INVESTIGATION OF A DIETARY BERAVIOR QUESTIONNAIRE
AS A PREDICTOR OF DIETARY SODIUM INTAKE
A Clinical Research Project
Presented to the Intercollegiate Center for Nursing Education
Washington State University, Spokane, Washington
In Partial Fulfillment of the Requirements for the Degree
Master of Nursing
By
Diane Walker
Spring 1996
11
BETIY M, ANDERSON LIBRARY
JUN 2, 4 1996
We, the undersigned members of the committee,
INTERCUL.LEGIATE CENTER FOR
NURSING EDUCATION
hav read and approved this project
INVESTIGATION OF
DIETARY BEHAVIOR QUESTIONNAIRE AS A
PREDICT R OF DIETARY SODIUM INTAKE
By
Diane Walker
Chair
Date
Committee Members
Intercollegiate Center for Nursing Education
Washington State University, Spokane, Washington
Spring 1996
3
Acknowledgments
No one completes a long and intensive research project such as this one alone, and with
that in mind I want to express my gratitude to all who have given me advice, direction and
support in making this clinical research project possible. I would like to thank my committee
members for their dedication and commitment to helping me succeed. In particular I wish to
acknowledge the help and support of Lorna Schumann, Chairperson, who skillfully guided me
through my Nurse Practitioner Program. She is an inspiration to others for her selflessness and
mentorship to her students. A deep nod of appreciation also goes to Jackie Banasik, whose
guidance in pathophysiology gave me new insights while working on this project. Lastly,
sincere and heartfelt thanks to Linda Massey, who permitted me to assist in her own research,
guided me along as I pursued my own research goals, and along with Lorna and Jackie, was
always there to answer the inevitable questions that always came up. Thanks to you all, for
without you this research project would not have been possible.
I would like to thank the Library staff and Leslie Woodside who have an unparalleled
attitude and have given me support and direction during my time at ICNE.
Most of all, thanks to my wonderful husband for his support and assistance while this
project was being accomplished.
4
Investigation Of A Dietary Behavior Questionnaire As A Predictor Of Dietary Sodium Intake
Abstract
Sodium intake in the United States population exceeds the physiologic need. Excessive
salt intake is associated with hypertension, kidney stone formation, osteoporosis and
cardiovascular accidents. A lifestyle modification, such as dietary salt restriction, is an
inexpensive, effective disease prevention option. There is currently no questionnaire available to
assess an individual's sodium intake.
The purpose of this study was to detemline if a researcher developed Dietary Behavior
Questionnaire reflects an individual's sodium intake. Thirty-nine subjects participating in a
Kidney Stone Research study completed a Dietary Behavior Questionnaire and a commercial
Food Frequency Questionnaire. Responses to the Dietary Behavior Questionnaire were
compared with sodium intake estimated from the Food Frequency Questionnaire, the sodium
previously calculated from a 24-hour dietary record, and the 24-hour urinary sodium level
previously measured during the Kidney Stone Research study. No significant correlations were
found between either individual question or a totaled score and the urinary and dietary measures
of sodium. Although results of the analysis showed few statistically significant correlations
among the variables, certain behaviors from the questionnaire were clinically significant.
5
Table Of Contents
Acknowledgments........................................................... .. ...
..
3
Abstract.....................................................................................
4
Table Of Contents.......................................................................... .....
5
List Of Tables........................................................................................ ..
7
List Of Appendices. ..................................................................
8
Chapter 1
9
Statement of the Problem..........................................................................
10
Statement of the Purpose..........................................................................
10
Review of Literature.................................................................................
11
Research Questions..................................................................................
13
Significance to Nursing......................................................................
13
Definition of terms...................................................................................
13
Chapter 2..............................................................
15
Setting and Sample...................................................................................
15
Data Collection Procedure........................................................................
15
Instrumentation.........................................................................................
16
Data Analysis............................................................................................
16
Human Subjects Protection.......................................................................
17
Chapter 3......................................................................... .....
18
Sample Characteristics.............................................................................
18
Research Questions..................................................................................
19
Chapter 4....................................................................................................... ....
23
Discussion...............................................................................................
23
Limitations..............................................................................................
25
Recommendations...................................................................................
25
6
References............................................................................... . . . . . .
26
Appendices..................................................................................................
30
7
List Of Tables
Table 1 Correlation coefficients between individual questions
from the DBQ and 24-h urine Na, FFQ Na, and 24-h dietary
record Na. ..................................................... ......
21
Table 2 Correlation coefficients between 24-h diet record, the
FFQ Na, Adjusted Na, Totaled Score from the DBQ, and 24-h
urine Na.............................................................
22
8
Appendices
A. Food Frequency Questionnaire......................................................................
30
B. Dietary Behavior Questionnaire.....................................................................
37
C. Frequency of Responses to the Dietary Behavior Questionnaire...................
41
D. Internal Review Board Approval Fornl.........................................................
45
E. Dietary Behavior Questionnaire Totaled Scores compared with dietary
habitual Na and urine Na..............................................................................
47
F. Individuals who were between 75 and 125% RDA for Kilocalories............
49
G. Adjusted Sodium for RDA. .... ......... ............ .... ........................ ...
51
H. Sample Characteristics.............................................................
53
I. Correlation coefficients between individual questions from the DBQ
and 24-h urine Na, FFQ Na, and 24-h dietary record Na......................
55
9
Chapter 1
Dietary habits are directly related to the incidence of several serious diseases. The role of
excessive salt intake in the etiology of primary hypertension in genetically susceptible
individuals is generally accepted (Elliott, 1989; Haddy & Pamnani, 1995). More than 90% of
hypertensive patients have essential hypertension (Coody, Yetman, & Portman, 1995). Primary
or essential hypertension implies that no known underlying disease is present. Hypertension has
been estimated to affect over 25% of the adult population in North America, and is the leading
risk factor for coronary artery disease, congestive heart failure, stroke, kidney disease, and
retinopathy (Rabkin, 1994). Blood pressure response to sodium (Na) intake is genetically
determined with approximately 50% of primary hypertension patients experiencing an elevated
blood pressure during high salt intake (Coody, et aI., 1995). Adams et aI. (1995) found that high
,
I
)
~
sodium diets injure arteries and increase mortality in salt-resistant rats, suggesting that even saltresistant individuals may protect themselves from vascular injury by reducing salt intake.
As a lifestyle modification, salt restriction has proven to be effective in lowering blood
pressure and is a therapeutic option for many hypertensive individuals (McAbee, 1995). Even a
small decrease in mean blood pressure by populations can produce a substantial reduction in
mean blood pressure rates, as well as a large decrease in cardiovascular risk. It is estimated that
a 2 mm Hg shift downward in the systolic blood pressure (BP) might reduce the annual mortality
from stroke, coronary heart disease, and all causes by 6%, 4% and 3% respectively. The
corresponding benefits for a 3 mm Hg shift in diastolic blood pressure have been estimated to be
8%, 5%, and 4%, respectively (Dyer & Elliott, 1989). A reduction in salt intake will often lower
blood pressure by abollt 5 mm Hg (Rabkin, 1994). Strategies aimed at promoting moderation in
salt intake ( < 100 mmol/day) could reduce both the incidence and prevalence of hypertension
among older individuals (Rabkin, 1994; Flack, 1994).
Several national and international organizations, including the American Medical
Association, American Heart Association, American Dietetic Association, and National Research
1
J
t
10
Council, support measures for decreasing the intake of salt to reduce hypertension (SanchezCastillo, Warrender, Whitehead, & James, 1987). High salt intake also increases the potential
risk for kidney stone formation by elevating urinary saturation of calcium phosphate and
monosodium urate, and decreasing the inhibitory activity against calcium oxalate crystallization
(Massey & Whiting, 1995; Flack, High, Padalino, Whitson, & Pale, 1993). Recent research
indicates that high intakes of sodium chloride result in increased excretion of calcium, suggesting
that high habitual salt intake may increase the risk for developing osteoporosis (Goulding, 1990;
Flack et aI, 1993; Massey & Whiting, 1995).
