Dietary Reference Intakes of sodium for Koreans: focusing on a new DRI component for chronic disease risk reduction

Hyun Ja Kim,Yeon-Kyung Lee,Hoseok Koo,Min-Jeong Shin 한국영양학회 2022 Nutrition Research and Practice Vol.16 No.no.sup1

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 effect of salt usage behavior on sodium intake and excretion among Korean women

Jeung Yun Lee,Dong Sook Cho,Hyun Ju Kim 한국영양학회 2012 Nutrition Research and Practice Vol.6 No.3

This study was done to explore the effect of Korean women’s salt usage behavior on their sodium intake and excretion according to aging. Dietary sodium intake and salt usage behavior were analyzed to compare the difference between young and middle-aged women. One hundred fifty six young women and 77 middle-aged women without hypertension or any current medication were recruited. Body mass index, waist hip ratio, blood pressure were measured from each subject. Salt usage behaviors were surveyed with questionnaire, sodium intake with 24-hr recall method, and sodium excretion with spot urine. Middle-aged women were more obese than young women according to body mass index and waist hip ratio. Blood pressure was significantly higher for the middle-aged. Young women consumed more fats and middle-aged women more carbohydrates. Middle-aged women consumed more sodium and potassium, and excreted more sodium. Among questionnaire items, kimchi, soup or pot stew, or salted vegetables were found to be related with high sodium diet. Salted vegetables and salted nuts and potato chips were significantly correlated with young women’s high sodium diet, while soy sauce on fried food, kimchi, salted vegetables accounted for middle-aged women’s high sodium diet. With these results, we concluded that middle-aged women consumed more carbohydrates, less fat, and more sodium and potassium than young women. Middle-aged women frequently choose kimchi, soup or pot stew, or salted vegetables, and they contribute to high sodium intake. We recommend to choose low-salt kimchi, less soup or pot stew, and more fresh vegetables for lower sodium diet.

나트륨 저감 제품에 대한 태도, 수용도 및 나트륨 인지가 나트륨 저감 식품 구매의도에 미치는 영향 - 식품전문가를 중심으로 -

이보나,김진우,Lee, Bo-Na,Kim, Jin-woo 한국식품영양학회 2016 韓國食品營養學會誌 Vol.29 No.1

This research study aimed to examine the seriousness related to sodium over intakes that is becoming a global issue, evaluate how the recognition of sodium-reduced products and its acceptance can influence the intention of purchasing sodium-reduced products, and generate basic data for establishment of marketing strategy of campaigns such as reducing sodium intake and commercialization of sodium-reduced products. According to the results of the research, the acceptance of sodium-reduced products significantly influenced the purchasing intention of sodium-reduced products, while the attitude towards sodium and recognition of sodium did not significantly influence the purchasing intention of sodium-reduced products. Extension of these research findings to ordinary people and the analysis of main causes that affect the recognition of sodium-reduced products and purchasing intention provide a solid basis for efficient sodium-reduction publicity and development of directions for campaigns.

Controlled Conversion of Sodium Metal From Nuclear Systems to Sodium Chloride

Herrmann, Steven,Zhao, Haiyan,Shi, Meng,Patterson, Michael Korean Radioactive Waste Society 2021 방사성폐기물학회지 Vol.19 No.2

A series of three bench-scale experiments was performed to investigate the conversion of sodium metal to sodium chloride via reactions with non-metal and metal chlorides. Specifically, batches of molten sodium metal were separately contacted with ammonium chloride and ferrous chloride to form sodium chloride in both cases along with iron in the latter case. Additional ferrous chloride was added to two of the three batches to form low melting point consolidated mixtures of sodium chloride and ferrous chloride, whereas consolidation of a sodium-chloride product was performed in a separate batch. Samples of the products were characterized via X-ray diffraction to identify attendant compounds. The reaction of sodium metal with metered ammonium chloride particulate feeds proceeded without reaction excursions and produced pure colorless sodium chloride. The reaction of sodium metal with ferrous chloride yielded occasional reaction excursions as evidenced by temperature spikes and fuming ferrous chloride, producing a dark salt-metal mixture. This investigation into a method for controlled conversion of sodium metal to sodium chloride is particularly applicable to sodium containing elevated levels of radioactivity-including bond sodium from nuclear fuels-in remote-handled inert-atmosphere environments.

