Changes in 24-hour urinary excretion of sodium and potassium in a community-based heath education program on salt reduction

PURPOSE: To examine changes in urinary excretion of sodium, potassium and sodium/potassium ratio in a community-based health education program on salt reduction. SUBJECTS AND METHODS: The surveyed community was Kyowa town (census population in 1985 = 16,792) where we have conducted a community-based blood pressure control program since 1981 and health education on reduction of salt intake since 1983 for primary prevention of hypertension. A 24-hour urine collection was conducted for systematically selected samples of the participants aged 40-69 in cardiovascular risk surveys in 1982-86 (early period) and in 1990-94 (later period) to estimate changes in urine excretion of sodium, potassium, and sodium/potassium ratio. RESULTS: A 24-hour urine collection was available for 565 persons (410 men and 155 women) in 1982-86 and 1,461 persons (571 men and 890 women) in 1990-94. A decline in mean sodium excretion was larger in ages 40-49 than in other age groups, and for ages 40-69 combined, the decline was 0.9-1.1 g per day for men and women. Mean sodium excretion declined to 10 g or less per day for men and women aged 60-69. Mean potassium excretion did not change except for men aged 60-69 with an increase in potassium. Sodium/potassium ratio tended to decline for women aged 40-49, and declined significantly for other sex-age groups. A larger reduction in sodium excretion was seen among persons with a history of hypertension compared to those without it. CONCLUSIONS: A significant reduction in urinary excretion of sodium and sodium/potassium ratio was observed in a community-based health education program. Men and women aged 60-69 reached a recommended level of 10 g or less in sodium intake.     

Japanese traditional miso soup attenuates salt-induced hypertension and its organ damage in Dahl salt-sensitive rats

ObjectiveWe investigated the effects of long-term miso soup drinking on salt-induced hypertension in Dahl salt-sensitive (Dahl S) rats.MethodsDahl S rats were divided into four groups that consumed 1) water, 2) a 0.9% NaCl solution, 3) a 1.3% sodium NaCl solution, or 4) miso soup containing 1.3% NaCl. They were followed for 8 wk. Systolic blood pressure and hypertensive organ damage were determined.ResultsSystolic blood pressure increased in an age- and dose-dependent manner in Dahl S rats drinking salt solutions. The systolic blood pressure increase was significantly less in the Dahl S rats that drank miso soup, although the ultimate cumulative salt loading was greater than that in the Dahl S rats given the 1.3% NaCl solution. This blood pressure decrease was associated with a morphologic attenuation of glomerular sclerosis in the kidney and collagen infiltration in the heart. Urinary protein excretions were less in the miso group than in the rats given the 1.3% NaCl solution. The fractional excretion of sodium was increased and that of potassium was decreased in Dahl S rats given the 1.3% NaCl solution, and these effects were reversed in rats given miso soup toward the values of the control.ConclusionWe found that long-term miso soup drinking attenuates the blood pressure increase in salt-induced hypertension with organ damage. This may be caused by a possible retardation of sodium absorption in the gastrointestinal tract or by the direct effects of nutrients in the miso soup from soybeans. The decrease was associated with decreases in cardiovascular and renal damage.     

Salty Food Preference and Intake and Risk of Gastric Cancer: The JACC Study

Background

High sodium intake is a potential risk factor of gastric cancer. However, limited information is available on the relationship between salty food preference or intake and risk of gastric cancer. The aim of the present study was to determine the association between these variables among the Japanese population.

Methods

Between 1988 and 1990, 15 732 men and 24 997 women aged 40–79 years old with no history of cancer or cardiovascular disease completed a lifestyle questionnaire that included information about food intake. The subjects were enrolled in the Japan Collaborative Cohort (JACC) Study for Evaluation of Cancer Risk Sponsored by Monbusho. After a median follow-up of 14.3 years, 787 incident gastric cancers were documented. We examined the associations between salty food preference and intake and gastric cancer incidence using the Cox proportional hazard model.

