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Jung, Son, and Kwon: 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
Original Article
Korean Journal of Community Nutrition

Korean Journal of Community Nutrition 2012; 17(6): 752-771.

Published online: 31 December 2012

DOI: https://doi.org/10.5720/kjcn.2012.17.6.752

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

Eun Jin Jung, Sook Mee Son, Jong-Sook Kwon1

Department of Food Science & Nutrition, The Catholic University of Korea, Bucheon, Korea.

1Department of Food & Nutrition, Shingu College, Seongnam, Korea.

Corresponding author: Jong-Sook Kwon, Department of Food & Nutrition, Shingu College, 377 Gwangmyeong-ro, Seongnam, Gyeonggi-do 462-743, Korea. Tel: (031) 740-1642, Fax: (031) 740-1590, jskwon@shingu.ac.kr

Received 6 November 2012       Revised 4 December 2012       Accepted 4 December 2012

Copyright © 2012 The Korean Society of Community Nutrition

(open-access):

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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), β-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.

Keywords: sodium reduction education program, nutrition counseling, blood pressure, dietary behavior

Figures and Tables

Fig. 1
Process of the program.
kjcn-17-752-g001
Table 1
Nutrition education program for the hypertension
kjcn-17-752-i001
Table 2
General characteristics of subjects
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Table 3
Changes of anthropometric characteristics and blood pressure during the education program
kjcn-17-752-i003

1) Difference 1= difference (8weeks-baseline), Difference 2=difference (16weeks-8week), Difference 3=difference (16weeks-baseline)

2) Mean ± SD

3) *: Means significantly different among 3 times at p < 0.05, **: p < 0.01, ***: p < 0.001 by repeated GLM

4) @: Means significantly different between baseline and 8weeks or 8weeks and 16weeks or baseline and 16weeks within group at p < 0.05, @@: p < 0.01, @@@: p < 0.001 by paired t-test

5) #: Means significantly different among 3 differences at p < 0.05, ##: p < 0.01, ###: p < 0.001 by one-way GLM

Table 4
Changes of biochemical characteristics during the education program
kjcn-17-752-i004

1) Difference 1 = difference (8 weeks-baseline), Difference 2 = difference (16 weeks-8 week), Difference 3 = difference (16 weeks-baseline)

2) Mean ± SD

3) *: Means significantly different among 3 times at p < 0.05, **: p < 0.01, ***: p < 0.001 by repeated GLM

4) @: Means significantly different between baseline and 8weeks or 8weeks and 16weeks or baseline and 16weeks within group at p < 0.05, @@: p < 0.01, @@@: p < 0.001 by paired t-test

5) #: Means significantly different among 3 differences at p < 0.05, ##: p < 0.01, ###: p < 0.001 by one-way GLM

Table 5
Changes of nutrient intakes during the education program
kjcn-17-752-i005

1) Difference 1 = difference (8 weeks-baseline), Difference 2 = difference (16 weeks-8week), Difference 3 = difference (16 weeks-baseline)

2) Mean ± SD

3) @: Means significantly different between baseline and 8weeks or 8weeks and 16weeks or baseline and 16weeks within group at p < 0.05, @@: p < 0.01, @@@: p < 0.001 by paired t-test

4) mean % of RNI (Recommended Nutrient Intake of Dietary reference intakes for Koreans)

5) #: Means significantly different among 3 differences at p < 0.05, ##: p < 0.01, ###: p < 0.001 by one-way GLM

6) *: Means significantly different among 3 times at p < 0.05, **: p < 0.01, ***: p < 0.001 by repeated GLM

Table 6
Changes of food intakes frequency during the education program
kjcn-17-752-i006

1) Difference 1 = difference (8 weeks-baseline), Difference 2 = difference (16 weeks-8week), Difference 3 = difference (16 weeks-baseline)

2) Mean ± SD

3) *: Means significantly different among 3 times at p < 0.05, **: p < 0.01, ***: p < 0.001 by repeated GLM

4) #: Means significantly different among 3 differences at p < 0.05, ##: p < 0.01, ###: p < 0.001 by one-way GLM

5) @: Means significantly different between baseline and 8weeks or 8weeks and 16weeks or baseline and 16weeks within group at p < 0.05, @@: p < 0.01, @@@: p < 0.001 by paired t-test

Table 7
Changes of nutrition knowledge related to sodium and hypertension during the education program
kjcn-17-752-i007

1) Difference 1 = difference (8weeks-baseline), Difference 2 = difference (16 weeks-8 week), Difference 3 = difference (16weeks-baseline)

2) Mean ± SD

3) *: Means significantly different among 3 times at p < 0.05, **: p < 0.01, ***: p < 0.001 by repeated GLM

