• Korean Journal of Community Nutrition
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• v.25 no.4
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• pp.317-328
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• 2020

Objectives: 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.

• Journal of the East Asian Society of Dietary Life
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• v.25 no.6
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• pp.963-969
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• 2015

High sodium intake in many countries has become the leading cause of chronic diseases. This situation requires correct dietary behavior to ensure proper sodium intake in the younger population. The purpose of the present study was to assess eating behavior regarding sodium intake and identify its correlation with common dietary attitudes in children. This cross-sectional study was conducted by surveying 588 elementary school children in Korea. Sodium-related dietary behavior and common eating attitudes were examined through questionnaires, and analyses were conducted by comparing the results between boys and girls. The most undesirable sodium-related dietary behavior in subjects was they 'eat kimchi with every meal' followed by the 'tendency to eat hot and spicy food'. Girls had better dietary behavior regarding sodium intake than boys (P<0.05). However, the common eating attitude between boys and girls was not significantly different. For all subjects, sodium-related dietary behavior and eating attitude showed a significant positive correlation (P=0.0032). The present study shows that a common eating attitude is better when the sodium-related dietary behavior is more desirable in children.

• Journal of the Korean Society of Food Culture
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• v.29 no.2
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• pp.212-221
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• 2014

Korean style DASH (Dietary Approaches to Stop Hypertension) and a dietary education program for sodium reduction were developed. Reduced sodium diets (15 and 30% reductions) were developed from general diets for 3 consecutive weeks from Monday through Saturday. Subjects (19 total) were classified into two groups according to dietary education. Experimental period was from June 24 to July 23, 2012. Total sum of adaptation scores for low sodium diets significantly increased in the group that underwent dietary education compared to that without (p<0.05). After the experiment, both groups showed significantly increased values in terms of food group balance, sodium-related nutrition knowledge, attitude, and practice by paired t-test. Especially, group that underwent dietary education showed significantly higher values for attitudes by ANCOVA pre-test as a variation (p<0.01). For the results of the nutrient intake survey, group that underwent dietary education showed significantly increased values for dietary fiber (p<0.01), vitamin A (p<0.001), vitamin K (p<0.001), vitamin C (p<0.01), Folic acid (p<0.001), vitamin B12 (p<0.01), calcium (p<0.01), iron (p<0.05), and zinc (p<0.05) and significantly decreased values for sodium (p<0.05) and chloride (p<0.005). Subjects adapted to reduced sodium diets showed apparent improvements in sodium-related knowledge, attitude, practice and intake of nutrient, and these improvements were even higher in the group that underwent dietary education compared to that without. Thus, adaptation to low sodium diet combined with dietary education can improve dietary habits.

• Nutrition Research and Practice
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• v.16 no.sup1
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• pp.70-88
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• 2022

Sodium is a physiologically essential nutrient, but excessive intake is linked to the increased risk of various chronic diseases, particularly cardiovascular. It is, therefore, necessary to accomplish an evidence-based approach and establish the Korean Dietary Reference Intakes (KDRIs) index, to identify both the nutritional adequacy and health effects of sodium. This review presents the rationale for and the process of revising the KDRIs for sodium and, more importantly, establishing the sodium Chronic Disease Risk Reduction Intake (CDRR) level, which is a new specific set of values for chronic disease risk reduction. To establish the 2020 KDRIs for dietary sodium, the committee conducted a systematic literature review of the intake-response relationships between the selected indicators for sodium levels and human chronic diseases. In this review, 43 studies published from January 2014 to December 2018, using databases of PubMed and Web of Science, were finally included for evaluating the risk of bias and strength of evidence (SoE). We determined that SoE of the relationship between dietary sodium and cardiovascular diseases, cerebrovascular disease, and hypertension, was moderate to strong. However, due to insufficient scientific evidence, we were unable to establish the estimated average requirement and the recommended nutrient intake for dietary sodium. Therefore, the adequate intake of sodium for adults was established to be 1,500 mg/day, whereas the CDRR for dietary sodium was established at 2,300 mg/day for adults. Intake goal for dietary sodium established in the 2015 KDRIs instead of the tolerable upper intake level was not presented in the 2020 KDRIs. For the next revision of the KDRIs, there is a requirement to pursue further studies on nutritional adequacy and toxicity of dietary sodium, and their associations with chronic disease endpoint in the Korean population.

