• Journal of Nutrition and Health
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• v.55 no.1
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• pp.174-187
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• 2022

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.

• Korean Journal of Community Nutrition
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• v.17 no.6
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• pp.724-736
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• 2012

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 'Maintenance (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.

• Korean journal of food and cookery science
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• v.32 no.1
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• pp.136-146
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• 2016

The purpose of this study was to investigate whether there was a gender difference in motivating university students to decrease their sodium intake and to identify effective motivating factors. Within the protection motivation theory (PMT) framework, a survey questionnaire was developed to measure participants' perceptions on the severity of and the vulnerability to risk of serious diseases due to the high sodium intake, as well as the effectiveness (response efficacy) and the ability to perform preventive measures (self-efficacy). Behavioral intentions on five specific practices (checking nutrition label, consuming more fruits and vegetables, consuming less soups, avoiding spicy and pungent food, purchasing less instant or restaurant foods) related to decreasing sodium intake were also included. A total of 294 usable response data were collected from university students (92 male, 202 female) in Busan and Gyeongnam in June 2015 and analyzed using IBM SPSS 22. Severity was the highest (4.04) PMT factor followed by response efficacy (3.72), self-efficacy (3.42), and vulnerability (3.26). Compared to male students, female students thought that the threat was more severe (t=6.035, p<0.001) and reducing sodium intake would be effective to prevent serious illnesses (t=4.724, p<0.001), but their vulnerability and self-efficacy perceptions were not different from male students. Among the five items measuring behavioral intention, female students were more likely to increase fruits and vegetables consumption (t=3.811, p<0.001), while male students were more likely to avoid spicy and pungent foods (t=2.336, p=0.020). Based on findings of this study, the recommended strategy to effectively motivate university students to lower their sodium consumption level is the development of campaign focused on increased vulnerability perception, response efficacy, and ease of practicing preventive measures instead of emphasizing the severity of the consequences.

• Korean Journal of Community Nutrition
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• v.17 no.3
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• pp.341-352
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• 2012

It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.

• Korean Journal of Community Nutrition
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• v.13 no.5
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• pp.640-652
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• 2008

Hypertension is among the most common and important risk factors for stroke, heart attack, and heart failure which is considered to be the leading cause of death in Korea. The prevalence rate of hypertension in Korea is 27.9%, according to the 2006 Korea National Health and Nutrition Survey. Since non-pharmacologic nutrition education is recommended as the first step in the management of hypertension, evaluation of nutrition program is needed to form strategies for improving patients' dietary adherence. This study was designed to evaluate the overall effectiveness of a hypertension nutrition education program (HNEP) for reducing the salt intake, at a public health center located in Gyunggi-province. The HNEP was offered for 16 weeks from May to September in 2007. Nutrition education activities included cooking classes, food preparation demonstrations, physical fitness programs, salty taste preference test sessions, games, case-study presentations, planning and evaluation of menus, etc. Forty patients participated fully in the program which had 47 female enrollees. Data about nutrient intake (24-hour recall), nutrition knowledge, food behavior were collected before (baseline) and after the program. Changes after program completion indicated the following: 1) diastolic blood pressure was decreased (p < 0.05), 2) sodium (salt) intake was also decreased (p < 0.01), especially baseline high salt intake group, 3) nutrition knowledge was improved (p<0.001), 4) dietary behaviors for maintaining a low salt diet was improved (p < 0.001), 5) participants preferred cooking class from nutrition education methods. As a conclusion, it appears that a nutrition education program for hypertensive female elderly for reducing the salt intake might effectively decrease blood pressure and salt intake. It also improves nutrition knowledge, dietary behavior, and finally adherence to a recommendable low-sodium diet.

• Journal of Nutrition and Health
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• v.33 no.8
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• pp.833-839
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• 2000