Results

The risk of gastric cancer among subjects with a strong preference for salty food was approximately 30% higher than among those who preferred normal-level salty food (hazard ratio [HR] 1.31; 95% confidence interval [CI], 1.02–1.67). The risk of gastric cancer in subjects who consumed 3 and ≥4 bowls/day of miso soup was approximately 60% higher than in those who consumed less miso soup (HR 1.67; 95% CI, 1.16–2.39 and HR 1.64; 95% CI, 1.11–2.42, respectively). Sodium intake correlated positively and linearly with risk of gastric cancer (P for trend = 0.002).

Conclusions

The present study showed that salty food preference, consumption of large quantities of miso soup, and high sodium intake were associated with increased risk of gastric cancer among Japanese people.Key words: salt, gastric cancer, prospective study     

Self-Reported Taste Preference Can Be a Proxy for Daily Sodium Intake in Middle-Aged Japanese Adults

Reducing dietary salt intake remains a challenging issue in the management of chronic disease. Taste preference is suspected to be an important proxy index of daily sodium consumption. This study examined the difference in daily sodium intake according to self-reported taste preference for miso soup as representative of homemade cooking in middle-aged urban Japanese adults. Among 896 candidates randomly selected from examinees of cancer screening provided by the National Cancer Center, Japan, 143 men and women participated in this cross-sectional study. During the period from May 2007 through April 2008, participants provided a food frequency questionnaire, which included information on taste preference and dietary behaviors, a weighed food record over 4 consecutive days, a simultaneous 24-hour urine collection, and a sample of miso soup as it is usually prepared in the home. Mean 24-hour urinary sodium excretion and daily sodium intake were compared according to the self-reported taste preference for miso soup. Taste preference was significantly associated with both 24-hour urinary sodium excretion (trend P<0.01) and daily sodium intake (trend P=0.01), with a corresponding regression coefficient per 1 rank preference increment of 403 mg and 315 mg/day, respectively. The observed association between preference and urinary excretion was attenuated by further adjustment for discretionary salt-related behaviors. These findings suggest that self-reported taste preference for homemade cooking is a defining feature of daily sodium intake through discretionary salt-related dietary behaviors. A reduction in daily sodium consumption per 1 rank light preference was estimated to equate to approximately 1 g salt/day.     

Health education

The Central Health Education Bureau of the Ministry of Health of India guides state and district health education units. In fact, health education programs in India are among the most extensive in developing countries. Yet India continues to experience high infant and maternal mortality. The most effective communication strategies and messages are those that consider the cultural attitudes and behavior of the community, but all too often messages are developed without considering these components. Since only 39% of the Indian population is literate, use of print media to impart health messages is controversial. Yet the Directorate of Audio-Visual Publicity conducts health campaigns using newspapers, posters, and pamphlets. Besides 60% of promotions do not exhibit adequate information. Since people tend to remember images longer and visual media educate while entertaining the audience, visual media hold much promise in imparting health education messages, especially family planning messages. Yet research shows that the mass media have not been successful in reaching rural populations. Folk media (puppets, drama, story telling, and music) provide another means to educate the public about health. Ill people and family members in a hospital are a captive audience and tend to be receptive to public health messages. Further health workers at clinics and during home visits can inform clients about health. In addition, traditional health practitioners can communicate health messages in underserved areas. A potentially receptive audience for health education messages is primary school children. In fact, India has implemented the child to child program where children actually educate each other about health. Health educators have not yet tapped perhaps the greatest resources such as religious leaders, traditional healers, and dais.     