• The Korean Journal of Food And Nutrition
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• v.30 no.1
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• pp.166-174
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• 2017

The purpose of this study was to compare dietary self-efficacy for sodium intake reduction and dietary behaviors by eating areas. Subjects (797 males and 767 females) were classified according to perceived dietary habit levels related to sodium intake (lowest: ${\leq}10$ (n=434), low: $11{\sim}{\leq}13$ (n=471), high: $14{\sim}{\leq}15$ (n=360), highest: $16{\leq}$ (n=299)) using an online survey with a sample that was geographically representative of the population. The highest group was significantly younger and had a higher student proportion than the lowest group. Dining contexts regarding home led to a significantly higher sodium intake in the highest group, but it was eating out for the lowest group. The highest group had a significantly lower intention to reduce sodium intake compared to the lowest group. In the home cooked meals, the highest group displayed a significantly lower cooking frequency, less effort with respect to a low sodium diet and cooking habits related to sodium intake as compared to the lowest group. Also, regarding eating out and food service, the highest group exhibited significantly lower efforts and dietary behaviors to reduce sodium intake than the lowest group. The dietary score for sodium reduction behavior in the highest group was significantly lower compared to the lowest group, for home cooked meals, eating out, as well as food service. Thus, dietary guidelines and nutrition education for the reduction of sodium intake by eating areas need to be developed and provided.

• Journal of Nutrition and Health
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• v.50 no.6
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• pp.578-584
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• 2017

Purpose: Excess intake of sodium is a major diet-related risk factor for human diseases including hypertension and cancer as well as obesity and inflammation. However, findings are still controversial, and evidence is lacking in Koreans. Therefore, for better understanding of the role of dietary sodium intake in disease etiology, this study investigated the effects of dietary sodium intake on adiposity, inflammation, and hormones in Koreans. Methods: A total of 80 males and females joined the study. The general characteristics and dietary intake data were investigated by trained interviewers using a questionnaire and 24-h dietary recall, respectively. For the markers of adiposity, body weight, body mass index, percent of body fat, visceral fat area, and waist and hip circumference were measured. For the inflammation and hormone markers, leptin, adiponectin, insulin, tumor necrosis $factor-{\alpha}$, and interleukin-6 were also analyzed. Results: Multivariate linear regression analyses suggested that dietary sodium intake was not associated with adiposity. However, dietary sodium showed a significant association with insulin level: Plasma insulin concentration increased with sodium intake independent of other dietary intake or percent of body fat (${\beta}=0.296$, adjusted $r^2=0.276$, p < 0.01). Other markers for inflammation and hormonal responses were not associated with dietary sodium intake. Conclusion: Findings suggested that dietary sodium intake may be a critical modifying factor in the level of plasma insulin. However, it showed a limited effect on obesity and other inflammation markers and hormone levels. These findings should be confirmed in larger, well-designed investigations.

• Nutrition Research and Practice
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• v.7 no.3
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• pp.192-198
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• 2013

Dietary sodium intake is considered one of the major causal factors for hypertension. Thus, to control the increase of blood pressure and reduce the risk of hypertension-related clinical complications, a reduction in sodium intake is recommended. The present study aimed at determining the association of dietary sodium intake with meal and snack frequency, snacking time, and taste preference in Korean young adults aged 20-26 years, using a 125-item dish-frequency questionnaire. The mean dietary sodium intakes of men and women were 270.6 mmol/day and 213.1 mmol/day, which were approximately 310% and 245% of the daily sodium intake goal for Korean men and women, respectively. Dietary sodium intake was positively correlated with systolic blood pressure in the total group, and BMI in the total and men-only groups. In the total and men-only groups, those who consumed meals more times per day consumed more dietary sodium, but the number of times they consumed snacks was negatively correlated with dietary sodium intake in the total, men-only, and women-only groups. In addition, those who consumed snacks in the evening consumed more sodium than those who did so in the morning in the men-only group. The sodium intake was also positively associated with preference for salty and sweet taste in the total and women-only groups. Such a high intake of sodium in these young subjects shows that a reduction in sodium intake is important for the prevention of hypertension and related diseases in the future.