성남 지역 외식업소의 나트륨 저감화 현황과 종사자의 저감화 실행에 대한 인식 및 실천용이도

안소현,권종숙,김경민,이윤나,김혜경 한국영양학회 2019 Journal of Nutrition and Health Vol.52 No.5

Purpose: With the increase of going out to eat, reducing the sodium in restaurant foods has a crucial impact on reducing sodium intake. This study aimed to assess the current status and perceptions of restaurant staffs related to reducing sodium use in restaurants. Methods: Restaurant managers and chefs (n=312) in Seongnam area completed a questionnaire on the current status related to sodium use, the barriers to practice for reducing sodium use, support needs, and the practicability of methods for reducing sodium use in restaurants. Results: The percentage of restaurants in the preaction stage (including the precontemplation, contemplation, and preparation stages) for reducing sodium use was 79.7%. Logistic regression analysis showed that measuring salinity while cooking was associated with measuring seasoning (OR, 4.761; 95% CI, 2.325~9.751), action/maintenance stages of behavior change (OR, 2.829; 95% CI, 1.449~5.525) and providing salinity information of restaurant foods (OR, 6.314; 95% CI, 2.964~13.45). Maintaining taste and hindering the cooking process were the main barriers to reduce sodium use. The total practicability of actions for reducing sodium was higher in staffs who worked in restaurants that measured seasoning and salinity while cooking (p<0.05 and p<0.01, respectively). The hardest item to practice was ‘purchase foods after comparing sodium content in the nutrition labeling’. ‘Avoid serving salt-fermented foods as side dishes’, ‘serve small portions of kimchi and less salty kimchi’, and ‘put up promotional materials for reducing sodium intake’ were selected as easy items to perform. The majority (82%) was willing to reduce sodium in restaurant foods under the support of local government and they desired the promotion of participating restaurants and education on cooking skills to reduce sodium. Conclusion: Measuring seasoning and salinity while cooking is a meaningful practice that is associated with stages of behavior change and the practicability of actions for reducing sodium. It is necessary to provide support and education with a gradual approach to staffs for reducing sodium in restaurant foods.