Influence of the changes in food intake patterns and smoking and drinking habits on stroke--20-year follow-up survey in the Oki-Islands, Shimane Prefecture, Japan

In 1968 (the first survey), the food intake patterns and smoking and drinking habits of the 3,546 male and 4,350 female inhabitants aged 40-74, of the Oki-Islands, Shimane, Japan were investigated. The response rates were 64% for males and 65% for females. A second survey according the same protocol was carried out from 1987 to 1988. A total of 1,140 males and 1,694 females were randomly selected from the cohort members who were completely followed up from 1968 to 1987. The overall response rates at the second survey were 91.2% for male and 88.9% for female. The results are summarized as follows: 1. 'Saltless' dietary habits significantly advanced in both sexes of all age groups (40-49, 50-59, and 60-74 years old in 1968) and in both hypertensives and normotensives; the frequency of pickle intake significantly decreased, while that of miso soup intake did not change. Nutritional improvement was remarkable in that the frequency of fish, meat, eggs, milk, green vegetable and fruit intakes increased in both sexes of all age groups and in both hypertensives and normotensives. 2. The frequency of smoking significantly decreased in all age groups and in both male hypertensives and normotensives, in contrast with that of drinking. The frequencies of smoking and drinking showed the same tendencies in females. 3. The frequencies of smoking, drinking, and miso soup intake were higher in males who died from strokes than in those who died from other causes from 1968 to 1987, in contrast with the intakes of eggs and milk.(ABSTRACT TRUNCATED AT 250 WORDS)     

Association of Estimated Salt and Miso Intake with the Prevalence of Obesity in People with Type 2 Diabetes: A Cross-Sectional Study

Salt intake is often estimated by the amount of sodium excreted in urine, and miso has been reported to increase it. This cross-sectional study investigated the relationship between obesity and high estimated salt intake with and without habitual miso consumption. Estimates of salt intake (g/day) were calculated using urinary sodium excretion, and a high estimated intake was defined as greater than the median amount of 9.5 g/day. Participants were divided into four groups based on estimated salt intake and miso consumption. Among 300 people, the proportions of obesity were 77.8% (n = 14/18), 40.2% (n = 53/132), 26.0% (n = 33/127), and 34.8% (n = 8/23) in the (+/−), (+/+), (−/+), and (−/−) groups of high estimated salt intake/habitual miso consumption, respectively. Compared with the (+/−) group, the adjusted odds ratios for obesity were 0.07 (95% confidence interval (CI): 0.02–0.26, p < 0.001), 0.16 (95% CI: 0.03–0.76, p = 0.022), and 0.14 (95% CI: 0.04–0.51, p = 0.003) in the (−/+), (−/−), and (+/+) groups, respectively. The presence of obesity was not much higher in people with high estimated salt intake with habitual miso consumption than that in people without. Clinicians should be aware that miso consumption promotes salt excretion, which may lead to an apparently higher estimated salt intake than actual.     

Urinary isoflavonoid excretion is similar after consuming soya milk and miso soup in Japanese-American women

Based on the hypothesis that isoflavones are absorbed more efficiently from fermented than from non-fermented soya foods, we compared the urinary isoflavonoid excretion (UIE) after intake of miso soup or soya milk. We recruited twenty-one women with Japanese ancestry who consumed standardized soya portions containing 48 mg isoflavones. On day 1, half the women consumed soya milk, the other half started with miso soup. On day 3, the subjects ate the other soya food and on day 5, they repeated the first food. Each participant collected a spot urine sample before and an overnight urine sample after soya food intake. All urine samples were analysed for daidzein, genistein and equol using LC-MS and were expressed as nmol/mg creatinine. We applied mixed models to evaluate the difference in UIE by food while including the baseline values and covariates. Relative to baseline, both groups experienced significantly higher UIE after consuming any of the soya foods. We observed no significant difference in UIE when soya milk was compared to miso soup (P = 0.87) among all women or in the seven equol producers (P = 0.88). Repeated intake of the same food on different days showed high reproducibility within subjects. These preliminary results indicate similar UIE after consuming a fermented soya food (miso) as compared to a non-fermented soya food (soya milk). Therefore, recommendations favouring fermented soya foods are not justified as long as the intestinal microflora is capable of hydrolysing the isoflavone glucosides from non-fermented soya foods.     

