Objective The objective of this study was to verify the validity of a mobile phone application (app) that applies a 24-hour dietary recall with meal photos, as a means of being a more accurate method of estimating dietary sodium intake. Methods Of the 203 subjects enrolled, 172 subjects (84 males and 88 females) were selected for the final analysis, excluding those with an intake less than 500 kcal and urine output less than 500 ml. Dietary sodium assessment methods used for comparing with the 24-hour urinary sodium excretion are as follows: 1) face-to-face 24-hour dietary recall, 2) 24-hour dietary recall using the mobile app, 3) face-to-face 24-hour dietary recall considering liquid intakes from soup, stew, water kimchi and noodle, etc (liquid-based dishes), 4) 24-hour dietary recall using the mobile app considering liquid intakes from liquid-based dishes, and 5) food frequency questionnaire. Repeated ANOVA with Bonferroni method was used for comparing the average sodium intake, and Pearson’s correlation was applied to correlate the methods used. Results In women, no significant difference was observed in the average sodium intake between all methods. Moreover, analysis in men and total adults revealed no significant difference between the 24-hour urinary sodium secretion, and 24-hour dietary recall using the app and 24-hour dietary recall using the app considering liquid intakes.
Sodium intake by food frequency questionnaire was significantly different when compared with the intake determined from 24-hour urinary sodium excretion. Sodium intake from all methods (except food frequency questionnaire) significantly correlated with values obtained from 24-hour urine sodium excretion. Conclusions Results of this study validated a mobile phone app using a 24-hour dietary recall with meal photos to better estimate dietary sodium intakes. It is believed that further studies in the future will enable the application as a tool to more accurately determine sodium intake.
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PURPOSE The aim of this study was to analyze the association between sodium excretion and obesity for healthy adults in the Gwangju area. METHODS The participants included 80 healthy adults aged 19 to 69 years in Gwangju. The dietary intake and sodium excretion were obtained using the 24-hour recall method and 24 hour urine collection. The participants were classified into two groups according to the amount of urinary sodium excretion: (≤ 141.75 mmol/dL, > 141.75 mmol/dL). RESULTS After adjusting for sex, age, smoking history, and income, the high excretion of sodium group was significantly higher for weight, body mass index, body fat mass, percent body fat, visceral fat area (VFA), waist circumference, hip circumference, and WHR. The energy and nutrients intake were significant after adjusting for sex, age, smoking history, and income. The LSE group had a significantly higher fat intake and Na/K intake ratio. The HSE group had significantly higher fiber intake, and K intake. As the amount of urinary sodium excretion increased, the risk of obesity before correction was 3.57 (95% CI: 1.13–11.25) times greater, and the risk of obesity of T3 increased significantly by 3.33 times (95% CI: 1.05–10.59). After correcting for sex and age, the obesity risk of T2 increased significantly by 4.23 times (95% CI: 1.11–16.06), and after correcting for sex, age, smoking history, and income, the obesity risk of T2 increased significantly by 6.81 times (95% CI: 1.44–32.19) the risk of obesity. CONCLUSIONS An association exists between sodium excretion and obesity in Korean adults. In this study, the high excretion of sodium group was obese and the risk of obesity was higher than the low excretion of sodium group.
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OBJECTIVES Excess sodium intake has been linked to obesity and obesity-related indices. However, the scientific evidence for this association is inadequate. The purpose of this study was to investigate the association between urinary sodium excretion and obesity-related indices among Korean adults. METHODS A convenience sample of 120 subjects (60 obese and 60 non-obese subjects) were recruited applying frequency matching for sex and age between two groups. Sodium intake level was assessed through 24-hour urine collection. Obesity-related metabolic risk factors, including fasting blood lipid indices, subcutaneous and visceral fat through computed tomography (CT), insulin resistance indices, blood pressure and liver enzymes were measured in all subjects. These obesity-related metabolic risk factors were compared between obese and non-obese group according to sodium excretion levels (<110 mEq/day, 110~180 mEq/day, >180 mEq/day). RESULTS After adjusting for age, gender, health behaviors (smoking, exercise, drinking), and energy intake, several obesity-related metabolic risk factors, including abdominal circumference, body fat percentage, subcutaneous and visceral fat, triglyceride, and systolic blood pressure were found to be significantly deteriorated as the sodium excretion level increases. In addition, multivariate adjusted-odds ratios of abdominal obesity, high blood triglyceride, and high blood pressure were found significantly higher in the highest sodium excretion group compared to the lowest group. The mean number of metabolic syndrome risk factors was also significantly greater in the highest sodium excretion group than in the lowest group. CONCLUSIONS The current study findings suggested that high sodium intake can affect obesity and metabolic syndrome risk negatively, implying the necessity of future research on low-sodium diet intervention in relation to obesity and related health problems.