• Journal of the East Asian Society of Dietary Life
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• v.25 no.1
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• pp.12-19
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• 2015

This study was performed for the purpose of establishing proper dietary behaviors and improving sodium intake status by investigating nutrition knowledge, dietary behaviors, and food intake frequency related to sodium in 398 university students living in Gyeonggi-do and Incheon. Female students showed a higher rate of eating out more than five times a week as well as daily snack intake than male students. Female students showed a higher score for sodium-related nutrition knowledge than male students, whereas male students showed higher sodium intake than female students. Subjects who showed a higher frequency of eating out and snack intake also showed a higher salt intake ratio and sodium-related nutrition knowledge. Subjects with higher scores related to sodium-related nutrition knowledge showed a higher low salt intake ratio and incidence of low sodium food intake. From this research, depending on the level of nutrition knowledge related to sodium university students showed differences in dietary behavior related to sodium intake. This result would be helpful to develop lower sodium training materials specific to low sodium food selection tips, reading nutrition labels, and so on.

• Korean Journal of Community Nutrition
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• v.20 no.5
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• pp.327-337
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• 2015

Objectives: Dietary life is closely associated with dietary attitude and diet-related knowledge. Particularly, dietary habit such as sodium intake can be affected by various dietary behaviors such as food choices, dietary attitude toward salty food and a preference for salty taste. The purpose of this study was to assess sodium-related nutrition knowledge and to identify sodium-related attitude and behaviors according to the level of sodium-related knowledge of university students. Methods: Anthropometric measurements were provided by 408 students who participated in this study. The study participants answered questionnaires to provide information on general dietary behaviors, sodium-related dietary attitude and other behavioral factors. A total score of nutrition knowledge was used to categorize study participants in to two groups, namely, low level in sodium-related knowledge (LNaK) or high level in sodium-related knowledge (HNaK) and the attitude and the behaviors of students toward sodium intake were compared between these two groups. Results: The ratio of female students in HNaK group was higher than that in the LNaK group. HNaK group had a higher score in checking nutrition label of processed food than the LNaK group. Total score of sodium-related attitude and behaviors of HNaK group were 34.81 and 32.75, respectively and these scores were significantly higher than that of the LNaK group whose scores were 32.57 and 30.57, respectively. Total energy intake was not different between two groups but the intakes of calcium, vitamin B2 and folate were higher in HNaK group than in the LNaK group. Correlation analysis adjusted for age and gender revealed that total score of sodium-related nutrition knowledge was positively correlated with total score of sodium-related attitude and behaviors. Conclusions: In conclusion, students who had high level of sodium-related nutrition knowledge had desirable attitude and behaviors toward sodium intake and these results can be considered in nutrition education for university students.

• Nutrition Research and Practice
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• v.17 no.2
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• pp.175-191
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• 2023

BACKGROUND/OBJECTIVES: The scientific evidence of a sodium-obesity association is limited by sodium intake assessments. Our specific aim is to synthesize the association between dietary sodium intake and obesity across the sodium intake assessments as evidenced by systematic reviews in adults. SUBJECTS/METHODS: A systematic search identified systematic reviews comparing the association of dietary sodium intakes with obesity-related outcomes such as body mass index (BMI), body weight, waist circumference, and risk of (abdominal) obesity. We searched PubMed on October 24, 2022. To assess the Risk of Bias in Systematic Reviews (ROBIS), we employed the ROBIS tool. RESULTS: This review included 3 systematic reviews, consisting of 39 unique observational studies (35 cross-sectional studies and 4 longitudinal studies) and 15 randomized controlled trials (RCTs). We found consistently positive associations between dietary sodium intake and obesity-related outcomes in cross-sectional studies. Studies that used 24-h urine collection indicated a greater BMI for those with higher sodium intake (mean difference = 2.27 kg/m²; 95% confidence interval [CI], 1.59-2.51; P < 0.001; I² = 77%) compared to studies that used spot urine (mean difference = 1.34 kg/m²; 95% CI, 1.13-1.55; P < 0.001; I² = 95%) and dietary methods (mean difference = 0.85 kg/m²; 95% CI, 0.1-1.51; P < 0.05; I² = 95%). CONCLUSIONS: Quantitative synthesis of the systematic reviews has shown that cross-sectional associations between dietary sodium intake and obesity outcomes were substantially different across the sodium intake assessments. We need more high-quality prospective cohort studies and RCTs using 24-h urine collection to examine the causal effects of sodium intake on obesity.