The purpose of this study was to investigate sodium consumption and related psychosocial factors among hypertensive patients and normal adults through questionnaire development. The Theory of Planned Behavior provided the basis for the study. The mean blood pressure of subjects was 117. 1 mmHg/78.55mgHg in normal adults(N-218), 159.65mmHg/102.05mmHg(systolic/diastolic) in hypertensive group(N=219) and the sodium consumption was 5219.4${\pm}$1821.3mg in normal adults and 4631.4${\pm}$1749.1mg in hypertensive group. The results of Multiple logistic regression analysis showed that the odds of being hypetensive group were increasd as subjects felt that dalty food (OR=1.5) (OR=0.8). The odds of beign hypertensive group increased as subject received more support. With respect to perceived control, the odds of being hypertensive group were increased as subjects felt more confident in contolling salty intake when spouse likes to take salty food(OR=1.4). In contrast, subjects felt less confident in contolling sodium consumption when they took medicine(OR=0.8). Study findings revealed that all three factors, attitudes, subjective norms, and perceived control contributed to the model for explaining intentions, with subjective norms being most important. This findings provided the empirical evidence for the TPB in explaining salt intake. This study suggest that educational interventions for hypertension patients focus on changing sodium consumption through changing attitude toward high sodium consumption, subjective norms, perceived control over reducing sodium consumption of specific situations, specially subjective norms and perceived control. In addition, interventions may include strategies to change attitudes toward sodium consumption by helping hypertensive patients realize negative beliefs and modifying positive beliefs and to elicit and maintain subjective norm from doctors, family and neighbors, and to increase control beliefs for reducing sodium consumption.(Korean J Nutrition 33(8) : 833-839, 2000)

• Journal of Nutrition and Health
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• v.52 no.5
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• pp.475-487
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• 2019

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.

• Nutrition Research and Practice
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• v.10 no.6
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• pp.635-640
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• 2016

BACKGROUND/OBJECTIVES: This study was conducted to evaluate the feasibility of a sodium reduction program at local restaurants through nutrition education and examination of the health of restaurant owners and cooks.SUBJECTS/METHODS: The study was a single-arm pilot intervention using a pre-post design in one business district with densely populated restaurants in Seoul, South Korea. The intervention focused on improving nutrition behaviors and psychosocial factors through education, health examination, and counseling of restaurant personnel. Forty-eight restaurant owners and cooks completed the baseline survey and participated in the intervention. Forty participants completed the post-intervention survey. RESULTS: The overweight and obesity prevalences were 25.6% and 39.5%, respectively, and 74.4% of participants had elevated blood pressure. After health examination, counseling, and nutrition education, several nutrition behaviors related to sodium intake showed improvement. In addition, those who consumed less salt in their baseline diet (measured with urine dipsticks) were more likely to agree that providing healthy foods to their customers is necessary. This study demonstrated the potential to reduce the sodium contents of restaurant foods by improving restaurant owners' and cooks' psychological factors and their own health behaviors. CONCLUSIONS: This small pilot study demonstrated that working with restaurant owners and cooks to improve their own health and sodium intake may have an effect on participation in restaurant-based sodium reduction initiatives. Future intervention studies with a larger sample size and comparison group can focus on improving the health and perceptions of restaurant personnel in order to increase the feasibility and efficacy of restaurant-based sodium reduction programs and policies.

• Journal of the Korean Society of Food Culture
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• v.35 no.4
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• pp.351-362
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• 2020

This study investigated the possibility of reducing sodium and sugar intake in the Bulgogi bowl and yogurt, respectively, by utilizing food and non-food factors. Sodium and sugar replacers were the target food factors, and eating environment was the target non-food factor. The sodium content of Bulgogi bowls was reduced by 40%, and a flavor enhancer was applied to compensate for the reduced saltiness. Low calorie sweeteners, such as sucralose and stevia, were used to lower the sugar content of yogurt by 30%. Consumers were asked to evaluate the samples in one of the three eating environments: private booth evaluation, BOOTH; watching video clips during evaluation, VIDEO; conversation with friends during evaluation, FRIEND. The results showed that applying sodium or sugar replacers were effective in lowering sodium or sugar intake, respectively, without compromising the acceptance level of samples. Significant influences of the eating environment were observed on liking and perception of samples, but the influence patterns were not consistent between Bulgogi bowl and yogurt.

• Food Science and Industry
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• v.49 no.2
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• pp.18-24
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• 2016

Sodium chloride (NaCl) is a very important as one of major food ingredients in food industries. Recently, as the potential risk of adult diseases such as hypertension by overingestion of sodium, health authorities of many countries are executing policies for the reduction of sodium to suppress the overingestion of sodium by intake of NaCl. As general ways, the replacement of NaCl with either alternative salts, such as solar salts and minerals, for examples calcium, magnesium, potassium, lactic acid, and so on, and the addition of flavor enhancers were used to reduce the contents of sodium in foods. Recently, controls of particle size of sodium chloride or release point are emerging as new salt-manufacturing technologies for the sodium reduction. Upon reducing NaCl in foods it is important to develop practically adaptable technologies on the basis of the consideration of the unique functions of NaCl in foods, in particular effects on rheological characters, function as a humectant, shorten shelf life time, and so on.