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OBJECTIVES This study was conducted to examine blood pressure and other characteristics of a high sodium intake group assessed with 24-hr urine analysis and the dietary factors related to the risk of high sodium intake among Korean adults. METHODS A cross-sectional study was conducted with adults aged 20-59 years. Subjects who completed 24-hr urine collection (N = 205) were divided into 3 groups (tertile) according to the sodium intake estimated with 24-hour urine analysis. We compared the blood pressure, BMI and dietary related factors of the 3 groups (low, medium, high sodium intake group) with General Linear Model (GLM) and Duncan's multiple range test (p < 0.05). The risk factors related to high sodium intake were assessed with odds ratio (p < 0.05). RESULTS The sodium intake (mg/day) of the 3 groups were 3359.8 +/- 627.9, 4900.3 +/- 395.1 and 6770.6 +/- 873.9, respectively, corresponding to daily salt intake (g/day) 8.5, 12.4 and 17.2, respectively. High sodium group showed significantly elevated age, BMI and systolic/diastolic blood pressure. Being male gender was associated with significantly increased risk of sodium intake (OR = 1.972; 95%CI: 1.083-3.593). The other factors related to high sodium intake were higher BMI (> or = 25) (OR = 2.619; 95% CI: 1.368-5.015), current alcohol consumption (OR = 1.943; 95%CI: 1.060-3.564), and having salty soybean paste with salt percentage > 14% (OR = 3.99; 95% CI: 1.404-6.841). The dietary attitude related to increased risk of high sodium intake included 'enjoy dried fish and salted mackerel' (p < 0.001) and 'eat all broth of soup, stew or noodle' (p < 0.001). CONCLUSIONS Because high sodium intake was associated with higher blood pressure, nutrition education should focus on alcohol consumption, emphasis on related dietary factors such as using low salt soybean paste, improvements in the habit of eating dried fish and salted mackerel or eating all broth of soup, stew or noodle.
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The purpose of this study was to compare regional differences in salty taste assessments, nutrition knowledge, dietary attitudes and dietary behaviors associated with high-salt diets in four national regions in Korea (Region 1: Seoul, Sokcho, Region 2: Buyeo, Jecheon, Gong Ju, Region 3: Daegu, Gyeongsan, Region 4: Jeon Ju). Subjects were 860 persons who participated in sodium reduction campaign. The result of the salty taste assessment by region was not significantly different. The nutrition knowledge score of subjects in Region 1 was the highest. Dietary attitude scores that showed preference for high-salt diets of Region 2 and Region 4 subjects were higher than those of Regions 1 and 3 subjects (p < 0.001). Dietary behavior scores were not significantly different among regions. The correlation between sodium intake and salty taste assessment was significant (p < 0.01). Older subjects who had high blood pressure levels and lower nutrition knowledge were more likely to have high sodium intakes. Even though the salty taste assessment and dietary behavior scores by region were not significantly different, the salty taste assessment scores had a significant negative correlation with nutrition knowledge and had a significant positive correlation with dietary attitude and dietary behavior in terms of preference for high-salt diets. Therefore, nationwide education regarding salt intake reduction and health and a campaign to encourage favorable attitudes and behavioral changes regarding consumption of a no-salt / low-salt diet is needed.
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We attempted to define the sources of sodium intake for the Korean population at prepared dish level to provide a basis for developing sustainable nutrition policies and feasible programs for sodium intake reduction. Dietary intake data from 2008 and 2009 Korea National Health and Nutrition Examination Survey was used in the analysis for sodium intake sources. Sodium intake from individual dish consumed by each subject was calculated and used in delineating major sodium sources at dish and dish group level for sub-populations of different sex and age. Also, sodium intake was compared between eaters and non-eaters of some specific dish groups with considerable contribution to total sodium intake. The number of subjects included in the analysis was 18,022 and mean sodium intake was 4,600 mg/capita/day. Major sources of sodium intake at dish group level were in the following order: kimchi (1125 mg, 24.5%), noodles (572 mg, 12.4%), soups (488 mg, 10.6%), stews (399 mg, 8.7%), and cooked rice (284 mg, 6.2%). The magnitude of contribution to total sodium intake by soups and stews was different by age group. Sodium intake difference between eaters and non-eaters was much larger for kimchi group (2,343 mg for male, 1,452 mg for female) than for soups or stews. Interaction between consumption of aforementioned specific dish groups and age was highly significant (p < 0.0005) for both sexes. This study revealed an importance of having not only the control over sodium content of foods/dishes, but also the customized approach for different groups of population to accomplish an appreciable reduction in sodium intake.
