incidence of hypertension was the highest, followed by allergy, hyperlipidemia, diabetes mellitus, joint rheumatism. Incidence rates of chronic disease increased with age, which were lower than those from 2011 Korea National Health and Nutrition Examination Survey (KNHANES). Weekly drinking frequency rate and smoking rate decreased with age, and exercise performing rate was high at male and HA, which showed the same tendency as KNHANES. Female and HA showed more healthy dietary behaviors such as restricting salt, sugar, oily foods, foods containing food additives, calorie, caring for balanced diet, and referring to nutrition label. Subjects chose stress as the first factor, followed by diet, exercise, etc., among 13 suggested factors which strongly influence on human's life-span. In general, public health center visitors, especially female and HA, showed better dietary behaviors and health-related lifestyles compared with KNHANES.

Blood Pressure, Sodium Intake and Dietary Behavior Changes by Session Attendance on Salt Reduction Education Program for Pre-hypertensive Adults in a Public Health Center / 대한지역사회영양학회지

This study was performed to evaluate the differences in blood pressure, sodium intake and dietary behavior changes according to the extent of session attendance on sodium reduction education program for pre-hypertensive adults in a public health center. Sodium reduction education program consisted of 8 sessions for 8 weeks. Fifty three patients who completed the pre and post nutritional assessments were classified into 2 groups according to the session attendance rate. Nineteen participants who attended the education program 3 times or less ( or = 4) into the more attendance (MA) group. Blood pressure, anthropometric measurements, serum lipid profile, nutrient intakes including sodium, nutrition knowledge and dietary behavior score were assessed before and after the nutrition education program. Mean sodium intakes (p < 0.001), systolic/diastolic blood pressure (p < 0.001), and weight (p < 0.001) were significantly decreased in the MA group after sodium reduction education program. Compared to the MA group, mean sodium intakes, systolic/diastolic blood pressure were not significantly changed after the education program even with significantly increased nutrition knowledge (p < 0.05) and dietary behavior score (p < 0.01) in the LA group. It appears that pre-hypertensive adults need to attend the sodium reduction education program for at least 4 times or more to gain beneficial effects from the intervention. Positive feedback of healthcare team or offering more cooking classes may be needed to raise the attendance rate in the sodium reduction education program.

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.

The Effect of Sodium Reduction Education Program of a Public Health Center on the Blood Pressure, Blood Biochemical Profile and Sodium Intake of Hypertensive Adults / 대한지역사회영양학회지

This study was conducted to investigate the effect of sodium reduction education program of a public health center on the blood pressure, blood biochemical profile and sodium intake of hypertensive adults. The program continued for 16 weeks with an 8-week nutrition education and an 8-week follow-up to forty two subjects, 6 males and 36 females aged 46 to 80 years. Subjects received nutrition education including lectures, activities, cooking classes and nutrition counseling. Physical fitness, management of stress, and nutrition counseling were provided during the follow-up. The program was evaluated three times, before and after the nutrition education, and after the follow-up. Systolic blood pressure (p < 0.0001) and diastolic blood pressure (p < 0.001) were decreased after completion of the program. Body weight (p < 0.005), percent body fat (p < 0.005) and body mass index (p < 0.001) were decreased, too. There were no significant differences in blood glucose, HDL-cholesterol and triglycerides, while elevated levels of total cholesterol (p < 0.001) and LDL-cholesterol (p < 0.001) appeared after the program completion. Decreased intakes of vitamin A (p < 0.05), beta-carotene (p < 0.001) and sodium (p < 0.001) were observed. Consumption frequency of noodles, soups, stews, kimchi, fishes/shellfish, seasoned vegetables, and salted seafoods/pickles (p < 0.05~p < 0.001) were decreased, while that of all food groups were not changed during the follow-up. Total score of nutrition knowledge related to sodium intake and hypertension (p < 0.001), and that of dietary behavior associated with high sodium intakes were changed positively (p < 0.001) only during the nutrition education. This sodium reduction education program, including the follow-up study showed positive effects on the blood pressure, sodium intake, nutrition knowledge and dietary behavior of hypertensive adults.

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.

A Study on Application of Food Photographs for Estimating Individuals' Dietary Intake / 대한지역사회영양학회지

This study was performed to investigate the validity of food photographs for estimating individuals' dietary intakes and compare it with other dietary assessment methods. Subjects were 7 professors, 2 researchers, 12 dietitian and 16 graduate students majoring in food and nutrition. Among the subjects, 20 subjects had research experiences in the dietary intake survey more than one year while 17 had not. Each subject estimated 50 food portions displayed in computer monitor by comparing with standard food photographs, which were weighed portions of 28 foods from typical Korean diet. No significant differences between the estimated value and the weighed value of 17 (34%) food portions were shown in research-experienced group and those of 14 (28%) food portions were shown in no-researchexperienced group. 24-hour recall was the most frequently-used method for dietary assessment followed by in the order of food frequency questionnaire, dietary record, diet history and weighing method. After estimating food portions by photographs, 30 subjects (81%) were willing to use the method for dietary assessment because of its convenience and easy communication between researcher and subject. This study suggests that digital photography method would be a useful and convenient new instrument for estimating individuals' dietary intake. However, it is necessary to create standard database for food portions and carry out systematic education for food estimation in order to apply this method in the fields.

