Adherence to the salt restriction diet among people with mildly elevated blood pressure

Korhonen, MH; Litmanen, Hannu; Rauramaa, R.; Väisänen, SB; Niskanen, Leo; Uusitupa, M

doi:10.1038/sj.ejcn.1600869

Cited by 48 publications

(46 citation statements)

References 26 publications

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“…Another study showed that selfmonitoring of urinary salt excretion at home, using chloride titrator strips, could, in conjunction with dietary counseling, facilitate compliance with a reduced salt intake (19). However, another report indicated that short counseling sessions with advice on salt restriction were not successful in producing dietary changes (5). Taken together, these results suggest that repeated monitoring of urinary salt excretion, along with providing feedback to patients, is the most important and practical way to achieve the reduction of salt intake in individual hypertensives.…”

Section: Discussionmentioning

confidence: 99%

“…Salt restriction is now also widely promoted as an effective non-pharmacological approach to managing mild hypertension, as well as an important adjunct to pharmacological treatment in moderate and severe hypertension (3)(4)(5)(6)(7). The seventh report of the Joint National Committee (JNC 7) recommends sodium reduction to a level of no more than 100 mmol/day in hypertensive patients (8).…”

Section: Introductionmentioning

confidence: 99%

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Relationship between the Awareness of Salt Restriction and the Actual Salt Intake in Hypertensive Patients

et al. 2004

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A 24-h home urine collection was conducted to estimate accurate salt intake in hypertensive outpatients.Using 24-h urinary creatinine excretion as a criterion for success, urine samples were obtained from 534 hypertensive patients. The urinary salt excretion of hypertensive outpatients ranged widely from 1.5 to 23.4 g/day (mean value 9.7 3.9 g/day). Urinary salt excretion was higher in males than in females (10.6 4.0 vs. 9.2 3.7 g/day, p 0.01). Based on the questionnaires, the patients were divided into salt-conscious patients, or those who were careful to reduce their daily salt intake, and non-salt-conscious patients. It was found that urinary salt excretion was lower in the salt-conscious group than in the non-salt-conscious group

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship between the Awareness of Salt Restriction and the Actual Salt Intake in Hypertensive Patients

et al. 2004

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“…However, adherence to reduced sodium regimens has generally been low. Simple advice provided at health care settings, even when given at every visit, tends to have low effectiveness (4)(5)(6)(7). With intensive counseling, only 20% to 40% of participants in sodium reduction trials reduce their sodium intakes to below the recommended upper limit of 2,300 mg/day (100 mmol/day) (7)(8)(9)(10).…”

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confidence: 99%

Acceptability of Sodium-Reduced Research Diets, Including the Dietary Approaches to Stop Hypertension Diet, among Adults with Prehypertension and Stage 1 Hypertension

Karanja¹,

Lancaster²,

Vollmer³

et al. 2007

Journal of the American Dietetic Association

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Objective-Examine the acceptability of sodium-reduced research diets.Design-Randomized crossover trial of three sodium levels for 30 days each among participants randomly assigned to one of two dietary patterns.Participants/setting-Three hundred fifty-four adults with prehypertension or stage 1 hypertension who were participants in the Dietary Approaches to Stop Hypertension (DASHSodium) outpatient feeding trial.Intervention-Participants received their assigned diet (control or DASH, rich in fruits, vegetables, and low-fat dairy products), each at three levels of sodium (higher, intermediate, and lower) corresponding to 3,500, 2,300, and 1,200 mg/day (150, 100, and 50 mmol/day) per 2,100 kcal. Copyright © 2007 by the American Dietetic AssociationAddress correspondence to: Eva Obarzanek, PhD, RD, Research Nutritionist, National Heart, Lung, and Blood Institute, 6701 Rockledge Dr, Room 10018, Bethesda, MD 20892. obarzane@nhlbi.nih.gov. NIH Public AccessAuthor Manuscript J Am Diet Assoc. Author manuscript; available in PMC 2011 November 17. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMain outcome measures-Nine-item questionnaire on liking and willingness to continue the assigned diet and its level of saltiness using a nine-point scale, ranging from one to nine.Statistical analyses performed-Generalized estimating equations to test participant ratings as a function of sodium level and diet while adjusting for site, feeding cohort, carryover effects, and ratings during run-in.Results-Overall, participants rated the saltiness of the intermediate level sodium as most acceptable (DASH group: 5.5 for intermediate vs 4.5 and 4.4 for higher and lower sodium; control group: 5.7 for intermediate vs 4.9 and 4.7 for higher and lower sodium) and rated liking and willing to continue the DASH diet more than the control diet by about one point (ratings range from 5.6 to 6.6 for DASH diet and 5.2 to 6.1 for control diet). Small race differences were observed in sodium and diet acceptability.Conclusions-Both the intermediate and lower sodium levels of each diet are at least as acceptable as the higher sodium level in persons with or at risk for hypertension.Reducing salt consumption lowers blood pressure both in short-and long-term studies (1,2). The effect is greater among individuals with hypertension than those with normal blood pressure and among African Americans compared with whites (1-3). However, adherence to reduced sodium regimens has generally been low. Simple advice provided at health care settings, even when given at every visit, tends to have low effectiveness (4-7). With intensive counseling, only 20% to 40% of participants in sodium reduction trials reduce their sodium intakes to below the recommended upper limit of 2,300 mg/day (100 mmol/day) (7-10).Researchers speculate that patients and research participants have difficulty adopting reduced-sodium diets because they are largely asymptomatic and may fail to perceive a benefit from a diet that they may consider too restrictive...