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The purpose of this study was to assess calcium and sodium intakes and urinary excretion of adults in Busan and to evaluate the relationship between urinary calcium excretion (UCa) and the status of anthropometric, blood pressure, urine analysis, and nutrient intake of subjects. Nutrient intake by 24 hr recall, 24 hr urinary calcium and sodium excretion (UNa) were measured with 87 adults aged 20-59 yrs (42 men and 45 women). The mean calcium intake was 88.0% for men and 103.0% for women of Recommended Intake. The mean sodium intake was 283.4% for men and 250.5% for women of Adequate Intake (AI). The mean 24hr UCa was 127.4 mg in men and 107.3 mg in women. The mean 24 hr UNa was 3650.6mg in men and 3276.4mg in women. The intake and urinary excretion of calcium and sodium were not significantly different by gender. UCa showed significantly positive correlations with sodium intake and UNa in men (p < 0.001, p < 0.05) and women (p < 0.001, p < 0.001) and with age, systolic blood pressure (SBP) and sodium density in women (p < 0.05, p < 0.05, p < 0.01). The UCa/creatinine showed significantly positive correlations with age, sodium intake, sodium density, and UNa in women (p < 0.05, p < 0.01, p < 0.01, p < 0.01). When UCa was stratified into quartile (Q1-Q4), age, SBP, UCa, UNa, sodium intake, and AI percentage of sodium (p < 0.01, p < 0.05, p < 0.001, p < 0.001, p < 0.001, p < 0.001) were significantly higher in Q4. The mean intake and AI percentage of sodium in Q4 were 4768.8mg and 329.0. Based on the results, UCa was related to age, SBP, UNa, and sodium intake. Therefore, nutritional education of decreasing sodium intake for decreasing UCa is needed.
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Sodium is a necessary element for the body. Excessive intake of sodium is known as one of the risk factors for chronic diseases. Recently, increasing numbers of people in Korea are suffering from chronic diseases. Major causes of deaths were chronic degenerative disease with the rising aging population. Especially, the population of rural areas is growing older fast. In rural areas, it is known that under nutrition and high sodium intake were major nutritional problems. For sodium intake, there were some studies about contributing food items. They were not enough to show diets relate to sodium intakes. Thus, this study analyzed dishes contributing to sodium intakes of elderly living in rural areas. Dietary intakes using "the 24hour recall method" were used. For the analysis for sodium intakes, "Can-pro3.0" was used. Ranking of dishes by contributions of sodium intakes were Korean cabbage, kimchi (19.6%), seasoned soybean paste (5.3%), soybean paste (4.6%), soybean paste soup dried radish leaves (3.5%), hot pork and kimchi stew (3.4%) in order. Ranking of dish groups by sodium intakes was kimchies (28.3%), soup and hot soups (22.8%), stews and casseroles (9.7%), seasonings (8.2%),and seasoned vegetables (6.0%) in order. One-dish meals among cooked rice, wheat noodles among noodle and mandu, soups using the soybean paste, stews using soybean paste and kimchi, salted fish among grilled foods, stir-fried anchovy among stir-fried foods, seasoned spinach, and Korean cabbage kimchi contributed to sodium intakes. As the nutrition deficiency of the elderly living in rural areas could be a problem, and excessive sodium intakes is threatening to their health, it is needed for the senior citizens to have adequate knowledge for diets containing less sodium. And recipes for healthy food and nutrition education based on their diets are needed.