The Comparative Study on Food Consumption Patterns, Dietary Behavior, and Nutrition Knowledge of Korean Professional Soccer Players and Non-athletic Males / 대한지역사회영양학회지

This study was performed to compare food consumption patterns, dietary behavior, and nutrition knowledge between Korean professional soccer players and the non-athletic males. Data were collected from 53 soccer players working for Korean professional soccer clubs and 44 non-athletic males, using self-administered questionnaires. There were significant differences in food consumption frequency between two groups. Meats and eggs, fishes and shellfishes, sea weeds were consumed more frequently by the soccer players. The frequency scores of foods rich in iron, calcium, and protein were also higher in the soccer players compared with the non-athletes. Meanwhile, the consumption of alcohol was more frequent in the non-athletes. As for the cooking method, the soccer players showed higher preference for steaming/parboiling and consumed raw vegetables and fruits more frequently than the non-athletic males (p < 0.05). The average scores of soccer players on nutrition knowledge for basic nutrition and athletic nutrition were lower than the respective values of the non-athletic males. However, the soccer players showed better eating behaviors and dietary habits compared with non-athletic males (p < 0.001). They had well-balanced, regular diet and good habits for chronic disease prevention. No significant relationship could be observed with respect to nutrition knowledge and nutritional behavior. Moreover, the experience of getting nutrition information did not affect either nutrition knowledge score or nutritional habits score, except that for habits of chronic disease prevention in non-athletes. Therefore, it is suggested that more effective and practical nutrition education program be needed for promoting healthy eating habits and improving nutritional status in young males.

The Comparative Study on the Supplement Use Habits of Korean Professional Soccer Players and Non-Athletic Males / 대한지역사회영양학회지

This study was performed to compare nutritional supplementation habits for Korean professional soccer players with those for the non-athletic male adults. Information about prevalence and kinds of supplements taken, information sources, nutrition knowledge were collected. Data were obtained from 53 football players working for Korean professional football clubs and 44 non-athletic males, who answered a list of questionnaires which had been prepared in advance. The prevalence of supplement use in the soccer player group (96%) was strikingly higher than in the nonathletic male group (34%). Vitamins were taken most frequently, followed by red ginseng, multivitamin, Chinese medicine and amino acids supplements in the soccer player group, with each player taking 2.96 kinds of supplements in average. Multivitamin was the most popular supplement in the non-athletic male group. The major reason for taking supplements was not to feel and recover from fatigue in both groups. It appeared that the non-athletic males started to use supplements mostly by recommendation of friends or colleagues. Meanwhile, soccer players took supplements on their needs, with half of them (50.1%) provided with nutrition information. The most important information source was coaches for soccer players group, and mass media for the non-athletic male group. The average scores of soccer players group on basic nutrition and athletic nutrition were lower than the respective values of the non-athletic males. Among the soccer players, 68% had taken more than 3 kinds of supplements during the last year; nonetheless, more than half could not perceive the effectiveness of the supplements. Our results show that supplementation practices were widespread in soccer players, and suggest that nutrition education for proper use of supplements and overall health care is needed for soccer players.

A Study on Blood Pressure and Serum Biochemical Indices of Cerebrovascular Accident Patients in Korean Urban Adults / 대한지역사회영양학회지

This study was done to investigate the blood pressure, BMI and serum lipids of cerebrovascular accident patients in Seoul. The subjects were 195 Korean urban cerebrovascular accident patients who were hospitalized at Dong Seo Oriental Hospital in Seoul from June, 1997 to December, 1997. There were more cerebral infarction patients(164) than cerebral hemorrhage patients(31). Cerebral infraction patients were prevalent for subjects in their sixties, but cerebral hemorrhage patients were most commonly in their fifties. The BMI of cerebral infarction accidents was significantly higher than that of cerebral hemorrhage patients(p<0.05). Mean diastolic blood pressure of cerebral hemorrhage patients was significantly higher than that of the cerebral infarction patients(p<0.05). The mean systolic blood pressure of the cerebral hemorrhage patients was higher than that of the cerebral infarction patients, not statistically significant. The serum total cholesterol and glucose levels of the cerebral infarction patients was significantly higher than those of the cerebral hemorrhage patients(p<0.05). Serum total cholesterol(p<0.01), triglyceride(p<0.05) and LDH(p<0.01) levels of female subjects were significantly higher than those of male subjects. Serum total cholesterol has a negative correlation with serum GOT and GPT, but has a positive correlation with triglyceride. Serum triglyceride has a negative correlation with diastolic blood pressure but has a positive compellation with serum glucose.