Virtually all sodiunl ingested in the diet is readily absorbed from the gut. The sodium is
carried by the blood to the kidneys where it is filtered out and then returned to the blood in
amounts needed to nlaintain levels required by the body. The levels of sodiunl in the urine
reflect the dietary intake. In a healthy human, urinary sodium will equal consumption (Oh,
1992).
Statement Of The Problem
Reduction of adverse effects through lifestyle modifications, is one of the most cost
effective interventions a practitioner can provide. Therefore the assessment of dietary salt habits
is crucial in screening individuals at risk for certain diseases. Twenty-four hour urinary excretion
is believed to provide the best estimate of sodium intake (Schachter et aI, 1980). A history on a
patient should include intake of sodium (Setaro & Moser, 1995). A review of the published
literature shows that there is currently no questionnaire available to assess an individual's sodium
intake.
Statenlent Of The Purpose
The purpose of this study is to determine if a Dietary Behavior Questionnaire can reliably
identify individuals who consume high amounts of salt in their diet. A dietary questionnaire may
be useful for identification of those at risk for diseases associated with high salt intake. Through
identification of individuals consuming high salt levels, interventions to reduce salt intake may
decrease hypertension, cardiovascular accidents, osteoporosis, and kidney stones.
11
Review Of Literature
About 50 million adults (one in every four) in the United States have high blood pressure.
High blood pressure or hypertension is an elevation of the systolic or diastolic pressure and is
based on blood pressure levels associated with increased risk of cardiovascular complications
(McAbee, 1995). Hypertension is associated with an increased risk of developing coronary heart
disease, stroke, congestive heart failure, renal insufficiency, and peripheral vascular disease
(Coody et aI, 1995; Fodor, 1994; Chobanian, 1990; Blumenfeld,1994). Epidemiological studies
have demonstrated a direct association between blood pressure and stroke, with 10 to 15% of
hypertensive population suffering from this adverse event ( Xie, Joossens, Sasake, & Kesteloot,
1992; Sasake, Kesteloot, & Zhang, 1995; Rose & Stamler, 1989; Elliot, 1989).
The cost for physician and nursing services related to hypertension management exceeded
$4 billion in 1989 (Gullickson, 1993). Approximately 50% of patients with hypertension drop
Ollt of treatment at some time during their illness management (Fodor, 1994). Pharmacological
management of hypertension produces numerous side effects including hypokalemia, glucose
intolerance, hyperuricemia, increased levels of low-density lipoproteins and decreased levels of
high-density lipoproteins, fatigue, insomnia, lack of concentration, impotence, etc. (Gullickson,
1993). Nonpharmacological interventions such as low salt diet can be a beneficial treatment
modality and avoid the negative side effects of medications, as well as being less costly.
In the 1982 Intersalt study, an international study which included 32 countries and 10,079
individuals, relationships were assessed between electrolyte intake and blood pressure. The
study concluded that sodium excretion is significantly related to BP in individuals, and to a rise
in BP with age. Estimates of the size of this effect is that an average 100 mmol increase in
sodium/day corresponds to 2.2 mmHg rise of systolic pressure between ages 25 and 55. The
effect in susceptible individuals is likely to be underestimated. Even small differences in
pressure can be said to have considerable impact on the prevalence of hypertension and longterm mortality. A very low sodium intake is associated with low BP and near absence of
hypertension (Dyer & Elliott, 1989; Rose & Stamler, 1989). African Americans and the elderly
12
populations may experience a greater reduction in blood pressure than others following a
reduction in salt intake (McAbee, 1995).
Hypertension and atherosclerosis are the two major causes of cardiovascular accident
(CVA) morbidity and mortality. Epidemiological studies demonstrate the role of hypertension as
a nlajor contributor to cardiovascular disease, particularly strokes. In the Intersalt study, the 24hour urinary sodiunl excretion correlated significantly and positively with cerebral vascular
accident mortality in men. In several epidemiological studies a significant positive relationship
between dietary 24-hour sodium excretion and blood pressure could be established (Xie et aI.,
1992).
High urinary sodium from salt excess is a recently recognized nutritional risk factor for
kidney stone formation. Urinary sodium is often increased in patients with nephrolithiasis.
Increased urinary sodium is thought to cause calcareous stone formation by inhibiting renal
tubular reabsorption of calcium, thus producing hypercalciuria and increasing the saturation of
stone-forming calcium salts. Increased urinary sodium excretion also increases urinary
saturation of mono-sodium oxalate and decreases renal excretion of citrate, an inhibitor of
calcareous stone formation (Sakhaee, Harvey, Padalino, & Whitson, 1993; Cirillo et aI, 1994).
Most individuals in the U.S. consume a diet that contains between 150 and 200 mmol of
sodium per day; this corresponds to 9 to 12 grams of salt or 4 to 5 grams of sodium. This
exceeds the physiologic need for salt and is much more salt than that eaten by individuals in
earlier societies (McAbee,1995). Previous researchers found that sodium intake levels in the
U.S. population range from 10-12 grams of salt or 4000-5000 mg of sodium per day (Dunaif &
Khoo, 1986). Since 1982, there has been an increase in availability of sodium labeling and
availability of low or reduced sodium products to keep pace with the growing public concern of
high levels of sodium intake (Heimbach, 1986). The American Medical Association expressed
concern that the public is inadequately informed about the sodium content of foods and has
adopted a policy statement that includes recommendations for control of dietary sodium not only
for persons with hypertension, but for the general public (Council on Scientific Affairs, 1983).
13
Processing-added sodium is the major contributor of sodium in diets (77% of the total
intake). Sodium naturally inherent in foods is, minor, but the second largest source of sodium in
the diet, about 11 %. The addition of table or cooking salt combined contribute very little to
sodium in the diet, about 7.5 % (Mattes & Donnelly, 1991). Water was found to be a trivial
source. This data is important to health care professionals who act upon the recommendation
that sodium be moderated in the U.S. population. Since using salt for cooking and at the table
contribute very little to the total sodium intake, a tool to identify individuals who consume
processed foods with high sodium is needed.
Hypothesis
An individual's relative dietary sodium intake can be determined through use of a Dietary
Behavior Questionnaire.
1. There is a significant positive correlation between dietary behaviors as measured by a Dietary
Behavior Questionnaire, and habitual daily sodium as measured by a 24-hour dietary record.
2. There is a significant positive correlation between dietary behaviors as measured by a Dietary
Behavior Questionnaire, and habitual daily sodium as measured by a Food Frequency
Questionnaire.
3. There is a significant positive correlation between the dietary behaviors as measured by a
Dietary Behavior Questionnaire and 24-hour urinary sodium.
Significance To Nursing
This study would allow for the development of a reliable and efficient instrument useful
for the identification of individuals who may benefit from a sodium controlled diet.
Definition Of Terms
Salt- A mixture of two minerals-sodium and chloride. In a teaspoon of salt, which weighs 5000
milligrams, 2000 of the 5000 would be sodillffi and the other 3000 milligrams would be chloride.
Salt is 40% sodium and 60% chloride (Natow & Heslin, 1993).
Sodium Chloride- Common table salt. The chemical term for ordinary table salt which is
composed of the two elements, sodium and chloride. Most of the sodium in the diet is in the
14
form of sodium chloride, a white granular substance used to season and preserve food (Natow &
Heslin, 1993).