6개월간의 저염식이 여자 대학생의 짠맛에 대한 인지와 기호, 혈압 및 뇨 나트륨 배설량에 미친 영향

장순옥(Chang Soon-Ok) 韓國營養學會 2010 Journal of Nutrition and Health Vol.43 No.5

본 연구는 여자대학생을 대상으로 장기간의 자율적 저염식 실시가 짠 맛에 대한 인지와 기호에 영향을 미쳐 나트륨 섭취나 혈압에 변화를 가져 올 수 있는지를 조사하고자 실시되었다. 14명의 실험군 대상자들은 나트륨 관련 영양교육과 정보를 제공받아 저염식을 하도록 지시 받았고 10명의 대상자는 평상시의 식생활을 유지하도록 하였다. 짠 맛의 인지와 기호는 9점 척도의 관능검사로 평가하였고 뇨 나트륨 배설량과 최적 염미 나트륨 정량 분석하였으며 혈압을 측정하였다. 주요 연구 결과는 아래와 같다. 1) 연구 시작시의 실험군과 대조군은 나트륨 관련 식행동, 신체 계측치, 혈압, 24시간 회상법에 의한 나트륨 섭취량, 6단계의 염분용액에 대한 짠 맛 인지나 기호에서 차이가 없었다. 2) 6개월의 저염식 실시 후 실험군 대상자들은 0.5% 이하 염분 용액에서 짠 맛 인지도가 높아졌고 대조군은 낮아져 저염식 실시로 낮은 농도의 염분에 적응한 듯하나 연구 시작과 종료시의 paired t-test에서 통계적 유의성은 없었다. 기호도는 시작 시에는 두 군 모두 0.5% 염분 용액을 가장 선호했고 연구 종료시 대조군은 0.75%와 0.5% 염분 용액에 비슷한 기호도를 보인 반면 실험군은 0.5%, 그 다음으로 0.3% 용액에 높은 기호도를 보였으나 그 변화가 유의적 수준은 아니었다. 3) 최적 염미 나트륨 농도는 실험군에서 105.6 m㏖에서 저염식 적응 후 80.7 ㎜ol로 유의적 (p = 0.015) 감소를 보였고 대조군은 변화가 없었다. 뇨 나트륨 배설량은 대조군은 연구 시작과 종료시 차이가 없었고 실험군은 연구 종료시 1,398 ㎎에서 906 ㎎으로 유의적 감소를 하였다. 4) 수축기 혈압은 실험군 대상자에서 111 ㎜Hg에서 106 ㎜Hg로 유의적으로 감소하였고 이완기 혈압은 대조군, 실험군 모두에서 유의적으로 감소하였다. 혈압과 뇨 나트륨 배설량은 상관관계를 나타내지 않았다. 5) 최적 염미 나트륨 농도와 뇨 나트륨 배설량은 양의 상관관계 (r = 0.418)을 보여 짠 맛에 대한 기호가 나트륨 섭취량에 영향을 미친 것으로 보인다. 최적 염미 나트륨 농도와 뇨 나트륨 배설량은 0.5% 이하의 낮은 염분 용액에 대한 짠 맛의 인지와는 음의 상관관계 (r = -0.338~-0.399)를 보여 저염식을 하는 대상자는 낮은 염도에도 잘 반응함을 보여 주었다. 본 연구의 대상자들은 6개월 간의 실험 경과 후 최적 염미도와 뇨 중 나트륨 배설량에서는 대조군과 실험군의 차이가 분명하였고 관능검사 결과는 0.5% 이하의 저염 농도에 실험군 대상자들이 짠 맛 인지와 기호도가 유의적이지는 않으나 향상하였다. 혈압은 수축기 혈압이 실험군에서만 유의적으로 감소하여 전반적으로 6개월 간의 저염식 적응이 유효한 듯하다. 그러나 본 연구결과만으로는 저염식에 적응해가는 변화과정을 알 수 없고 분석 자료의 표준편차로 보아 개인차 커 일부 비적응자가 있었음을 알 수 있다. 앞으로 저염 적응 기간 중 개인별 반응과 함께 여러 시점에서의 관찰이 필요하다고 본다. The study aim was to examine the effect of sensory responses of subjects after 6-month dietary sodium reduction with the aid of nutritional education. Fourteen female college students voluntarily restricted their sodium intake for 6 months, during which time they received nutritional education on the low sodium diet. As a control group, 10 students, whose anthropometric measurement, sodium intake behavior, and blood pressure were not different from those of the experimental group, were maintained on a normal diet. For the sensory responses of subjects, the salt taste perception and pleasantness for graded (0.15-1.3%) NaCl solutions were measured by a 9-point hedonic scale. The optimum sodium concentration, urinary sodium excretion, and blood pressure were measured. All the measurements were done at the beginning and end of the experiment. The sensory evaluation revealed an absence of any difference between the two groups in salt taste perception and pleasantness responses at the beginning. After 6-month adaptation, the experimental group subjects showed higher responses to low NaCl solution (0.15, 0.3, 0.5%) in salt taste perception and pleasantness evaluation while the control group subjects exhibited the opposite response. The optimum sodium concentration was reduced from 105.6 m㏖ to 80.7 m㏖ (p = 0.015) and the urinary sodium excretion was also reduced from 1,398 ㎎ to 906 ㎎ (p = 0.041) only in the experimental group. Systolic blood pressure was significantly reduced in the experimental group, although there was no correlation between the urinary sodium excretion and blood pressure. The optimum sodium concentration was negatively correlated with the urinary sodium excretion (r = 0.418, p = 0.053), indicating that adaptation to low sodium diet can reduce sodium intake. Further study on the individual responses of subjects on a low sodium diet by periodical evaluation may provide useful data for setting the duration needed to stabilize a lowered appetite for sodium.

한국식품의 營養成分에 관한 硏究 : 나트륨, 칼륨 함량 측정 Determination of Sodium and Pstassium Concentrations

權赫姬,金達秀,金素姬,權五蘭,金吉女,尹寶奎,崔惠淑 국립보건연구원 1992 국립보건원보 Vol.29 No.2

Ecabet Sodium의 추가가 Helicobacter pylori 일차 삼제 요법의 제균율에 미치는 효과

김지연,이동호,손준혁,김재연,권지은,박영수,김나영,신철민,정현채,송인성 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.6

