Dietary salt reduction in rural patients with albuminurea using family and community support: the Mima study

Abstract

BackgroundResidents of rural communities are often more socially connected compared to urban dwellers. Using family and community support to motivate health behavior change may be useful in rural settings. The objective of this study was to pilot a salt reduction (SR) intervention for rural albuminuria patients using support from family and neighborhood residents compared to a usual care condition. The primary outcome was change in urine albumin-creatinine ratio (ACR).MethodsAll consecutive outpatients with an ACR >= 30 mg/gCr were recruited from the Koyadaira Clinic. Patients self-selected their participation in the intervention group (IG) or the control group (CG) because the rural population expressed concern about not being treated at the same time. In the IG, patients and their families were educated in SR for 30 minutes in their home by experienced dieticians. In addition, patients, families and neighborhood residents were also educated in SR for 2 hours at a public town meeting hall, with educational content encouraging reduction in salt intake through interactive activity. The CG received conventional treatment, and ACR and blood pressure (BP) were measured after 3 months.ResultsOf the 37 subjects recruited (20 male, 16 female, mean age; 72.8 ± 9.2 years), 36 completed the 3-month follow up and were analyzed. In the IG, ACR decreased significantly from baseline (706 ± 1,081 to 440 ± 656; t = 2.28, p = 0.04) and was reduced compared to the CG (213 ± 323 to 164 ± 162; F = 3.50, p = 0.07), a treatment effect approaching significance. Systolic BP in the IG (145 ± 14 to 131 ± 13 mmHg; t = 3.83, p = 0.002) also decreased significantly compared to the CG (135 ± 13 to 131 ± 14; F = 4.40, p = 0.04).ConclusionsSimultaneous education of patients, their families and neighborhood residents may be important in rural areas for treatments and interventions requiring health behavior change.Trial registrationUMIN000001972

Effect of salt reduction interventions in lowering blood pressure: A comprehensive systematic review and meta-analysis of controlled clinical trials

“…Most of the studies included both genders, two recruited only females [ 34 , 38 ], and one study included only males [ 39 ]. Of the 50 trials, 25 assessed the effects of the interventions among hypertensive participants [ 23 , 24 , 26 , 29 – 31 , 39 , 42 – 50 , 52 – 54 , 58 ], three among normotensive individuals [ 30 , 34 , 35 ], and 22 among both hypertensive and normotensive participants [ 21 , 22 , 25 , 27 , 28 , 31 , 33 , 36 – 38 , 40 , 41 , 51 , 55 – 57 , 59 , 60 ]. In 29 studies, BP was measured with an automatic sphygmomanometer, in five with a manual mercury sphygmomanometer [ 31 , 40 , 42 , 49 , 53 ], and six studies did not report BP measurement method [ 22 , 30 , 48 , 51 , 59 , 60 ].…”

“…Of the 50 trials, 25 assessed the effects of the interventions among hypertensive participants [ 23 , 24 , 26 , 29 – 31 , 39 , 42 – 50 , 52 – 54 , 58 ], three among normotensive individuals [ 30 , 34 , 35 ], and 22 among both hypertensive and normotensive participants [ 21 , 22 , 25 , 27 , 28 , 31 , 33 , 36 – 38 , 40 , 41 , 51 , 55 – 57 , 59 , 60 ]. In 29 studies, BP was measured with an automatic sphygmomanometer, in five with a manual mercury sphygmomanometer [ 31 , 40 , 42 , 49 , 53 ], and six studies did not report BP measurement method [ 22 , 30 , 48 , 51 , 59 , 60 ]. Furthermore, in all the studies, BP measurement was performed by health professionals or trained personnel, with the exception of three studies that relied solely upon self-reported measures [ 34 , 35 , 47 ].…”

“…Furthermore, in all the studies, BP measurement was performed by health professionals or trained personnel, with the exception of three studies that relied solely upon self-reported measures [ 34 , 35 , 47 ]. The included studies employed different types of intervention strategies that were categorized into four domains; 21 trials with nutritional education [ 21 , 28 , 31 , 38 , 40 – 42 , 46 , 49 , 50 , 52 , 55 , 56 , 59 – 61 ], 17 used salt substitutes [ 23 , 25 – 27 , 29 – 31 , 33 , 43 – 45 , 54 , 58 ], ten used self-help materials [ 34 – 37 , 39 , 47 , 48 , 51 , 53 , 57 ], and two trials employed food reformulation [ 22 , 24 ]. The control groups of all trials received usual care or no intervention.…”

“…According to the quality criteria mentioned in the methods section, 18 studies were regarded as high-quality [ 22 , 23 , 25 , 27 – 30 , 36 , 37 , 43 – 46 , 51 , 53 , 57 , 61 ], 18 as moderate [ 21 , 24 , 26 , 31 , 33 – 35 , 38 , 39 , 41 , 42 , 47 – 50 , 54 , 56 , 58 – 60 ], and two studies as low-quality [ 40 , 55 ]. All RCTs described the randomization, of which 4 studies had an inappropriate random allocation method [ 39 , 40 , 50 , 54 ], and 17 studies did not provide precise information of randomization [ 24 , 26 , 34 , 35 , 38 , 41 , 44 , 45 , 55 , 56 , 58 – 60 ]. While 15 studies used allocation concealment to prevent selection bias [ 23 , 27 – 30 , 37 , ...…”

“…Furthermore, in several trials, participants and personnel’s blinding was not completely applicable due to the nature of the intervention strategies, such as education and self-help materials. In addition, 29 articles that described dropouts and their causes and also group differences in terms of dropout were considered as low risk of bias [ 21 – 26 , 28 – 30 , 36 – 40 , 42 – 45 , 47 , 48 , 50 – 54 , 56 , 57 , 60 , 61 ]. Moreover, 11 studies had incomplete outcome data [ 27 , 31 , 33 – 35 , 41 , 46 , 49 , 55 , 58 , 59 ].…”