Sodium- A principle cation in the body. The major sources of sodium is salt (sodium chloride)
used in cooking, processing, and seasoning. Many processed foods contain high levels of salt.
Other sodium containing additives such as monosodium glutamate may be used in some foods as
well. Sodium is present in all foods in varying amounts (Natow & Heslin, 1993).
24-hour urine sodium- Sodium measured from a 24-hour urine sample which was collected as a
prescreening tool from the Milk and Kidney Stone research study.
Dietary Behavior Questionnaire- The researcher created questionnaire consisting of 31 questions
which reflect behaviors associated with a low and high salt intake.
24-hour dietary record- A recall of the diet during the past 24-hours which was attained from the
Milk and Kidney Stone study.
Food Frequency Questionnaire- A commercially available questionnaire designed to record a
client's nlltritional habits quickly and efficiently. The food intake questionnaire uses a data base
of 141 food groups with average nutrient values taken from foods that fall within that food
group. The data is entered into Nutritionist IV software for analysis and for calculation of a
nutritional profile on a client.
15
Chapter 2
A correlational design was used to evaluate if a Dietary Behavior Questionnaire could be
used as a predictor of an individual's dietary sodium intake. Burns and Grove (1994) explain that
correlating designs investigate relationships between two or more variables. The design is
appropriate for this study because the relationship between a Dietary Behavior Questionnaire
(DBQ), habitual dietary sodium intake and actual urinary sodium are examined.
Subjects were recruited from a Milk and Kidney Stone study directed by Linda K. Massey, Ph.D.
through the Food Science and Human Nutrition Department at Washington State University.
Subjects were asked to complete a Dietary Behavior Questionnaire which addressed behaviors
associated with salt, as well as a Food Frequency Questionnaire (FFQ). Data on subjects' 24hour urinary sodium levels along with dietary sodium levels measured from a 24-hour dietary
record were obtained from the Milk and Kidney Stone study.
Setting & Sample
The sample for this study included 41 subjects who were screened for participation in a
Milk and Kidney Stone research study. This sample reported a history of a calcium oxalate
kidney stone, and had completed the screening process that included a 24-hour urine collection
and a corresponding 24-hour diet record.
Data Collection Procedure
Each subject was given the researcher developed Dietary Behavior Questionnaire and a
Food Frequency Questionnaire. Subjects were informed that the questionnaire was not part of
the original study and that their participation would be strictly voluntary, participation or nonparticipation would not affect their benefits from in the original research study. The return of the
completed questionnaires was accepted as consent to participate in the study. The questionnaires
were distributed up to a period of 6 months after the data collection in the Milk and Kidney
Study. Of the 41 questionnaires distributed, 39 questionnaires were returned.
16
Instrumentation
The instruments used in this investigation were a commercially available Food Frequency
Questionnaire (Appendix A) and a Dietary Behavior Questionnaire developed by this researcher
(Appendix B). The Dietary Behavior Questionnaire consisted of 31 questions characterizing
dietary behaviors associated with high or low sodium intake. Three experts in the field reviewed
and modified the Dietary Behavior Questionnaire for face validity prior to data collection. The
nutrient intake from the Food Frequency Questionnaire was analyzed using Nutritionist IV
version 3 software. Urinary sodium data obtained from the Milk and Kidney Stone study was
measured by atomic absorption spectrophotometer (Perkin-Elmer). Dietary sodium data from the
Kidney Stone Study estimated using a 24-hour dietary record was analyzed using Nutritionist IV
version 3 software.
Data Analysis
Pearson's correlation matrix was used to examine relationships between each question on
the Dietary Behavioral Questionnaire with the urine sodiunl and with the dietary sodium level
analyzed from the Food Frequency Questionnaire and 24-hour dietary record. A frequency of
responses to each question was tabulated (Appendix C).
Habitual dietary sodium as measured by the FFQ and the 24-hour dietary record was
compared as both raw data and adjusted to 100% of the expected kcal for age and gender. This
adjustment was made to compensate for over or under reporting of food intake. Pearson's
correlation matrix examined the relationships with the adjusted sodium levels.
The Dietary Behavior Questionnaire was converted into a total score by using a four point
Likert scale given numerical values and adjusted for negative questions. Using Pearson's
correlating matrix, the total score was compared with urinary sodium and habitual dietary sodium
as measured by the FFQ and 24-hour dietary record. The data was coded and analyzed using
Systat (version 4.0) statistical program and Excel 5.0. A probability of 5% was set as the
criterion for statistical significance.
17
Human Subjects Protection
The proposal to conduct this study was submitted for approval from the following:
1. Clinical Research Project Committee, Intercollegiate Center for Nursing Education,
Spokane,Washington.
2. Institutional Review Board, Washington State University, Pullman, Washington.
See Appendix D for copy of Institutional Review Board approval.
Subjects were informed of the purpose of the study. Any foreseeable risks and benefits
were explained. Confidentiality was insured throughout the study and afterward by the use of
blinded identification numbers on the data collection tools. Participant's names were in the sole
possession of Linda K. Massey, researcher of the Milk and Kidney Stone study and kept locked
in a secure filebox. Subject's names were not mentioned in the data analysis.
Participants were provided with information regarding the person to contact to answer
any questions. Subject participation in this study was voluntary.
The benefit to the participant was an analysis of the subject's usual dietary intake as an
individual nutrition report. This report included most nutrients with comparison to the
Recommended Daily Allowance (RDA) for those nutrients, kilocalories, and percent of calories
from protein, carbohydrates and fat for their appropriate age and gender.
18
Chapter 3
An exploratory correlational design was used to investigate if a Dietary Behavior
Questionnaire could be used as a predictor of an individual's sodium intake. Subjects who
participated in a Milk and Kidney Stone research study conducted by Linda K. Massey through
Washington State University Human Nutrition Department were contacted for participation in
this study. The individuals who participated had a history of at least one calcium-oxalate kidney
stone. All individuals participating in the Milk and Kidney Stone study consumed 1 and 1/2
cups of milk during the day of the 24-hour dietary record and 24-hour urine sodium collection.
The dietary behavior questions were measured on a 4-point Likert scale. A correlational analysis
was performed with the results obtained from the Dietary Behavior Questionnaire, the urine
sodium levels, and the sodium levels obtained from tIle Food Frequency Questionnaire and from
the 24-hour dietary record. Tabulated scores from the Dietary Behavioral Questionnaires were
correlated with urine sodium and dietary sodium levels as measured by the FFQ and the 24-hour
dietary record (Appendix E).
Sample Characteristics
The Dietary Behavior Questionnaire was distributed to 41 participants in the Milk and
Kidney Stone study. Ninety-five percent of the potential participants (39 out of 41) completed the
self-administered questionnaire. The sample consisted of 29 males and 10 females. The 31-item
Dietary Behavior Questionnaire and FFQ took 30 to 40 minutes to complete. The mean age of the
subjects was 51 with a range of23 to 76 years. Seventy-four percent of the population were male.
Urine sodium levels ranged from 1835 mg to 7174 mg (80 to 312 mmol). The average urine
sodium was 3749 mg (163 mmol SD=45). The range for the sodium measured from the FFQ was
1354 to 14105 mg (58 to 613 mmol) with a mean of3367 mg (146 mmol SD=52). The range for
the sodium measured from the 24-hour dietary record was 1261 to 13649 mg (55 to 593 mmol)
with a nlean of 3515 mg (152 mmol SD=50) (Appendix E).
