DOI QR코드

DOI QR Code

Effect of nutrition education in reducing sodium intake and increasing potassium intake in hypertensive adults

  • Lee, You-Sin (Department of Home Economics Education, Dongguk University) ;
  • Rhee, Moo-Yong (Cardiovascular Center, Dongguk University Ilsan Hospital) ;
  • Lee, Sim-Yeol (Department of Home Economics Education, Dongguk University)
  • Received : 2019.11.11
  • Accepted : 2020.04.02
  • Published : 2020.10.01

Abstract

BACKGROUND/OBJECTIVES: Hypertension is the major risk factor for cardiovascular disease, a leading cause of deaths in Korea. The objective of this study was to evaluate the effect of a nutrition education in reducing sodium intake and increasing potassium intake in hypertensive adults. SUBJECTS/METHODS: Subjects who participated in this study were 88 adults (28 males and 60 females) who were pre-hypertension or untreated hypertensive patients aged ≥ 30 yrs in Gyeonggi Province, Korea. These subjects were divided into 2 groups: a lowsodium education (LS) group and a low-sodium high-potassium education (LSHP) group. Nutrition education of 3 sessions for 12 weeks was conducted. Blood pressure, blood and urine components, nutrient intake, and dietary behavior were compared between the two education groups. RESULT: Blood pressure was decreased in both groups after the nutrition education (P < 0.05). In the LSHP group, levels of blood glucose (P < 0.05), total cholesterol (P < 0.01), and lowdensity lipoprotein-cholesterol (P < 0.05) were decreased after the program completion. Sodium intake was decreased in both groups after the nutrition education (P < 0.05). However, Na/K ratio was only decreased in the LS group (P < 0.05). Intake frequency of fish & shellfish was only significantly reduced in the LS group (P < 0.05), while intake frequencies of cooked rice, noodles & dumplings, breads & snacks, stew, kimchi, and fish & shellfish were reduced in the LSHP group (P < 0.05). Total score of dietary behavior appeared to be effectively decreased in both groups after the education program (P < 0.001). CONCLUSIONS: This education for reducing sodium intake was effective in reducing blood pressure and sodium intake. The education for enhancing potassium intake resulted in positive changes in blood glucose and serum cholesterol levels.

References

  1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23.
  2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-72.
  3. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2017: Korea National Health and Nutrition Examination Survey (KNHANES VII-2). Cheongju: Korea Centers for Disease Control and Prevention; 2018.
  4. Karppanen H, Mervaala E. Sodium intake and hypertension. Prog Cardiovasc Dis 2006;49:59-75.
  5. Adrogue HJ, Madias NE. Sodium and potassium in the pathogenesis of hypertension. N Engl J Med 2007;356:1966-78.
  6. Cappuccio FP, Kalaitzidis R, Duneclift S, Eastwood JB. Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. J Nephrol 2000;13:169-77.
  7. Blaustein MP, Hamlyn JM. Pathogenesis of essential hypertension. A link between dietary salt and high blood pressure. Hypertension 1991;18:III184-95.
  8. Binia A, Jaeger J, Hu Y, Singh A, Zimmermann D. Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J Hypertens 2015;33:1509-20.
  9. Houston MC. The importance of potassium in managing hypertension. Curr Hypertens Rep 2011;13:309-17.
  10. Yim KS. The effects of a nutrition education program for hypertensive female elderly at the public health center. Korean J Community Nutr 2008;13:640-52.
  11. Moon EH, Kim KW. Evaluation of nutrition education for hypertension patients aged 50 years and over. Korean J Community Nutr 2011;16:62-74.
  12. Kim HH, Shin EK, Lee HJ, Lee NH, Chun BY, Ahn MY, Lee YK. Evaluation of the effectiveness of a salt reduction program for employees. Korean J Nutr 2009;42:350-7.
  13. Son SM, Kim MJ. The effect of nutrition education program for various chronic disease in elderly visiting public health center. Korean J Community Nutr 2001;6:668-77.
  14. Park SY, Kwon JS, Kim HK. Effect of a public health center-based nutrition education program for hypertension in women older than 50 years of age. J Nutr Health 2018;51:228-41.
  15. Sim JH. The Effects of Diet Health Education Program for Prehypertension Group on the Diet Habit and Blood Pressure. J Korean Soc Health Educ Promot 2006;23:1-12.
  16. Moshfegh A, Goldman J, Cleveland L. What We Eat in America, NHANES 2001-2002: Usual Nutrient Intakes from Food Compared to Dietary Reference Intakes. Washington, D.C.: U.S. Department of Agriculture, Agricultural Research Service; 2005.
  17. Son SM, Huh GY, Lee HS. Development and Evaluation of Validity of Dish Frequency Questionnaire (DFQ) and Short DFQ Using Na Index for Estimation of Habitual Sodium Intake. Korean J Community Nutr 2005;10:677-92.
  18. Son SM. Pilot Study for Low Salt Consumption Projects for Korean People. Seoul: Ministry of Health & Welfare; 2006.
  19. Yoon JS. Developing Nutrition Education model for Reducing Sodium Intake and Evaluation. Daegu: Keimyung University Industry-Academic Cooperation Foundation; 2011.
  20. Rhee MY. Sodium Intake: Research for the Improvement in Measurement Methods and the Effect of Sodium Intake on Cardiovascular Health. Seoul: Dongguk University Industry-Academic Cooperation Foundation; 2011.
  21. Ard JD, Svetkey LP. Diet and blood pressure: applying the evidence to clinical practice. Am Heart J 2005;149:804-12.
  22. Mattes RD. The taste for salt in humans. Am J Clin Nutr 1997;65:692S-697S.
  23. Jung EJ, Kwon JS, Ahn SH, Son SM. 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. Korean J Community Nutr 2013;18:626-43.
  24. Obarzanek E, Sacks FM, Vollmer WM, Bray GA, Miller ER 3rd, Lin PH, Karanja NM, Most-Windhauser MM, Moore TJ, Swain JF, Bales CW, Proschan MA; DASH Research Group. Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) trial. Am J Clin Nutr 2001;74:80-9.
  25. Juraschek SP, Miller ER 3rd, Weaver CM, Appel LJ. Effects of sodium reduction and the DASH diet in relation to baseline blood pressure. J Am Coll Cardiol 2017;70:2841-8.
  26. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N, Simons-Morton D, McCullough M, Swain J, Steele P, Evans MA, Miller ER, Harsha DW; DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 1997;336:1117-24.
  27. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH, Aickin M, Most-Windhauser MM, Moore TJ, Proschan MA, Cutler JA; DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 2001;344:3-10.
  28. Suter PM, Sierro C, Vetter W. Nutritional factors in the control of blood pressure and hypertension. Nutr Clin Care 2002;5:9-19.
  29. Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013;346:f1378.
  30. Yon M, Lee Y, Kim D, Lee J, Koh E, Nam E, Shin H, Kang B, Kim JW, Heo S, Cho H, Kim C. Major sources of sodium intake of the Korean population at prepared dish level - based on the KNHANES 2008 & 2009 -. Korean J Community Nutr 2011;16:473-87.
  31. Kim HH, Lee YK. Analysis of presumed sodium intake of office workers using 24-hour urine analysis and correlation matrix between variables. Korean J Nutr 2013;46:26-33.
  32. Park YH, Chung SJ. A Comparison of sources of sodium and potassium intake by gender, age and regions in Koreans: Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. Korean J Community Nutr 2016;21:558-73.