J Nutr Health.  2017 Dec;50(6):664-678. 10.4163/jnh.2017.50.6.664.

Evaluation of the sodium intake reduction plan for a local government and evidence-based reestablishment of objectives: Case of the Seoul Metropolitan Government

• Lim AH
• Hwang JY
• Kim K

• KMID: 2401022
• DOI: http://doi.org/10.4163/jnh.2017.50.6.664

Abstract

PURPOSE
To identify the effectiveness of policy evaluation, consistent monitoring is necessary. This study aimed to carry out mid-term evaluation of objectives and programs related to comprehensive plans for sodium intake reduction by 2020 for Seoul city and then reestablish the objectives of the sodium intake reduction plans.
METHODS
Literature reviews, data analysis, and reviews of expert focus-groups were performed to evaluate objectives, to develop a new goal, and to identify the priority subjects of the sodium intake reduction programs. In order to examine target populations for the programs, awareness and behaviors related to sodium intakes among Seoul citizens were examined by sex, age, and income level using the 2008~2013 Korea National Health and Nutrition Examination Survey data.
RESULTS
Current objectives of the sodium intake reduction plan by 2020 for Seoul city were not appropriate, so objectives were reset to 3,600 mg of sodium intake by 2020 among Seoul citizens with 2% reduction per year. Although sodium intake showed a decreasing trend by year, it was still high, especially in men. The sodium intake reduction programs currently in progress have not been assessed at multiple levels across multiple sectors and have only been assessed fragmentarily. For dietary behavior related to sodium intakes by sex, age, and income level, sodium intake was higher in the group with less than 100 g of fruit intake compared to the group with 100 g or more. Subjects aged 30~59 years and the low household income group showed relatively higher sodium intakes. Based on the data analysis and the expert review, the priority subject of the sodium intake reduction programs was determined to be adult men. In terms of a program strategy for sodium intake reduction, multi-level and setting approaches, including work sites, home, and restaurants, were suggested to reduce sodium intakes of the target subject.
CONCLUSION
The suggested objectives should be consistently monitored by data analysis, and the determined programs need to be phased in over 5 years.

Keyword

sodium intake; dietary behavior; policy evaluation; programs for sodium intake reduction

MeSH Terms

Adult
Family Characteristics
Fruit
Health Services Needs and Demand
Humans
Korea
Local Government*
Male
Nutrition Surveys
Restaurants
Seoul*
Sodium*
Statistics as Topic
Sodium

Reference

1. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2013: Korea National Health and Nutrition Examination Survey (KNHANES VI-1). Cheongju: Korea Centers for Disease Control and Prevention;2014.

2. Statistics Korea. Cause of death statistics 2013. Daejeon: Statistics Korea;2014.

3. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ. 1988; 297(6644):319–328.

4. Elliott P, Stamler J, Nichols R, Dyer AR, Stamler R, Kesteloot H, Marmot M. Intersalt Cooperative Research Group. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. BMJ. 1996; 312(7041):1249–1253.

5. 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(1):3–10.

6. He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002; 16(11):761–770.

7. He FJ, Jenner KH, Macgregor GA. WASH-world action on salt and health. Kidney Int. 2010; 78(8):745–753.

8. Federal Food Safety and Veterinary Office (CH). Salt strategy for 2013-2016: paper on a strategy for reducing salt consumption. Bern: Federal Food Safety and Veterinary Office;2013.

9. Seoul Metropolitan Government, Division of Food Safety (KR). Comprehensive plan of reducing sodium intake in Seoul 2020. Seoul: Seoul Metropolitan Government;2013.

10. Department of Health (GB). New salt strategy to drive further progress to cut salt [Internet]. London: Department of Health;2013. cited 2015 Oct 25. Available from: https://responsibilitydeal.dh.gov.uk/salt-strategy/.

11. Yun SM. New salt strategy in U.K. Health Welf Policy Forum. 2013; 199:83–92.

12. Henney JE, Taylor CL, Boon CS. Strategies to reduce sodium intake in the United States. Washington, D.C.: National Academies Press;2010.