19
The Dietary Behavioral Questionnaire was scored using 26 of the questions which
contained a 4-point scale. The Likert scale was graded so that frequently, occasionally, seldom,
and never would correspond to 3, 2, 1, and 0 points, respectively. There were 16 positive
questions for which a high score would indicate a high sodium intake, and 10 negative questions
for which a high score would indicate a low sodium intake. Thus 48 would be the highest score,
and would indicate high sodium intake. A negative score of 30 would be associated with low
sodium intake. The obtained total scores ranged from negative 12 to positive 28. The average
total score was + 8.6.
Research Questions
Significance for statistical analysis was established at a probability level of 0.05 for a onetailed test. The critical value for the Pearson product moment correlation coefficient (r) was 0.27
(Le., to be considered statistically significant for the sample of 39).
Hl There is a significant positive correlation between dietary behaviors as measured by a
Dietary Behavior Questionnaire, and habitual daily sodium as measured by a 24-hour dietary
record
There was one question which had a significant negative correlation with the sodium
measured from the 24-hour diet record: "Many foods I eat taste too salty" (r = -0.362). The
Dietary Behavior Questionnaire did not reflect a similar reporting of salt intake in comparison to
the 24-hour dietary record. The 24-hour dietary record was a more sensitive indicator of food
intake than the Dietary Behavior Questionnaire (Table 1).
H2 There is a significant positive correlation between dietary behaviors as measured by a
Dietary Behavior Questionnaire, and habitual daily sodium as measured by a Food Frequency
Questionnaire.
There were five questions which had a significant positive correlation with the sodium
measured from the FFQ:
20
"I add salt to my meals at the table" (r = 0.304).
"I eat frozen "TV" dinners, frozen entrees, pot pies and pizza" (r = 0.301).
"I season my meat, fish, poultry and eggs with salt" (r = 0.274).
"I add salt to foods before 1 taste them" (r = 0.447).
"I add salt to foods after 1 taste them and find them lacking flavor" (r = 0.316).
Drily 5 of the 31 questions (6.2%) showed a correlation to habitual sodium dietary intake
as measured by the FFQ. Although less sensitive for dietary intake measurement for a particular
than a 24-hour dietary record, FFQs have been found to be reliable and valid methods of food
intake for longer time periods.
H3 There is a significant positive correlation between dietary behaviors as measured by the
Dietary Behavior Questionnaire, and 24-hour urinary sodium.
There were two questions which had a significant correlation with the 24-hour urine
sodium. "I use soy sauce and Worcestershire sauce when preparing foods" (r = 0.391).
"Ifreduced salt foods were available at a reasonable price 1 would buy them more" (r = - 0.389).
Accuracy of the diet record was assessed through analyses ofa 24-hour urine collection. As a
whole, the questionnaire was not reflective of an individual's urine sodium, thus not a true
indicator for an individual's dietary salt intake.
When each individual question was correlated with 24-hour urine sodium, FFQ sodium,
and 24-hour dietary record sodium, there were some significant correlations. Although 8 of the
93 correlations displayed a significant positive correlation, when the adjusted p value is
determined (0.05/93 = 0.00053), none of the correlations had an r value which exceeded the
adjusted critical value for significance. The adjusted p value is determined by taking the total
number of questions and multiplying by the total number of variables ( 31 questions from DBQ x
3 variables- FFQ, Urine, & dietary record) and dividing that number into the probability level of
21
0.05. This adjusted value is to protect against a type 1 error (rejection of the null hypothesis
when in fact the null hypothesis is true).
Table 1. Correlation coefficients between individual questions fronl the Dietary Behavior
Questionnaire and 24-hour Urine Na, FFQ Na, and 24-hour dietary record Na.
QUESTION #
from Dietary
Behavior
Questionnaire
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
24-h urine Na
FFQ Na
24-h dietary Na
-0.06
0.088
-0.079
-0.057
-0.015
0.045
* 0.391
0.045
-0.156
0.21
-0.194
-0.149
* 0.304
0.242
* 0.301
-0.062
-0.067
-0.174
0.068
0.008
-0.011
* 0.274
-0.151
-0.026
-0.09
-0.073
* 0.447
* 0.316
-0.007
0.055
-0.078
-0.015
-0.037
-0.064
0.37
0.14
0.262
0.032
0.126
-0.091
0.022
-0.212
-0.109
0.144
-0.171
-0.069
-0.098
0.09
0.058
0.056
-0.02
-0.012
0.044
-0.141
-0.159
-0.153
-0.044
0.105
0.129
-0.042
* -0.362
-0.073
0.078
-0.131
0.163
0.023
0.225
0.201
-0.169
0.039
-0.216
0.03
-0.089
0.047
o
-0.079
0.209
0.081
-0.064
-0.165
-0.06
-0.14
* -0.389
0.144
0.096
0.1
0.016
0.032
0.126
-0.091
0.022
-0.212
-0.106
* indicates a significance at the 0.05 level
22
Pearson's correlations were computed to assess relationships between urine sodium and
the Food Frequency Questionnaire (r = 0.027), and between urine sodium and the 24-hour
dietary record (r = 0.513). The FFQ, does not appear to be a good indicator for dietary salt intake
as measured by 24-hour urine sodium, whereas the 24-hour dietary record is consistent with salt
intake as measured by 24-hour urine (Table 2).
Using the total Dietary Behavior Questionnaire score, the correlation with urine sodium
was not significant (r = 0.157), nor was the correlation significant for sodiunl from the 24-hour
dietary record (r = -0.001) or from the FFQ (r= 0.310). When the sodillm from the diets is
adjusted (raw NA/ (%RDA kcal /100) the correlations still fall short of the significance level
(Table 2): between the total score and adjusted sodium from the FFQ (r = 0.012), and between
the total score and the adjusted sodium from the 24-hour dietary record (r=0.175).
Table 2. Correlation coefficients between 24-hour dietary record Na, the FFQ Na, Adjusted Na,
Totaled Score from the Dietary Behavior Questionnaire and 24-hour urine Na
FFQNa
Adjusted FFQ
24-H Diet
Adjusted 24-H
24-H
Na
Record Na
Diet Record Na
Urine Na
24-H Urine Na
0.043
0.012
0.514 *
0.380 *
Totaled Score
0.310
-0.114
0.001
0.175
from Dietary
Behavior
Questionnaire
FFQNa
0.005
* indicates significance at the 0.05 level
0.157
23
Chapter 4
This study explored the relationship between a Dietary Behavior Questionnaire, habitual
dietary sodium as measured from both a Food Frequency Questionnaire and 24-hour dietary
record, and urinary sodium measured from a 24-hour urine collection.
There is no published research regarding instruments which can be used to estimate an
individual's sodium intake. This study explored and correlated infomlation that has not been
studied prior to this time. The instrument developed by this researcher, a Dietary Behavioral
Questionnaire, does not appear to be valid or useful as a measurement of dietary sodium intake.
Although results of the analysis showed few statistically significant correlations among the
variables, certain behaviors from the questionnaire did prove significant; these can be abstracted,
refined and tested in further studies for the development of a dietary salt assessment instrument.
Discussion
Attempts to reduce the incidence of illness through primary prevention are a national
priority. Prevention is less costly in time, money, and resources to both the patient and the health
care system. Therefore, an aggressive program of prevention through increasing the awareness
of the population about the dangers of high sodium intake along with education in how to
prevent it, can have an immediate and positive impact on our already overburdened healthcare
system.
Reduction of salt intake has been suggested as a way to reduce morbidity and mortality.
Before we can counsel patients on reduction of salt intake, we must first identify those members
of the population who consume a high salt intake. This research was designed to see if an
effective Dietary Behavior Questionnaire could be developed for health care practitioners,
dietitians, and other health care personnel as a quick screen to identify persons who consume
high sodium diets. Since this was an untested instrument, identification of certain high sodium
diet related behaviors required validation by collection of urine sodium.