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“…The findings of the present study are consistent with these reports. However, more vigorous intervention, including group meetings and a free supply of low-salt bread, did reduce salt excretion (11,12). Although single-session dietary counseling by dieticians in addition to simple counseling by attending physicians may seem to be unproductive efforts, particularly in patients who consume large amounts of salt despite repeated instructions by their attending physicians (Fig.…”

Section: Discussionmentioning

confidence: 99%

Effects of single-session dietary counseling by dieticians on salt reduction in cardiology outpatients who consumed large amounts of salt

Yamasaki¹,

Sadanaga²,

Hirota³

2015

Experimental and Therapeutic Medicine

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Abstract. The purpose of the present study was to assess the effects of single-session dietary counseling on salt restriction in Japanese cardiology outpatients as assessed using spot urine measurements. A total of 72 patients (73±11 years old, including 30 females) who visited a cardiology outpatient clinic and had a salt intake of >8 g/day were included in this study. The patients received dietary counseling for salt restriction by expert dieticians at the time of enrollment. The daily dietary salt intake was estimated using the spot urine test at baseline prior to dietary counseling, at 3-9 weeks (next office visit), and at 24-52 weeks during follow-up evaluations. The baseline level of estimated salt excretion was 11.3±1.5 g/day, which was reduced to 9.6±2.3 g/day (P<0.01) at 3-9 weeks, but increased again at 24-52 weeks to 10.4±2.1 g/day, which was less than the baseline value (P=0.034 vs. 3-9 weeks; P=0.025 vs. baseline). The numbers of patients who achieved salt excretion levels of <6.0 and <8.0 g/day at 3-9 weeks were 4 (5.6%) and 19 (26%) patients, respectively, and were further reduced to no patients (0%; P=0.043 vs. 3-9 weeks) and 9 (13%; P=0.035 vs. 3-9 weeks) patients at 24-52 weeks of follow-up evaluation, respectively. In conclusion, the efficacy of dietary counseling by expert dieticians in restricting the salt intake of patients who consumed large amounts of salt was modest and temporary. Multiple nutritional-and behavioral-oriented approaches should be considered to achieve further reductions in salt intake. IntroductionDietary salt restriction is recommended for the prevention of cardiovascular disease in patients with hypertension and heart failure as well as in the general population (1,2). However, salt reduction is challenging to achieve in the real world, particularly in countries in which salt consumption is extremely high, such as Japan. We have previously reported that the estimation of salt intake using the spot urine method may be a useful tool to motivate patients to reduce their salt intake for 8-26 weeks (3), and the efficacy of this method was found to be maintained at long-term (up to 2 years) follow-up (4). However, the percentage of patients who could achieve a reduction in salt intake to the recommended level was very low (<10-15%) (3,4). In particular, patients who habitually consume large amounts of salt at baseline find it difficult to reduce salt intake to the recommended level regardless of gender, age and body weight (4). This might be partly explained by the lack of dietary counseling by expert dietitians in the majority (93%) of the patients included in the previous study (4).The purpose of the present study was to assess the effects of single-session dietary counseling on salt reduction in addition to the spot urine-guided salt reduction approach in outpatients who consumed large amounts of salt. Materials and methodsPatients. This was a prospective observational study of patients who visited the outpatient cardiology clinic of Ueki Hospital (Kumamoto, Japan) between...

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Adherence to the salt restriction diet among people with mildly elevated blood pressure

Cited by 48 publications

References 26 publications

Relationship between the Awareness of Salt Restriction and the Actual Salt Intake in Hypertensive Patients

Relationship between the Awareness of Salt Restriction and the Actual Salt Intake in Hypertensive Patients

Acceptability of Sodium-Reduced Research Diets, Including the Dietary Approaches to Stop Hypertension Diet, among Adults with Prehypertension and Stage 1 Hypertension

Effects of single-session dietary counseling by dieticians on salt reduction in cardiology outpatients who consumed large amounts of salt

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