Concordance of risk factors for cerebro-cardiovascular diseases among spouses

The present study was carried out to clarify the concordance or similarity of risk factors among 298 spouse pairs in a random sample who lived in Mizobe town of Kagoshima Prefecture. A sample of 298 spouse pairs was surveyed by using the house-to-house interviewing method and was classified into three groups by the marriage duration. The following results were obtained. 1) Statistically significant partial correlation coefficients were demonstrated among the spouses for blood pressure in the present study. However, they were smaller than among spouses in remote islands, this fact suggested that there was no higher spouse concordance in this surveyed area than in remote island areas, and also that there might be a difference in the shared environment of spouse pairs and the genetic effect on blood pressure between the former area and the latter. 2) In regard to the intake of salt in miso soup and the ratio of sodium to potassium (Na/K), an increasing gradient of partial correlation coefficients for the risk factors among the spouses was observed with increasing marriage duration, suggesting that the intake might be caused by the shared environment on the basis of a similar dietary pattern for the spouse pairs.     

Expanding the reach of health campaigns: community organizations as meta-channels for the dissemination of health information

This study investigates whether, and to what extent, community organizations can serve as viable channels of health information. We use Putnam's (2000) findings on social capital to argue that organizations can serve two major functions in health campaigns: instrumental (e.g., providing material support) and affinity (social support). Through a secondary analysis of data from the Stanford Five-City Project, we find significant support for our predictions about who joins community organizations. Membership in community organizations explains greater variance in health outcomes than that explained by general media use, demographic indicators, and health-specific media use. Implications for health campaigns are discussed.     

北京市东城区高血压社区管理初步分析

为开展城市慢性病预防自1989年起在北京市东城区疾病监测点作高血压调查,将居民按居委会随机分组,对干预组高血压进行管理,定期家访,健康教育,家庭保健指导。1991年共管理3190例患者,与1989年基线调查相比,高血压患者吸烟率下降8.37%,戒烟及减少吸烟增加5.81%,饮酒率下降8.77%,注意少吃盐增加5.49%,DBP<95mmHg者增加27.81%。将上述各指标在干预组和对照组与基线调查相比,二者差别显著,说明高血压社区管理效果良好。     

Soyfood intake in the prevention of breast cancer risk in women: a meta-analysis of observational epidemiological studies

Many studies have suggested that the intake of soy products may protect against the occurrence of breast cancer because of the considerable amount of isoflavones they contain. To review the results of the observational studies, we performed this meta-analysis of the relevant literature. We searched Medline for reports that examined the association between soyfood consumption (or isoflavone intake) and breast cancer risk from January 1966 to April 2006. The random-effects model was used to estimate the pooled relative risk (RR). Twenty-one independent studies (14 case-control studies and 7 cohort studies) were included in the final analysis. The pooled RR of breast cancer for soyfood intake was 0.75 with a 95% CI of 0.59-0.95. As the main types of soyfood in Japan and China, tofu and miso showed clear protective effects. Isoflavone intake resulted in a 20% decrease in risk (RR = 0.81, 95% CI 0.67-0.99). The pooled RR varied little according to study stratification. When the studies published in Japanese and Chinese were added, the inverse associations between soyfood, tofu and breast cancer risk became slightly stronger. The weak association of miso was possibly due to the high concentration of salt in miso soup. In the present analysis, we did not find strong evidence for publication bias in the combination of the studies. This meta-analysis supported the hypotheses that soyfood intake may be associated with a decreased risk of breast cancer due to the isoflavones. Further epidemiological studies need to be conducted with more comprehensive information about the soyfood, and more accurate assessment of the isoflavones.     

A process evaluation of a two-year community cardiovascular risk reduction program: what was done and who knew about it?

The County Health Improvement Program (CHIP) used a communityorganization approach to place cardiovascular risk reductionprograms in the media, worksites, health sector and communityorganizations of Lycoming County, Pennsylvania, a mixed urban—ruralarea with a population of 118 000. During a two-year period,mass media campaigns, primarily involving radio and newspaper,were the most extensive intervention; they were used to promoteCHIP activities and emphasize skills for smoking cessation,hypertension medication compliance and weight control. Otheractivities included risk reduction programs at six worksites,100 lectures to community organizations, two annual community-wideblood pressure screening and monitoring campaigns, and distributionof pamphlets and quit-smoking kits to doctors and dentists.Community-level awareness of CHIP increased significantly overthe two-year period, from 58% at one year to 76% at two. Thisincrease was observed for both sexes, all ages, urban and ruralresidents and persons with different levels of education. However,in both survey years the risk factors and mass education tacticsmost heavily emphasized prior to the surveys were the most salient.Measuring implementation and awareness can help program plannersform realistic expectations of the amount of community levelimpact that can be expected within a given time frame for programsof varying scope and intensity.     