24
The first research question failed to show a significant positive correlation between
dietary behaviors as measured by a Dietary Behavior Questionnaire, and habitual daily sodiunl as
measured by a 24-hour dietary record. The second research question failed to show a significant
positive correlation between dietary behaviors as measured by a Dietary Behavior Questionnaire,
and habitual daily sodium as measured by a Food Frequency Questionnaire. The third research
question also failed to show a significant positive correlation between dietary behaviors as
measured by the Dietary Behavior Questionnaire and 24-hour urinary sodium.
Many of the subjects who completed this questionnaire did not buy, prepare or serve their
food; thus some of the responses may not have been very reliable. Most of these individuals
were older men who participated little during food preparation at home and had little knowledge
in regards to added sodium. This would suggest that, in the future, to obtain a more accurate
survey the participants should be individuals who have some knowledge of food preparation or
who monitor their sodium intake. Of course, such a sanlpling would not be representative of the
population as a whole.
Only two of the 31 behavioral questions demonstrated a significant positive correlation
with urine sodium. Sixty percent of the individuals surveyed fell within 75-125% of the RDA
for calories in regards to age and gender (Appendix F), suggesting that for the remaining 40% of
individuals, this data may not be accurate. Adjusting the dietary sodium for the RDA for calories
(Appendix G) showed no change in correlations. A delayed time factor may have skewed the
results; perhaps diet behaviors had been modified between time of urine collection and time of
questionnaire.
The significant correlation between the urine sodium and the 24-hour dietary record
demonstrates the usefulness of the diet record as an accurate representation of the dietary sodium
level. This method would not be appropriate for a screening method since taking the data and
analyzing the sodium content would be limited by time and computer access.
25
Limitations
1. The study sample was drawn from one geographical area. The subjects were recruited from
another study with a prerequisite of having a history of a kidney stone. The subjects were not a
representative sample, therefore, the findings can not be generalized.
2. There was an unequal distribution of sex, 75% men.
3. A large percentage of the sample, mostly men, did not prepare the food in the household, and
therefore were uncertain on questions relating to food preparation and quantity.
4. Reliability of the self-reported data was assumed. Validation of responses was not feasible.
5. The study results are limited by the use of a newly devised instrunlent.
6. There are limitations to the interpretation of nutrient intake data used in this analysis. Salt
intake was estimated using the Food Frequency Questionnaire. The FFQ is probably less
sensitive than dietary records or recalls.
7. The 24-hour urine sodium was obtained with the clients includes 1 and 1/2 cups of milk
during that day if that was not their normal diet which may have been a factor with urine sodium
levels.
Recommendations
As a result of the findings of this study, it is suggested that similar studies be conducted
revising the Dietary Behavioral Questionnaire and using a larger sample size. A probability
sample should be obtained from within a population which is more representative of the larger
population. The Dietary Behavior Questionnaire needs modification and refining, removal of
ambiguous items and using the questions which show a level of significance. Construct validity
of the instrument needs further evaluation.
26
References
Adams, S., Maller, 0., Cardello, & Armand V. (1995). Consumer acceptance of food
lower in sodium. Journal of the American Dietetic Association, 95, 447-453.
Blumenfeld, J. D. MD. (1994). Renal and cardiac complications of hypertension.
Clinical Symposia, 46, (4), 3-32
Chobanian, Aram F. ,MD. (1990). Hypertension. Clinical Symposia 42, (5), 1-32.
Cirillo, M., Laurenze, M., Panarelli, W., & Stamler, J. (1994). Urinary sodium to
potassium ratio and urinary stone disease. Kidney International, 46, 1133-1139.
Council on Scientific Affairs. (1983). Sodium in processed foods. JAMA, 249, 784788.
Coody, D., Yetman, R. J., & Portman, R. J. (1995). Hypertension in children. Journal
of Pediatric Health Care, 9, 3-11.
Dunaif, G. & Khoo, C. (1986, December). Developing low-and reduced-sodium
products: An industrial perspective. Food Technology, 105-107.
Dyer, A., & Elliott, P. (1989). The INTERSALT study: Relations of body mass index
to blood pressure. Journal of Human Hypertension, 3, 299-308.
Elliott, P., Dyer, A., & Stamler, R. (1989). The INTERSALT study: Results for 24-hour
sodium and potassium, by age and sex. Journal of Human Hypertension, 3, 323-330.
Elliott, P. (1989). The INTERSALT study: An addition to the evidence of salt and blood
pressure, and some implications. Journal of Human Hypertension, 3, 289-298.
Flack, J. M. (1994). Blood pressure in older persons: A high risk special population.
Canadian Journal of Public Health, 85 (suppl. 2), 9-11.
27
Flack, J., High, B., Padalino, P., Whitson, P., & Pak, C. (1993). The potential role of
salt abuse on the risk for kidney stone formation. The Journal of Urology, 150, 310-312
Fodor, J.G. (1994). Hypertension control: Historic perspectives- 25 years of progress in
Canada and around the world. Canadian Journal of Public Health, 85 (supp!. 2), 7-8.
Goulding, A. (1990). Osteoporosis: Why consuming less sodium chloride helps to
conserve bone. New Zealand Medical Journal, 103, 120-122.
Gullickson, C. (1993). Client-centered drug choice: An alternative approach in
managing hypertension. Nurse Practitioner, 18, (2), 30-41
Haddy, F.J. & Pamnani, M.P. (1995). Role of dietary salt in hypertension. Journal of
American College of Nutrition, 14, 428-438.
Heimbach, Janles T. (1986, December). The growing impact of sodium labeling of
foods. Food Technology, 10
Kawasaki, T., Kazue, I., Keiko, U., Tetsuro, 0., Yutaka, Y., Shigeru, K., Tetsuro, 0.,
Michihiko,O., Sanjib, D., Sashi, S., & Acharya, G.P. (1993). Investigation of high salt intake
in a Nepalese population with low blood pressure. Journal of Human Hypertension, 7, 131-140.
Marsh, A.C. (1983, July). Process and formulations that affect the sodium content of
foods. Food Technology, 45-49.
Massey, L.K., & Whiting, S.J. (1995). Dietary salt, urinary calcium, bone loss and
kidney stone risk. Nutrition Reviews, 53,131-9.
Mattes, R. D., & Donnelly, D. (1991). Relative contributions of dietary sodium sources.
Journal of American College of Nutrition, 10, 383-393.
McAbee, R. (1995). Primary prevention of hypertension, A challenge for occupational
health nurses. American Association Of Occupational Health Nurses, 43, 306-312
28
Natow, A.B., & Heslin, J. (1993). The Sodium Counter. New York, NY: Pocket Books.
Oh, M. S. (1992). Salt output in relation to salt intake versus salt output alone: Which is a
better predictor of effective vascular volume? Nephron, 61,129-131.
Rabkin, S. (1994). Non-pharmacologic therapy in the management of hypertension: An
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Rose, G., & Stamler, J. (1989). The INTERSALT study: Background, methods and main
results. Journal of Human Hypertension, 3, 283-288.
Sakhaee, K., Harvey, J.A., Padalino, P.K., & Whitson, P. (1993). The potential role of
salt abuse on the risk for kidney stone formation. Journal of Urology, 150,310-312.
Sasaki, S., Zhang, S., & Kesteloot, H. (1995). Dietary sodium, potassium, saturated fat,
alcohol and stroke mortality. Stroke, 26, 783-788.
Sanchez-Castillo, C.P., Warrender, Sl, Whitehead, T.P., & James, W.P.T. (1987). An
assessment of the sources of dietary salt in a British population. Clinical Science, 72, 95-102.
Schachter, J., Harper, P.H, Radin, M., Caggiula, A.W., McDonald, R.H., & Diven, W.