Background/Aims: Ecabet sodium is known for its bactericidal effect against H. pylori. It was reported that a supplement of ecabet sodium to conventional triple therapy showed good results in Asia. The Aim of this study was to ascertain the efficacy of additional ecabet sodium on conventional triple therapy for eradication of H. pylori. Methods: We reviewed the cases of 111 patients (Group A) with H. pylori infection who received ecabet sodium with triple therapy (20 mg of rabeprazole, 1 g of amoxicillin, 500 mg of clarithromycin and 1 g of ecabet sodium, twice daily for 7 days). Another 186 patients (Group B) received PPI-based triple therapy (same as the above, except without the ecabet sodium). Eradication was evaluated 4 weeks later after completion of treatment by ^(13)C-UBT. Results: Eradication rates were 74.8% (83/111) in group A and 70.4% (131/186) in group B by intention-to-treat analysis (p=0.420), and 75.2% (82/109) in group A and 70.7% (128/181) in group B by per protocol analysis (p=0.405). Conclusions: The addition of ecabet sodium to conventional triple therapy did not increase the eradication rate of H. pylori in this study. These findings imply that ecabet sodium as an additional agent cannot overcome antibiotic resistance, which is the most important cause of failure of triple therapy. 목적: Ecabet sodium은 Helicobacter pylori에 대하여 항균성을 가지고 있다. 최근 아시아에서 ecabet sodium을 기존의 프로톤펌프 억제제를 기반으로 하는 삼제 요법에 추가하여 제균율을 증가시켰다는 보고들이 있다. 본 연구에서는 한국인 환자에서 ecabet sodium을 삼제 요법에 추가하여 H. pylori의 제균율에 대한 영향을 확인하고자 하였다. 대상 및 방법: H. pylori에 감염된 환자들 중 111명은 기존의 삼제요법에 ecabet sodium을 추가하여 치료하였고(rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, ecabet sodium 1 g, 1일 2회, 7일 간)(Group A), 186명은 삼제 요법으로 치료하였다(rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, 1일 2회, 7일간)(Group B). 투약이 완료된 4주 뒤에 제균 여부를 ^(13)C-요소 호기 검사로 확인하였다. 결과: 결과는 후향적으로 분석하였고, 제균율은 intention to treat 분석 시 Group A에서 74.8%(83/111)였고, Group B에서 70.4%(131/186)(p=0.420)이었다. Per protocol 분석 시에는 Group A에서 75.2%(82/109)였고, Group B에서 70.7%(128/ 181)(p=0.405)이었다. 결론: 본 연구에서는 Ecabet sodium을 기존의 프로톤펌프 억제제를 기반으로 하는 삼제 요법에 추가하여도 제균율이 증가하지 않았다. 이것은 ecabet sodium의 추가가 최근의 항생제 내성을 극복하지 못한 것으로 생각된다.

방문건강관리사업 영양사의 나트륨 관련 인식도, 식태도, 저감화 교육 요구도

모윤정(Yun Jeong Mo),김숙배(Sook Bae Kim) 대한지역사회영양학회 2014 대한지역사회영양학회지 Vol.19 No.6

The purpose of this study was to investigate recognition, dietary attitude and education needs for reducing sodium intakes of dietitian at customized home visiting health service (CHVHS). Methods: The subjects were 75 dietitian at CHVHS. We investigated several variables (recognition, dietary attitude, education needs for reducing sodium intakes) and determined sodium intakes level of subjects as ‘low’, ‘middle’ and ‘high’ by Dish Frequency Questionnaire 25 (DFQ 25). Also, we assessed the differences in recognition, dietary attitude, sodium intake level and education needs by dietitian career period (under 3 yrs vs. over 3 yrs) at CHVHS. Results: In recognition related reducing sodium intake, they showed ‘checking a sodium content in nutrition labeling’ score 2.5/4.0 and ‘perception difference between sodium and salt’ score 3.1/4.0. There was no difference in the recognition between under 3yrs’ group and over 3yrs’ group. In dietary attitude related reducing sodium intake, they showed ‘palatability for salty taste’ score 0.8/1.0, ‘attitude in related soups’ 0.7/1.0, ‘attitude in related using natural spice’ 0.6/1.0. There was a difference in ‘attitude in related soups’ between under 3yrs’ group and over 3yrs’ group (0.6 vs. 0.7). In sodium intake level by DFQ 25, they showed ‘low group’ 41.3%, ‘middle group’ 41.3% and ‘high group’ 17.3%. There was no difference in the distribution of sodium intake level by the career. In education needs related reducing sodium intakes, there were ‘teaching experience’ 93.3%, ‘have a difficulty in teaching about reducing sodium intakes’ 86.6%, and ‘necessity of education for CHVHS dietitians’ 100.0%. ‘Needed education contents for CHVHS dietitians’ were ranked as ‘cooking way to reduce sodium intake’ 58.7%, ‘relation between hypertension and sodium’ 17.3%, ‘composing way to reduce sodium intake’ 17.3%. There was a difference in needed education contents ‘relationship between hypertension and sodium’ (33.3% vs. 2.6%) and ‘The cooking way to reduce sodium intake’ (38.9% vs. 76.9%) by the career. Conclusions: The results suggested that a capacity training program for reducing sodium intake may be needed for dietitians at CHVHS to improve health of the community elderly. For effective training program related reducing sodium intake for dietitians at CHVHS, it may be necessary to consider the career period as dietitians at CHVHS.