The role of local mass media in promoting the consumption of iodized table salt.

Iodine deficiency disorder (IDD) is currently an important public health problem in Turkey. The use of iodized salt is a sample and cheap solution. The purpose of this study was to determine the prevalence of iodized salt use in the Trabzon region and the effect of a local mass-media education program in increasing usage. The overall aim was to use the findings to inform future health management and health education activities, and shape further development of the IDD program. Prior to the intervention, the prevalence of iodized salt consumption was 54.5%. Following the 3-month education program it increased to 62.4%. There was a significant difference in the pre- and post-intervention findings (P = 0.00237). The results show that the use of local mass media is effective in raising the prevalence of iodized salt use. Local mass media could therefore be used as part of a national strategy to prevent iodine deficiency disorders.     

杭州市社区高血压限盐干预效果评价

目的：探讨以健康教育和行为干预相结合的高血压社区综合干预效果。方法：在杭州市5个城区分别选取1个社区，每个社区随机抽取高血压户和非高血压户各100户．共计2590人，进行为期一年的限盐行为干预和健康教育，比较干预前后人群知信行水平和摄盐量的变化。结果：干预后11项知信行指标均有显著性提高（P〈0．05），高血压和非高血压人群摄盐量〈6克者均明显增加，由干预前34．56％上升43．02％（P〈0．05）。结论：健康教育和行为干预结合的社区综合干预模式是控制高血压的重要措施，也适合在一般人群中进一步推广。     

Hepatitis C in Australia: impact of a mass media campaign

BACKGROUND: Hepatitis C affects over 200,000 Australians. This study evaluated the impact of a public education campaign about this disease in New South Wales (NSW), Australia. DESIGN: Cohort and independent cross-sectional telephone surveys before and after the campaign. SETTING/PARTICIPANTS: Random population samples of adults in NSW. INTERVENTION: Television, radio and newsprint advertisements, posters and public display boards, public awareness events and media releases, and dissemination of information to healthcare professionals in April 2000. Data were analyzed in 2000 and 2005. MAIN OUTCOME MEASURES: Campaign recall, and knowledge and attitudes concerning hepatitis C. RESULTS: Recall of information about hepatitis C increased between baseline and follow-up, from 11.1% to 45.5% in the independent samples and 11.8% to 65.3% in the cohort. The proportion of people who knew that there was a low risk of disease transmission by kissing, sharing food utensils, or breastfeeding also increased significantly. In the cohort sample, a higher number of correct knowledge responses was associated with reporting exposure to information about hepatitis C after the campaign, postsecondary education, and a greater level of knowledge at baseline. Most people reported supportive attitudes toward people with hepatitis C and to prevention programs addressing this disease, and there was little apparent improvement in these. CONCLUSIONS: This campaign successfully increased public exposure to information about hepatitis C and improved knowledge about the means of transmission of this disease. There is room for further improvements in community understanding about hepatitis C. Mass media campaigns have a valuable role to play in this endeavor.     