F. (1980). Comparison of sodium and potassium intake with excretion. Hypertension, 2, 695699.
Schiffman, S. (1994). Changes in taste and smell: Drug interactions and food preferences.
Nutrition Reviews, 52 (8), sll-s14.
Setaro, J. & Moser, M. (1995). Hypertension evaluation: office workup of newly
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Tokunaga, S., Hirohata,T., & Hirohata, I. (1994). Reproducibility of dietary and other
data from a self-administered questionnaire. Environmental Health Perspectives, 102 (8) 5-10.
29
Xie, J.X., Sasaki, S., Joossens, J.V., & Kesteloot, H. (1992). The relationship between
urinary cations obtained from the INTERSALT study and cerebrovascular mortality. Journal of
Human Hypertension, 6, 17-21.
Yamamoto, M. E., Caggiula, A. W., Olson, M.B., Kelsey, S. F, & McDonald, R.
(1994). Application of overnight urine collections and food records for monitoring the sodium
and potassium intakes of groups and individuals. Journal of the American Dietetic Association,
~
897-899.
30
Appendix A
Food Frequency Questionnaire
IDs1nJcdOlll lor CompAedJII
Food IDtaU QaestiaaIIaift
-':or each food item listed.. put down haw maDy servings you eaL either per m, per 'Week. or per msmm. Mast imponantly,
be as aa:urate as powble. Pay special attention to the PORTION SIZE. of each food item listed. When your portion is
different from the ODe listed in the farm. adjust)'OUr auswer aamdiDgty.
Please put numbers in either thc per day, per wc:ck. or per month calumn. Please do DOl pat check mara. You must usc
numbers or}'Our nutrition repon CIDDOt be proczssed. If lOU dem't eat the food at alL lene it blaDL
Please put oDty one number per box. cw:D if the box lisu mUltiple entries. and round all entries to the nearest wRole number.
Please indudc every food that you eat at least oace a month.
Sample qaestioas:
How often do you eat
(or drink) the fallowiDg:
i
5eMD@S per:
~Ulk aDd Yopn
~""W-eek-"'I-M-O-D·1h-"I-.5erYiD--·-g-S-ize------...--Food--N-am-c·'-Descri---·P-bDD-·
------===":1
d ,:)~.
"
,
,
!
",-up
i
il
Lev.,iat milk
To calculate. compare ,aur uma1 saYiIlg size to tbe one listed. If you have twice as muc:II. )V1I WU1IId doable tile n1lDlber 01
servings entered in the day, week. or moDlD box. For example.. if you have lawfal milk once per day. and your serving is one
cup. theD enter a 1 in the box for per day.
SelVina
-
Day
No.
per:
Month
Week
25.
, Serving Size
1 each
leach
3 each
2 each
10 each
I
Fruits
I
Food Name I Dc:scrrptioa
I
i Pe:1cnes
~ec:unnes
~ .~Dna1tS
.I Plums
Cherries
I
Let's say thaL for one week. you hac1 rwo peaches. a neaanne. iour plUms. and twenty cherries. Thc pe:acDcs add up to nw
one-peach servings per week. The necarine is anotner sen1ng tper week). me plums arc two more. ana thc d1erries arc t'Wt1
more. The tOlal would then be :! + 1 + 2 .,. 2 = '7 seMngs per week. or 1 per day. You 1UOwd enu:r 1 in the per ~ box
Food Intake:
How oiten do you
~t
Servina per:
-
No.
l.
~ re:1ds.
,
I Day t, Week Month I Serving Size
I 1 slice
I
I
!.
3.
\
1
4.
I
I
5.
,
\ 1 slice. 1 e:u:h
,
I I
1 slice.. Vz hun
, 4 to 6 each
\
I
6.
(or drink) the iollowing!
~ to 6 e:lch.
.so e3ch
\ : e3ch.
7 e:lch
Cereals. Grain Prodac:a
,
Food Name / Desc:nl'bOD
. \\1l0h: \It·heat bread
50uraough or French brcadJroli
\Vhite ~rC3d. hamburger
or hotdog bUD
'.\.~oie ~r3in crackers tTriscuits. Wheal ThiDs. Ry Krisp)
~.:::r.~LJ c~c"ers
(Saltines. cheese.. Ritz). or
C~·.~tcr cr:lc~ers
!
C fJr.Jm cr:1ckers. or
~Illm:l1 ~r:lckcrs
_. --.-
I
~utntiOD
Evaluator ,Form • Page 4
7.
1 each
Tonilla. carD. 6- diameter
8-
leach
Tonilla. flour. medimD
9.
leach
MaffiDs (com. bran. blucbeny)
10.
'h each
EDpb mu11lD. baRd. pita bread
II.
3 each. or
Pancaka. or
leadl
WafDes. .,. diameter
12-
'hcup
Whole grain hOI a:real (rolled oats. rolled wbeal.
13.
'~CDp
Refined hot cereal (cream of wheat. aeam of ric:e)
14.
~CDp
or
1 package
IS.
3/4 cap.
t/. cup
16-
3/4 cup
17.
3/4 cap
I
lS-
,~
I 19.
I
20-
ClIp
caea1s. no supr (shn:dded wIIeaI. N1I1IipaiIl), or
GrapenulS
Cold
I Bran type cold cereais (raiml bID. braD fIaba, AD BID)
I Sweetened mid cereais (Frosted FIaka. Sapr SmKb)
, Granola
I Brown rice. cooked
ClIp
t White rice. cooked
'hcup
I PastaS. cooked (macamD. spaglleai. noodla)
ServiDgs per:
Day
No.
Fruits
Week
MODth
Semng Size
Food Name I DescriptioII
team
Apple. fresh. medium
23.
teach
Banana. medium
I
25.
1 each. or
each
I
1 each. or
, Peaches
leach
INeaarinCS
t~
3 each
2 each
10 each
26.
\
I
22-
24.
I
i
l1DstaDt hot c:ercal
,}, cup
,~
I
21.
or
..,.,
_I.
,
:8.
I
!9.
I
3/4 cup
I
I
30.
I
I
31.
I
I
Roman Meal)
t
Citrus fruit
Granefruil
..
..~DriCQts
I Plums
. Cherries
I
~
3emes
1'/6 c:ach
C.lntaiouDe. medium
11 cup
\telons (\\1l1cnncloD. honeydew. casaba)
\1 each
?e~~.
ircsh. medium
I ',~ cup
;
I 1 cu"
~ G r~oes. rrcsh
Pine:l~pie.
fresh
t
I
I
~utnlioD
EftiaalOr Form - Page: 5
-32-
2 tbsp
2eadl
2. eadl
4eadl
Dried fnIiIs:
Dates
Pnmcs
~
Apriaxs
33.
'nap
Calmed or frDzeD UiiSMEICLed fnlil
34.
'n CIIl'
Cumed or frDzeD swarned frail
Jaias
No.
Day
Week
MontA
Food Name I Daaiptioa
SaviDg Size
35.
'neap
36..
,~
37.
~cap
38.
'1\ ClIp
OraDp or papcfnlil. 'Cuu..e·. . .
ClIp
TomatO or V-I
, Other.
~ (apple. pa,e. ~)
Sweelaled juica or 1lecaD
, . . . . . ODa
I No.
Day
WeeK
MantA
39.
Food N_I n.caiplliia
I SaviD~ Size l
Vepable oils (CUlL P ...... sa,)
II tbsp
r
40.
1 tbsll
t Olive oil
41.
1 tbsl»
t
41-
~ 1 tbsp
43.
Its,
44.
t 1 up
l Batter
4S.
I S eadl
i Oliva
ShoneaiD~ vqeable
lLant
tMarpriDe
46-
1/8 eadl
Avocado
47.
