Excess sodium Na intake and insufficient potassium K intake are both associated with blood pressure elevation , and their alteration through diet may be an effective strategy to prevent hypertension.
Japanese traditional high-salt condiments, such as soy sauce and miso, are the major sodium sources. Previously, the use of potassium-enriched and sodium-reduced salt was reported to be associated with decreased CVD mortality in a long-term randomized trial in Taiwan . An intervention study in Finland, in which participants used processed foods and salt with less sodium that were rich in magnesium and potassium, demonstrated a significant decrease in BP .
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However, such studies in Japan are limited  and the results are inconclusive. Potassium is contained in many foods, including vegetables and fruits, and can be used in reduced sodium condiments to increase the salty taste . However, higher concentrations yield an acrid taste and may impair acceptability. They could have various uses; hypertensive people who find difficulties in reducing salt, normotensive people who want to prevent future elevation of BP, eating-out or food industries which are often receive criticism that they provide too salty foods.
Residents aged 40 years and older in a rural town in Iwate Prefecture located in north-eastern Japan who participated in an annual specific health check-up in spring were invited to enroll. We held an explanatory meeting before the enrollment and explained that participants would be asked to use potassium-enriched condiments for home cooking, and that they were unable to enroll if any of their family members required potassium restriction because of medical reasons.
The study procedures are shown in Figure 1. Two weeks prior to the beginning of the experimental periods, the study was explained to the participants by trained investigators.
After confirming that no family member required potassium restriction, written informed consent was received from each participant. The assignment was opened to the participants at the beginning of experiment period 1. The trial was conducted from November to December The ethics committee of the Research Institute of Strategy for Prevention approved the study protocol.
Participants brought their own condiments from home in order to make sure they only used the study condiments. Participants were requested to use the study condiments as usual, and were told that they did not have to restrict eating out or manufactured foods, and they were allowed to use other condiments, such as dressings, Worcester sauce, etc. At the end of experimental periods 1 and 2, they returned the remaining study condiments, which were measured to calculate the amount used. Two weeks prior to the beginning of the experimental period, a questionnaire was conducted by trained investigators.
Participants were asked if they were following a reduced salt diet. The number of household members was asked to estimate the amount of condiments to be provided. A short dietary propensity questionnaire SDPQ  was conducted, in which the frequency of food consumption for the previous two weeks was evaluated.
Another SDPQ was performed at the end of experimental periods 1 and 2, and participants were asked if they used the test condiments for foods they had at home as usual. The mean of two blood pressure measurements was used for analysis. Height and weight without shoes were measured. Participants were requested to take first morning spot urine samples on seven consecutive days prior to the beginning of experimental period 1, and during the latter half of experimental periods 1 and 2 Figure 1. The spot urine samples were kept at home and then brought to the study office at the beginning of experimental periods 1 and 2, and at the end of experimental period 2.
The urine samples were placed in a freezer 0 C soon after they were brought to the study office. After all study procedures were finished, all samples were measured in one batch. The amount of condiments used per person per day during the experimental periods were calculated as the amount used within experimental period 1 or 2 divided by number of family members and 14 days.
The results of the SDPQ and amount of condiments used were also compared between the periods.
Analysis of variance was used to compare the urinary results among the tertiles. The significance level was set at 0.
A total of 33 participants 8 men and 25 women were enrolled. All participants completed all study procedures. Their baseline characteristics are presented in Table 2. They had a mean age of On average, they had one bowl of miso-soup per day and did not eat out often. There was no significant difference in E24Na between the periods. There was no significant difference in the systolic or diastolic blood pressure. Food intake as evaluated by SDPQ was similar.
A significantly higher E24Na and lower E24K were observed in the high tertile. The tertiles had similar characteristics i. In each tertile, urinary results in the standard period were similar to those in the run-in period. The results were similar for the adjusted means of the difference; The estimated hr urinary potassium excretion significantly increased, which may help to prevent hypertension.
A higher Na intake and lower K intake in Japan compared with Western countries have been repeatedly reported [8, ]. Although the average Na intake in Japan has decreased with advances in food processing and preservation, there has been no notable decline and the intake remains above the recommended values by WHO10 and related authorities in Japan [12, ]. Moreover, salt reduction by persons following a reduced salt diet was found to be low, Thus, population approaches for salt reduction are needed.
During this period, eating out and use of ready-made dishes became more common due to the economic growth , and the participation of women in the workforce increased . These changes may be partially responsible for the high salt intake and insufficient potassium intake due to decreased fruit and vegetable consumption at home . In the present study, the condiments used at home were changed, but they tasted similar.
We asked participants to use the test condiments at home, and placed no restrictions on eating out or the use of manufactured foods. The average amount of the test soy sauce used was 4. According to a previous population study in Japan, the average amount of consumed soy sauce, including that in restaurant dishes and manufactured foods, was Japanese pickles and salted fish are also important Na sources, with the average salt intake being 1.
The differences may correspond to expected decrease of 1. Participants did not declare any difficulty in using the condiments, thus they would be facilitated in various situations such as home cooking, restaurants, and processed foods. There are some limitations in this study.
To accurately provide the designated condiments to each participant, the study was not blinded, and participants and research investigators knew the type of condiments used during the experimental periods. Thus, there is a possibility that participants altered their food consumption based on the condiments given.
Most of the participants reported that they were following a reduced salt diet and the possibility of a selection bias cannot be excluded. The amounts of test condiments used per person were calculated as the total amount used divided by the number of household members, and we did not separate the amounts consumed by the participant and the other family members.
Thus, the amount used may have been affected by the family members. The body of one its crew was found on top of a building near the square with a partially opened parachute. The airliner's number 3 starboard inner prop sliced off the Dakota's port horizontal stabilizer, while the starboard side of the Viscount was torn open with some passengers sucked out of the fuselage. An attempt to avoid the Dakota by the Viscount crew at the last moment was unsuccessful.
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