4) @: Means significantly different between baseline and 8weeks or 8weeks and 16weeks or baseline and 16weeks within group at p < 0.05, @@: p < 0.01, @@@: p < 0.001 by paired t-test

5) #: Means significantly different among 3 differences at p < 0.05, ##: p < 0.01, ###: p < 0.001 by one-way GLM

6) Total score = 100

  1. Nutrition labeling shows sodium contents of processed food

  2. Canned foods and instant foods contain lots of sodium

  3. Using spices such as vinegar, mustard or soybean sauce instead of salt can reduce sodium intake

  4. Salt substitute is a good way to reduce sodium intake

  5. Increased risk of hypertension is associated with high level of serum triglycerides

  6. Having family history of hypertension can elevate incidence of hypertension to descendent

  7. Lowering body weight can reduce blood pressure

  8. All the elderly has high blood pressure

  9. Stress can lead to elevate blood pressure

  10. Pregnancy can lead to elevate blood pressure in female

Table 8
Changes of dietary behavior related to sodium intakes during the education program
kjcn-17-752-i008

1) Difference 1 = difference (8 weeks-baseline), Difference 2 = difference (16 weeks-8 week), Difference 3 = difference (16 weeks-baseline)

2) Mean ± SD

3) *: Means significantly different among 3 times at p < 0.05, **: p < 0.01, ***: p < 0.001 by repeated GLM

4) @: Means significantly different between baseline and 8weeks or 8weeks and 16weeks or baseline and 16weeks within group at p < 0.05, @@: p < 0.01, @@@: p < 0.001 by paired t-test

5) #: Means significantly different among 3 differences at p < 0.05, ##: p < 0.01, ###: p < 0.001 by one-way GLM

6) Total score = 100

  1. Enjoying dried seafoods or seasoned fish

  2. Enjoying salted fish such as salted spicy pollack roe

  3. Enjoying cooked rice topped with seasoned meats/seafoods or one-dish meal

  4. Usually drinking all soup or stew

  5. Enjoying instant foods such as ramyon, canned food, ham.

  6. Eating-out or taking delivery dishes more than twice a week

  7. Enjoying Kimchi and pickled vegetables

  8. Adding lots of soy-sauce or vinegar-hot pepper paste to fried foods, pan-fried foods or sashimi

  9. Enjoying salty taste and thinking that salty taste is important one

  10. Usually using soy-sauce than vinegar when cooking vegetables

Table 9
Changes of general dietary habits during the education program
kjcn-17-752-i009

1) Difference 1 = difference (8 weeks-baseline), Difference 2 = difference (16 weeks-8 week), Difference 3 = difference (16 weeks-baseline)

2) Mean ± SD

3) @: Means significantly different between baseline and 8weeks or 8weeks and 16weeks or baseline and 16weeks within group at p < 0.05, @@: p < 0.01, @@@: p < 0.001 by paired t-test

4) *: Means significantly different among 3 times at p < 0.05, **: p < 0.01, ***: p < 0.001 by repeated GLM

5) #: Means significantly different among 3 differences at p < 0.05, ##: p < 0.01, ###: p < 0.001 by one-way GLM

  1. Having 3 meals a day without missing any meal

  2. Having breakfast everyday

  3. Having enough time when eating

  4. Having meals often after 10 PM.

  5. Eating until feeing full.

  6. Having cereals such as rice, breads, noodles, potatoes every meal.

  7. Having meats or eggs more than once a day

  8. Having fishes more than once a day

  9. Having soybean products such as tofu or soymilk everyday

  10. Having vegetable dishes (except kimchi) everyday

  11. Having dishes cooking with oils every meal

  12. Having milk or dairy products everyday

  13. Having fruits everyday

  14. Trying to have various foods in a day

Table 10
Changes of self efficacy scores during the education program
kjcn-17-752-i010

1) Difference 1 = difference (8 weeks-baseline), Difference 2 = difference (16 weeks-8 week), Difference 3 = difference(16 weeks-baseline)

2) Mean ± SD

3) *: Means significantly different among 3 times at p < 0.05, **: p < 0.01, ***: p < 0.001 by repeated GLM

4) @: Means significantly different between baseline and 8weeks or 8weeks and 16weeks or baseline and 16weeks within group at p < 0.05, @@: p < 0.01, @@@: p < 0.001 by paired t-test

5) Total score = 70

  1. Having three meals a day regularly

  2. Always having appropriate amount of fruits, vegetables and cereals

  3. Concerning about lowering salty foods

  4. Concerning about lowering consumption of foods with lots of sugar

  5. Concerning about lowering consumption of processed foods and instant foods

  6. Doing exercise more than three times a week regularly

  7. Concerning about health and reading the information about health management

Notes

This research was supported by a grant of the Food-Hygiene Fund, 2007, the Gyeonggi-Province.

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