1 tbsl»
MayoDDaile
4&.
1
49.
t tbsl»
Low-calorie: dressillp
50.
1 tbsl»
Souraam
51.
t tbs,
Cre:ua cbeese
52-
Ilbsp
Half & Half
53.
t
54.
I,
5~.
,
lbsl»
Regular saW! dressiDp
, 1 tbsp
\\nipping cream
, 1 tbsp
C~ffee
l ~ slices
3300n
Servina
- per:
No.
I
56.
I
f
whitener. imiaauOD cream
\Iilk and
Day' Week' Month I Serving Size
,
I 1 cup
-
Yon"
I
I
I ~oni3l milk
I
Food Name I Descrtpti01l
!
Nutrition EvalualOr Form - Page 6
57.
1 ClIp
Lowfat (29&) milt
58-
1 ClIp
Whole milk
59.
1 cup
Cloallate lowfat milk
60.
1 cup
Buttermilk
61.
1 cup
Yogun. lowfal plaiD
62.
1 cup
Yogun.lowfat with fruit
63.
1 cup
Yogurt, nonfat plaiD
!
servings per:
I
No.
1
I Day
Week
I 64.
I 65.
I
,
t
t
166-
, 67.
Month
1
I
I
I
Serving Size
v~
,
Food Name I DescrtptiOD
I Salads (letmc:c. celery. gr=a peppers. oDious)
1~cup
I Dark green leafy vegaables
1 eacb. or
Carrots. raw or
I
leach
, Tomatoes. fresh. medium
I
I
I Starchy vegetables (oom. peas. mixed vqetables. sua:masbl
I
69.
'~cup
Other cooked vegetables (gra:n beallS. c:auIiflowa'. beels.
1
70.
I
I
I
~
Week
Day
No.
I 73.
I
Month
I White potato. baked. boiled or masbed
~cup
, Sweet potatoes or yams
t~cup
I Winter squab (aooI'D. buttemuL hUbbard)
Saving Size
1 cup
I
! 74.
:
I
12 n.
07-
75.
12 n. 07-
76.
12
,
Food Name I DescrtptiOD
I Lemonade. pundl. Koolaid
I cala drinks with sugar (Coke. Pepsi. RCa etc.)
I
78.
I
1 cup
Regular coifee and tea
I
1 cup
D~c:l1Iein31ed
,t
1 cup
nOl
i
I
II: fi.
i 82.
;
I
1
79.
,! SO.
I
I
I
I
. 81.
I~
~.
I
I
I
\
\ Non-cola drinks with sugar (7.Up. Sprite. SUa:. elC.)
Diet non<.ola drinks
01-
I.. 11. az.
or non-aiCeinated hot drinks (sallia. herbal tea)
~hocoiale or COala
Beer
02-
I L: fl. az.
I.. n.
I
Diet cola drinks
t
i TI.
I
I
Beverqes
n. 0712 n. 07-
I
I
summer squash)
leach
Servings per:
I
II
'I
as~aragus.
I 71.
I 72-
I
I
'Il cup
I
I
, cooked
68.
I
1
I
i!
I
I
I
110 1'n cups
t~cup
I
Light beer
, \Vine.
I
~\\'~~l
nr dcssen (sherry. port. muscnel)
I \Vine. Jry or tJole
I
~utrition
Evaluator Form - Page 7
~_.__....
.I.l.~_O.O.z.
I....u_·q_ao.r.(.vodka._-wbisteY-·_".,... _11IIL_.e.te:..)
g m..'
Servings per:
!
I
No.
Day
Week
_
ProteiD Foods
Month
Food Name I DescriplioD
Serving Size
86.
I cup
Legumes (lentm. piDto beaDs. Davy beam). aJOkId
tr'I.
'1. cap
Nuts. seeds (peaD1I1S. almonds. cashews. slJll1lower seeds. etc.)
I
88.
1 tbsp
Peanut butter. Dut butteD
!
89.
4 ounces
Tofu
90.
3 ounces
Vegetarian meal substitutes. lowfat (Ska11ops. Qoplels. etc.)
91.
3 ounces
Vegetarian meat substitutes. medium fat (!DC8I1en cbktcn etr.)
92.
30uncc:s
93.
3 ounces
94.
30una:s
Beef. ground. axJb:d
95.
30UDa:s
Pork (chous. roast. haml
96-
30UDCZS
Lamb (chops. 1'OISt)
g'1.
30unca
98-
Vegetarian meat substitutes. high fat (Wbam. Pmsqe, ea:.)
I
Beef (rib rOUL steak. pot roast. veaL etc.)
I Poultry (cbicken. turter, duct)
30UDa:s
I
FISh. cumed with oil (taDL sardiDcs)
I Tuna. \Il3ter pack
I Fish. fresh or froz=. no breading (trout. ba1ibm. sole, eu:.)
99.
3 ounces
I 100.
3 ounces
101.
30una:s
102-
leach
103.
2eacb
104.
'/. cup
Egg substitutes
1 ounce
Cheeses (cheddar. colby, ameriem. mOIlten:r jaI:t
I
106-
louna:
I Cheeses. lower fat (swBs. mozzareUa. ricona. saiDl)
I
107.
Ylcup
108.
'}j
109.
1 ounce
110.
I each. or
:'each
IDS.
I
Shellfish (shrimp. sc:al1ops. lobster. dams)
Eggs. wbole- large
, Eggs. whites only. large
Cottage cheese. regular
cup
Day
Week
Lunch meats t bologDL salami. etc.)
I
Serving Size
Ill.
:e3ch
i 11:.
I 1 each
I 1 eacb
& Sweets
I
I
I 113.
Fr3nkfuners. or
Sausage iinks
D~§ert.c;
Month
\
Cottage cheese. lowfal
Servings per:
No.
I
I
Food Name I Descriptioll
('~\)~1C:S
I
~noco13te
chip. oatmeal. peanul bUller)
! Browntes. l'h inch by 1 inch
I Doul!nnut or sweetroll
-
1
iutrition Evaluator Form - Page 8
-114.
1 cadl
<:akI: without idq, 3 iadles by 2 iadles
11.5.
1 eadl
<:akI: with icing. 3 iD&:hcs by 2 iDdIa
116.
1 eadl
Graola bill
117.
1 slice
Pie. 118 of whole pie
118.
'neap
JeUo. regular. supr-SVtUIened
119.
'n ClIp
Jello., diet. DO sugar
'ncup
Pudding or cuswd
121.
'neap
Iceaam
122-
'neap
Ice milk
123.
1}j
cup
Sherbet
124.
1 eadl
125.
1'n ounce
126-
l~OUDce
I Hanl c:aDdy. gam drops. IJfaaw:a
127.
12 n.
, MjJJcsbake
I
120.
07-
Popsides
I Cmdy bu. dloco!ale. MItMs
SeniDgs ~
No.
Day
Week
MIsreI'·.......
Moum
Serving Size
128-
1 slice
, Pizza
129.
2 cups
, Po~m. popped without oil
130.
2 cups
I PopoorD. popped with oil
131.
1 ouna:. or
I
10 to IS eacb
I
POlalO
1 tbsp
Catsup or chili sauce
133.
'ncup
Tomato sauce
S slices. or
1 tbsp
Pickles. or
-13.5./
;
chips. com chips. lOnilla chips
132.
~~
1 .
I
Food Name I Description
I
-
Pickle relish
1 stick
I Chewing gum
136.
1 tbsp
I Sauces (soy sauce.. steak saua:. barbecue sauce)
137.
'1. cup
I Gravy {brown. giblet. while sauce)
1 cup
\
1 cup
I Soups. cream
138.
I
139.
140.
, leach
141.