社区慢性病患者参与综合防治情况分析

目的通过对社区慢性病患者参与防治工作情况的调查,了解社区慢性病综合防治工作效果和需求。方法从试点社区随机选择1473名糖尿病、高血压患者为调查对象,采用问卷调查的方法进行调查。结果87.3%被调查患者从社区获得健康教育资料,其中56.6%的患者阅读了资料,看过健康宣传栏和参加过相关讲座咨询活动的患者分别为43.1%和53.2%;85.4%的患者接受过≥4次的社区医生随访,对医生随访满意率高达99.3%;一半以上患者采取不同形式的非药物治疗,规律服药和定期检查的分别占76.4%和87.8%。结论社区慢性病患者对随访管理参与的积极性较高,提高患者对健康教育活动的参与度和对治疗的依从是试点进一步探索的工作内容之一。     

高血压知识、健康信念对食盐和烹调油摄入量影响的研究

目的评估广州市社区中老年居民的食盐和烹调油摄入情况以及高血压知识、健康信念水平,并探讨高血压知识和健康信念对食盐、烹调油摄入量的影响。方法对广州市474例社区中老年居民进行横断面调查,应用t检验、Spearman相关、Pearson相关分析和多重线性回归分析的方法对资料分别进行单因素和多因素的综合分析。结果食盐和烹调油摄入量分别为(8.5±2.6)g/人日,(24.5±7.9)g/人日,食盐和烹调油的过量摄入率分别为88.0%,52.5%,社区中老年居民的基础知识、病因知识、症状知识以及易患性认知、行为障碍认知水平比较低。食盐摄入量的影响因素包括性别,高血压家族史,易患性和健康动机,烹调油摄入量的影响因素为性别,易患性和健康动机。结论加强社区健康教育,在社区中老年居民中普及高血压知识,提高其健康信念水平,有助于培养良好的生活方式,对高血压的预防与控制具有重要意义。     

A media campaign to promote pneumococcal vaccinations: is a telephone survey an effective evaluation strategy?

PURPOSE: Media campaigns are used to achieve public health goals but few studies have documented whether the goals were met. METHODS: Two communities received community-wide efforts to increase the pneumococcal polysaccharide vaccine (PPV) rate in defined pneumococcal disease-risk groups. One community also received a media campaign consisting of television and newspaper advertisements. A random-digit-dial telephone survey was conducted before and after the media campaign in both of the designated media markets. In addition to direct mailings to a sample of Medicare beneficiaries whose Medicare billing records did not indicate a PPV billing claim after 1991, community-wide campaigns consisting of table tents, brochures, flyers, and posters occurred in both markets. A 29-day television campaign and a 5-week newspaper campaign occurred in one of the markets. RESULTS: We were unable to detect a significant effect of the media campaign on either PPV awareness or self-reported receipt of pneumococcal vaccine. CONCLUSION: While it is important to evaluate community health intervention efforts, evaluations can be very difficult. Because of financial and other limitations, most feasible evaluation methods will not have the power to detect changes attributable to the intervention nor to provide confidence that there was no important change.     

中国四城市中小学生看护人盐相关知信行现状及限盐行为影响因素分析

了解中国城市学生看护人盐与健康相关知识、信念、行为现状及限盐行为影响因素,为制定减盐行动策略提供依据.方法 采取分层随机抽样方法,对广州、成都、武汉、沈阳4个城市12 787名中小学生看护人进行问卷调查,收集其盐相关知识和限盐行为等信息.采用Logistic回归模型分析不同营养知识水平、性别、家庭收入等对学生看护人限盐行为的影响.结果 学生看护人知道盐推荐摄入量、钠影响健康、高盐饮食引起高血压、低钠盐、限盐勺、营养标签、营养标签中必须标示钠、所有高盐调味品、所有高盐食物的比例分别是46.4%,45.5%,76.0%,71.8%,66.7%,79.8%,38.0%,3.7%,0.9%.多因素Logistic回归分析显示,相对于对照组,文化程度高、知道盐推荐摄入量对学生看护人使用低钠盐、限盐勺、选择低盐食物等限盐行为影响的OR(95%CI)值分别是1.811(1.631~2.010),1.143(1.03~ 1.269);1.297(1.133~1.486),1.561(1.363~1.789);1.280(1.172~ 1.398),1.175(1.076~1.283).结论 四城市学生看护人盐相关知识知晓率较低,限盐行为不乐观.应加强学生看护人盐相关知识的营养教育,确立信念,进而转变为健康的行为,并促进学生乃至整个家庭合理膳食,预防慢性病的发生.