13. Yun SM. Analysis trend for new sodium reduction strategy in U.S.A. Health Welf Policy Forum. 2014; 209:106–114.

14. Sodium Working Group (CA). Sodium reduction strategy for Canada. Ottawa: Health Canada;2010.

15. Alberta Health (CA). Reducing the sodium intake of Canadians: a provincial and territorial report on progress and recommendations for future action [Internet]. Alberta: Alberta Health;2015. cited 2015 Oct 25. Available from: http://www.health.alberta.ca/documents/Sodium-Report-PTMH-2012.pdf.

16. Ministry of Health and Welfare (KR). The 3rd health plan 2020 (2011-2015). Seoul: Ministry of Health and Welfare;2011.

17. Ministry of Health and Welfare (KR). The 1st national nutrition care/management in Korea (2012-2016). Seoul: Ministry of Health and Welfare;2012.

18. Ministry of Health and Welfare (KR). Korea Food & Drug Administration. Sodium intake reduction movement headquarters [Internet]. Cheongwon: Korea Food & Drug Administration;2012. cited 2015 Oct 25. Available from: www.foodnara.go.kr/Na_down.

19. Bae SS. Health care business planning. 3rd edition. Seoul: Gyechuk Munwhasa;2015.

20. Laatikainen T, Pietinen P, Valsta L, Sundvall J, Reinivuo H, Tuomilehto J. Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population. Eur J Clin Nutr. 2006; 60(8):965–970.

21. Sadler K, Nicholson S, Steer T, Gill V, Bates B, Tipping S, Cox L, Lennox A, Prentice A. National diet and nutrition survey: assessment of dietary sodium in adults (aged 19 to 64 years) in England, 2011. London: Department of Health;2012.

22. European Commission. Implementation of the EU salt reduction framework: results of member states survey [Internet]. Belgium: European Union;2012. cited 2015 Sep 15. Available from: http://ec.europa.eu/health/nutrition_physical_activity/docs/salt_report_en.pdf.

23. Ministry of Health, Labour, and Welfare (JP). The 2012 national health and nutrition survey [Internet]. Tokyo: the Ministry of Health, Labour, and Welfare;2014. cited 2015 Oct 2. Available from: http://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/kenkou/kenkounippon21/en/eiyouchousa/kekka_todoufuken.html.

24. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008; 29:253–272.

25. Fielding JE, Teutsch S, Breslow L. A framework for public health in the United States. Public Health Rev. 2010; 32(1):174–189.

26. Kim MG, Kim KY, Nam HM, Hong NS, Lee YM. The relationship between lifestyle and sodium intake in Korean middle-aged workers. J Korea Acad Ind Coop Soc. 2014; 15(5):2923–2929.

27. Park YS, Son SM, Lim WJ, Kim SB, Chung YS. Comparison of dietary behaviors related to sodium intake by gender and age. Korean J Community Nutr. 2008; 13(1):1–12.

28. Kwon JH, Shim JE, Park MK, Paik HY. Evaluation of fruits and vegetables intake for prevention of chronic disease in Korean adults aged 30 years and over: using the third Korea National Health and Nutrition Examination Survey (KNHANES III), 2005. Korean J Nutr. 2009; 42(2):146–157.

29. Kim MK, Kim K, Shin MH, Shin DH, Lee YH, Chun BY, Choi BY. The relationship of dietary sodium, potassium, fruits, and vegetables intake with blood pressure among Korean adults aged 40 and older. Nutr Res Pract. 2014; 8(4):453–462.

30. Shin EK, Lee HJ, Jun SY, Park EJ, Jung YY, Ahn MY, Lee YK. Development and evaluation of nutrition education program for sodium reduction in foodservice operations. Korean J Community Nutr. 2008; 13(2):216–227.

