https://doi.org/10.24552/00002213 ©青森県立保健大学
Health guidance and food environment improvements to reduce dietary
sodium-to-potassium ratio and changes in awareness, frequency of usage,
and purchase of low-sodium seasonings and foods:
A project in Higashidori Village, Aomori Prefecture
Tatsuya Koyama1）, Teruko Kawabata2）, Masayo Aono3）, Masato Mikuni3）,
Hisashi Kawarada4）, Chikako Michibayashi5）, Masakazu Nakamura2）, Nobuo Yoshiike1）
1） Aomori University of Health and Welfare
2） Japan Association for Development of Community Medicine
3） Higashidori Village Office
4） Higashidori Clinic
5） Gifu University of Medical Science
（Recieved March 22, 2023; Accepted June 9, 2023）
ABSTRACT
［Objective］Higashidori village, Aomori prefecture began projects to reduce the dietary sodium-to-potassium
ratio among its residents through health guidance at the sites of health checkups and food environment
improvements in the community in mid-2021. To evaluate the project, we investigated changes in
participants’ awareness, frequency of usage, and purchase of low-sodium seasonings and foods.
［Methods］A self-administered, anonymous survey was conducted among individuals who underwent
village health checkups in fiscal years（ FY） 2021 and 2022 to assess awareness, frequency of use,
and purchase of low-sodium seasonings and foods. Health checkups have been regularly conducted in June,
September, October, and January of each fiscal year, with most residents thought to undergo health
checkups at the same period and site each fiscal year. New health guidance was implemented in
September 2021 specifically for reducing the dietary sodium-to-potassium ratio. Dietitians conducted
health guidance at health checkup sites through measuring the sodium-to-potassium ratio using spot
urine specimen, providing feedback of results, explaining low sodium foods, and providing them as
incentives. In addition, the food environment was improved with the cooperation of a supermarket
where residents most frequently purchased daily foods, to facilitate the display of information on
lowsodium foods on shopping floor shelves and inside a free shuttle bus for shoppers from the village.
Further, small printed cards showing low-sodium recipes were created, available both at stores and on
the village office website. Two subgroups for comparison were set to evaluate the project: individuals not
receiving health guidance in June 2021 as the “control group” and individuals receiving health guidance
after September 2021 as the “intervention group”. Changes in several indicators from FY2021 to FY2022 in
each subgroup were investigated.
［Results］No significant changes were observed in awareness and frequency of use of low-salt
seasonings in both subgroups. However, the intervention group showed an increased percentage of
individuals purchasing low-salt mentsuyu（ seasoned soy sauce for Japanese noodles）.
［Conclusions］Survey results suggest that health guidance to promote low-salt foods, combined with
food environment improvements, may increase purchases of low-salt foods.
Key words: sodium, potassium, health guidance, food environment improvement, health checkup