요석의 형성에 있어서 요중 Sodium의 영향

이상철 충북대학교 의과대학 충북대학교 의학연구소 2003 忠北醫大學術誌 Vol.13 No.2

연구목적: 나트륨(Sodium)은 직접적인 요석의 성분은 아니나 요석형성의 촉진자 역할을 하는 것으로 알려져 있다. 본 연구에서는 환자-대조군 연구를 통한 요석환자에서 요중 나트륨과 결정 형성물질과의 관계를 조사하여 그 역할을 규명하고자 하였다. 대상 및 방법: 요석 환자 746명(남자 503명, 여자 243명)과 요석의 과거력이 없는 정상 지원자 101명(남자 50명, 여자 51명)을 대상으로 하였으며, 24시간 소변을 채취하여 요량, 나트륨, 인, 칼슘, 마그네슘, 수산 및 구연산을 측정하였다. 각 군에서 나트륨의 평균 배설량을 비교하였고 또한 다른 요석형성 물질 몇 임상적 특징들과의 비교를 통하여 요석형성에 있어서 요중 나트륨의 역할을 조사하였다. 결과: 고나트륨뇨증은 환자군에 46.6%, 대조군에서 42.6%로 높게 관찰되었으나 두 군 사이에 평균 배설량에는 차이를 보이지 않았다. 요중 나트륨의 배설은 칼슘의 배설 및 요산도의 증가와 의미있는 상관성을 나타내었으며 나트륨이 100 mEq 증가할 때마다 칼슘은 53.2 mg씩 증가하는 것으로 조사되었다. 이전의 보고들과는 달리 구연산의 배설 역시 나트륨의 배설에 양의 상관성을 보였다. 임상적 특징들과의 비교에서는 연령이 증가함에 따라 의미 있게 나트륨의 배설을 감소시키는 것으로 조사되었다. 결론: 이러한 결과로 볼 때 요중 나트륨의 배설 증가 그 자체만으로는 요석의 위험인자로 보기는 어렵다. 그러나 나트륨의 요중 칼슘 배설을 증가시키는 효과는 상당하며 따라서 요석의 재발을 막기 위한 방법으로, 특히 고칼슘뇨증을 동반하는 환자에서는 저염식의 권장이 가장 먼저 시행할 수 있는 조치라고 생각한다. Purpose: High dietary sodium from salt abuse has been a well recognized environmental or nutritional risk factor for kidney stone formation and may promote a variety of metabolic changes that may detrimental to stone formers. This study was to determine the influence of urinary sodium on urolithiasis as a risk factor through the patients-control study. Materials and Methods: The 24-hour urine specimens of 746 stone formers (503 men and 243 women) and 101 normal volunteer (50 men and 51 women) who had no history of kidney stones were analyzed for sodium, phosphorus, calcium, magnesium, oxalate, pH and citrate. The roles of urinary sodium were determined by comparing the mean excretion of sodium in each group and by investigating the relationship with other lithogenic factors and clinical characteristics. Results: Although the incidence of hypernatriuria was as much high as 46.6% of stone formers and 42.6% of normal control, there were no significant differences of mean excretion of sodium in each group. The urinary sodium excretion was directly proprotional to that of calcium and pH. An 100 mEq increase of urinary sodium resulted in 53.2mg rise in urinary calcium excretion. Unexpectedly, direct proportion was also observed between urinary excretion of sodium and citrate. Sodium excretion was slightly decreased with age. Conclusion: These results showed that the increased sodium excretion itself was not a risk factor for urolithiasis but its calciuric action was largely significant. Thus, the dietary restriction of sodium should be considered as a first line approach for the prevention of recurrent urolithiasis, especially in hypercalciurlc stone formers.