This study was performed to assess the sodium intakes of Korean adults using a 24-hr urine analysis and dish frequency questionnaire (DFQ) according to each dish group and the regional area. The subjects of this study were comprised of 552 adults (male: 267, female: 285), aged 20-59yr residing in the metropolitan area (N = 200), Chungcheng-Do (N = 117), Jeolla-Do (N = 117), and Gueongsang-Do provinces (N = 118). The subjects were recruited from the residents who once participated or are participating in the various health programs offered by the public health center. The number of subjects who completed the 24-hr urine collection was 205 (male : 110, female : 95).The mean age and BMI of the subjects were 39.0+/-11.7 y and 23.1+/-2.9 kg/m2, respectively. The mean systolic and diastolic blood pressure was 119.5+/-15.4 mmHg, and 77.1+/-11.1 mmHg, respectively. Eighteen percent of the subjects responded that they are currently smoking, 36% drinking and 50.4% exercising. Twenty point six percent of the subjects were assessed as having hypertension according to their systolic or diastolic blood pressure(SBP > or = 140 mmHg or DBP > or = 90 mmHg) measurements in the present study. Salt intake of the subject estimated with 24-hr sodium excretion was 12.7 g/d (male : 13.4 g/d, female : 12.1 g/d) based on the sodium excretion rate as 82%. Salt intake estimated with DFQ was 14.7 g/d (male : 16.2 g/d, female : 13.4 g/d), 2 g more than the salt intake estimated with 24-hr urine analysis. The four dish groups that contributed most to the sodium intake in order were kimchi (I1571.4mg), soup and stew (1260.5 mg), fish and shellfish (706.3 mg) and noodle and ramyeon (644.3mg). Salt intake estimated with DFQ was the highest in the subjects of Gueongsang-Do (17.0 g/d), second highest Chungcheong-Do (16.4 g/d) and the lowest in the metropolitan area (13.0 g/d). Subjects of Gueongsang-Do showed the highest sodium intakes in most of the dish group, whereas subjects of the metropolitan area showed the lowest. Residents of Chuncheong-Do revealed the highest sodium intake with kimchi and ofJeolla-Do the higher sodium intake with the main dish (meat, fish and beans). The highest salt percentage of kimchi (3.0+/-0.8%) and soybean paste (14.5 +/-5.1%) were observed in Gueongsang-Do, whereas individuals of the metropolitan area were observed as having kimchi (1.6 +/-0.5%) and soybean paste (7.4 +/-1.6%) with the lowest salt percentage. Men were observed as having more salty kimchi (2.4 +/-0.1%) than women (2.1 +/-0.1%).
The assessment of sodium intake is complex because of the variety and nature of dietary sodium. This study intended to develop a dish frequency questionnaire (DFQ) for estimating the habitual sodium intake and a short DFQ for screening subjects with high or low sodium intake. For DFQ112, one hundred and twelve dish items were selected based on the information of sodium content of the one serving size and consumption frequency. Frequency of consumption was determined through nine categories ranging from more than 3 times a day to almost never to indicate how often the specified amount of each food item was consumed during the past 6 months. One hundred seventy one adults (male: 78, female: 93) who visited hypertension or health examination clinic participated in the validation study. DFQ55 was developed from DFQ112 by omitting the food items not frequently consumed, selecting the dish items that showed higher sodium content per one portion size and higher consumption frequency. To develop a short DFQs for classifying subjects with low or high sodium intakes, the weighed score according to the sodium content of one protion size was given to each dish item of DFQ25 or DFQ14 and multiplied with the consumption frequency score. A sum index of all the dish items was formed and called sodium index (Na index). For validation study the DFQ112, 2-day diet record and one 24-hour urine collection were analyzed to estimate sodium intakes. The sodium intakes estimated with DFQ112 and 24-h urine analysis showed 65% agreement to be classified into the same quartile and showed significant correlation (r = 0.563 p < 0.05). However, the actual amount of sodium intake estimated with DFQ112 (male: 6221.9 mg, female: 6127.6 mg) showed substantial difference with that of 24-h urine analysis (male: 4556.9 mg, female: 5107.4 mg). The sodium intake estimated with DFQ55 (male: 4848.5 mg, female: 4884.3 mg) showed small difference from that estimated with 24-h urine analysis, higher proportion to be classfied into the same quartile and higher correlation with the sodium intakes estimated with 24-h urine analysis and systolic blood pressure. It seems DFQ55 can be used as a tool for quantitative estimation of sodium intake. Na index25 or Na index14 showed 39~50% agreement to be classified into the same quartile, substantial correlations with the sodium intake estimated with DFQ55 and significant correlations with the sodium intake estimated with 24-h urine analysis. When point 119 for Na index25 was used as a criterion of low sodium intake, sensitivity, specificity and positive predictive value was 62.5%, 81.8% and 53.2%, respectively. When point 102 for Na index14 was used as a criterion of high sodium intake, sensitivity, specificity and positive predictive value were 73.8%, 84.0%, 62.0%, respectively. It seems the short DFQs using Na index14 or Na index25 are simple, easy and proper instruments to classify the low or high sodium intake group.