31. Jang JY, Kim MJ, Han JS. A study on food frequency, dietary habits and nutrition knowledge of the elderly who intake high sodium. J Korean Soc Food Sci Nutr. 2009; 38(10):1362–1372.

32. Lee HY, Kim MK. Dietary behavioral correlates of nutrition label use in Korean women. Korean J Nutr. 2008; 41(8):839–850.

33. Lee KA, Lee HJ, Park EJ. The effect of use of nutrition labelling on knowledge and perception of nutrition labelling, and awareness of nutrition labelling usefulness with among college students. J Korean Soc Food Sci Nutr. 2010; 39(2):253–266.

34. Hammons AJ, Fiese BH. Is frequency of shared family meals related to the nutritional health of children and adolescents? Pediatrics. 2011; 127(6):e1565–e1574.

35. Lee KW, Lee Y, Oh YJ, Cho YJ, Lee MJ. Attitudes toward family meals and comparisons of dietary quality between family meals and meals eaten alone in middle and high school students. J Korean Diet Assoc. 2008; 14(2):127–138.

36. Kwon JE, Park HJ, Lim HS, Chyun JH. The relationships of dietary behavior, food intake, and life satisfaction with family meal frequency in middle school students. Korean J Food Cult. 2013; 28(3):272–281.

37. Hong SM, Lee JH, Kim HK, Yu R, Seo JH, Huh EJ, Cho SS, Yang J. Study on sodium reduction: ‘Healthy Restaurant for Sodium Reduction’. J Korean Diet Assoc. 2014; 20(3):174–182.

38. Kim ES, Yim GS, Choi KS, Jeong GH, Lee MY, Ryu SH, Yoon EK. A guideline for sodium reduction of processed foods. Food Sci Ind. 2016; 49(2):8–17.

39. 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(1):26–33.

40. Lee JW, Cho HS. Nutrient intake status of Koreans by income level and age group analyzed from 2001 national health and nutrition survey data. J Community Nutr. 2004; 6(2):67–77.

41. Kim HY. Activation of nutrition labeling in food and restaurant industry for sodium reduction. Food Sci Ind. 2011; 44(1):28–38.

42. Kim MK, Han JI, Chung YJ. Dietary behavior related to salty food intake of adults living in a rural area according to saline sensitivity. Korean J Nutr. 2011; 44(6):537–550.

43. Korea Health Industry Development Institute. National food & nutrition statistics [Internet]. Cheongwon: Korea Health Industry Development Institute;2013. cited 2017 Jun 2. Available from: https://www.khidi.or.kr/kps/dhraStat/result16?menuId=MENU0 1670&gubun=ageall&year=2014&category=sodium.

44. Choi MK. An analysis of groups with diet problems associated with dining out. Korean J Food Nutr. 2008; 21(4):536–544.

45. Seoul Metropolitan Government. Campaign for “Let's eat the healthy kimchi” [Internet]. Seoul: Seoul Metropolitan Government;2009. cited 2017 Jun 5. Available from: http://spp.seoul.go.kr/main/news/news_report_body.jsp?searchType=ALL&searchWord=&list_start_date=&list_end_date=&pageSize=10&branch_id=&branch_child_id=&pageNum=1225&communityKey=B0158&boardId=1626&act=VIEW.

46. Ministry of Food and Drug Safety (KR). Campaign for “You can choose meals that are low in sodium” [Internet]. Cheongju: Ministry of Food and Drug Safety;2014. cited 2017 Jun 5. Available from: http://www.mfds.go.kr/index.do?x=0&searchkey=title:contents&mid=675&searchword=나트륨&y=0&division=&pageNo=5&seq=26007&sitecode=1&cmd=v.

47. Ministry of Food and Drug Safety (KR). Campaign for “Day for eating meals without soup or stew” [Internet]. Cheongwon: Ministry of Food and Drug Safety;2013. cited 2017 Jun 5. Available from: http://www.mfds.go.kr/index.do?mid=675&seq=19905&cmd=v.