I 1 tbsp
I
Sou~
•vegetable or noodle type)
I
type~
I F3St foods (hamburgers. burritos.
I
13005\
\
1
I Sugar. honey. jam. jelly. syrups
1
-
-
37
Appendix B
Dietary Behavioral Questionnaire
38
Dietary Behavior Questionnaire
1. I add salt to my meals at the table
frequently
occasionally
seldom
never
2. I add salt during the cooking and preparation of foods
frequently
occasionally
seldom
never
3. I eat frozen "TV" dinners, frozen entrees, pot pies and pizza
frequently
occasionally
seldom
never
4. When cooking foods such as pasta, hot cereal, potatoes etc., I routinely add salt to the boiling
water
frequently
occasionally
seldom
never
5. When buying foods I read food labels and avoid foods high in salt, Monosodium
glutamate(MSG), or other sodium containing items
frequently
occasionally
seldom
never
6. I use salt substitutes such as Mrs. Dash, Lemon pepper, Herb's in place of salt
frequently
occasionally
seldom
never
7. I use soy sauce and Worcestershire sauce when preparing foods
frequently
occasionally
seldom
never
8. When choosing food I look for products labeled sodium free, low sodium, or reduced sodium
frequently
occasionally
seldom
never
9. I use meat tenderizers when preparing meats
frequently
occasionally
seldom
never
10. I season meat, fish, poultry and eggs with salt
frequently
occasionally
seldom
never
11. I use a low sodium cookbook when preparing meals
frequently
occasionally
seldom
never
12. I have heartburn and use baking soda or other antacids for indigestion or heartburn
frequently
occasionally
seldom
never
seldom
never
14. I omit salt in recipes that I prepare at home
frequently
occasionally
seldom
never
13. Use a baking soda toothpaste
frequently
occasionally
39
15. I add salt to foods before I taste them
frequently
occasionally
seldom
never
16. I add salt to food after I taste them and find them lacking flavor
frequently
occasionally
seldom
never
17. I look at the sodium content of foods before I decide which foods to buy
frequently
occasionally
seldom
never
18. Many foods I eat taste too salty
frequently
occasionally
seldom
never
19. In preparing recipes I follow the no added salt or low salt directions
frequently
occasionally
seldom
never
20. If reduced salt foods were available at a reasonable price I would buy them
frequently
occasionally
seldom
never
21. I limit how much I eat of salty foods such as pickles, pretzels, ham and bacon
frequently
occasionally
seldom
never
22. Reduced salt foods are consumed by other members in my household
frequently
occasionally
seldom
never
23. Fresh foods such as dairy products, meat, cheese, fruits and vegetable spoil before I have a
chance to prepare and eat them
frequently
occasionally
seldom
never
24. I feel that I have a loss in taste perception
frequently
occasionally
seldom
never
25. I feel that I have a loss in sense of smell
frequently
occasionally
seldom
never
26. I eat meals away from home
frequently
occasionally
never
seldom
27. In preparing meals would you most likely eat
prepackaged foods
meals prepared from fresh foods
meals prepared from
cannedlboxed foods
28. If eating spaghetti which would you most likely use for spaghetti sauce
prepared mix
homemade with salt
homemade with low salt
40
29. In estimating the amount of salt I add to my food per day I would say it was
none 1/2tsp
Itsp
3tsp
4tsp
30. Does the water you drink have softeners added
no
yes
31. Do you or a family member prepare your own food
no
yes
5 tsp or more
41
Appendix C
Frequency of Responses to Dietary Behavior Questionnaire
42
Frequency of Responses to the Dietary Behavior Questionnaire
(the percentage does not add to 100 since not all persons answered each question)
1. I add salt to my meals at the table
frequently
occasionally
17%
37%
seldom
22%
never
19%
2. I add salt during the cooking and preparation of foods
frequently
occasionally
seldom
9.7%
21.9%
31.7%
never
31.7%
3. I eat frozen "TV" dinners, frozen entrees, pot pies and pizza
frequently
occasionally
seldom
9.7%
34.1%
41.4%
never
9.76%
4. When cooking foods such as pasta, hot cereal, potatoes etc., I routinely add salt to the boiling
water
frequently
occasionally
seldom
never
26%
21.9%
19.5%
26.8%
5. When buying foods I read food labels and avoid foods high in salt, Monosodium
glutamate(MSG), or other sodium containing items
frequently
occasionally
seldom
never
31.7%
19.5%
17%
26.8%
6. I use salt substitutes such as Mrs. Dash, Lemon pepper, Herb's in place of salt
frequently
occasionally
seldom
never
39%
19.5%
19.5%
17%
7. I use soy sauce and Worcestershire sauce when preparing foods
frequently
occasionally
seldom
never
9.7%
36.6%
39%
9.7%
8. When choosing food I look for products labeled sodium free, low sodium, or reduced sodium
frequently
occasionally
seldom
never
31.7%
24.4%
12%
26.8%
9. I use meat tenderizers when preparing meats
frequently
occasionally
seldom
60.9%
24.4%
9.7%
10. I season meat, fish, poultry and eggs with salt
frequently
occasionally
seldom
21.9%
12.2%
21.9%
never
never
39%
43
11. I use a low sodium cookbook when preparing meals
frequently
occasionally
seldom
80.5%
4.9%
4.9%
never
4.9%
12. I have heartburn and use baking soda or other antacids for indigestion or heartburn
frequently
occasionally
seldom
never
46.3%
19.5%
19.5%
9.8%
13. Use a baking soda toothpaste
frequently
occasionally
51.2%
12.2%
seldom
14.6%
never
14.6%
14. I omit salt in recipes that I prepare at home
frequently
occasionally
seldom
31.7%
24.4%
19.5%
never
17.1%
15. I add salt to foods before I taste them
frequently
occasionally
41.5%
26.8%
never
9.8%
seldom
17.1%
16. I add salt to food after I taste them and find them lacking flavor
frequently
occasionally
seldom
never
12.2%
9.7%
43.9%
29.3%
17. I look at the sodium content of foods before I decide which foods to buy
frequently
occasionally
seldom
never
43.9%
19.5%
9.8%
21.9%
18. Many foods I eat taste too salty
frequently
occasionally
2.4%
48.8%
seldom
29.3%
never
14.6%
19. In preparing recipes I follow the no added salt or low salt directions
frequently
occasionally
seldom
never
46.3%
14.6%
9.7%
19.5%
20. If reduced salt foods were available at a reasonable price I would buy them
frequently
occasionally
seldom
never
9.7%
29.3%
21.9%
29.3%
21. I limit how much I eat of salty foods such as pickles, pretzels, ham and bacon
frequently
occasionally
seldom
never
19.5%
19.5%
26.8%
29.3%
44
22. Reduced salt foods are consumed by other members in my household
frequently
occasionally
seldom
never
26.8%
21.9%
21.9%
21.9%
23. Fresh foods such as dairy products, meat, cheese, fruits and vegetable spoil before I have a
chance to prepare and eat them
frequently
occasionally
seldom
never
14.6%
58.5%
19.5%
2.4%
24. I feel that I have a loss in taste perception
frequently
occasionally
seldom
68.3%
19.5%
7.3%
25. I feel that I have a loss in sense of smell
frequently
occasionally
seldom
63.4%
14.6%
9.76%
26. I eat meals away from home
frequently
occasionally
2.4%
56.1%
seldom
36.6%
27. In preparing meals would you most likely eat
frequently
occasionally
seldom
4.8%
70.7%
17.1%
never
never
4.8%
never
never
28. If eating spaghetti which would you most likely use for spaghetti sauce
frequently
occasionally
seldom
never
43.9%
34.1%
17.1%
29. In estimating the amount of salt I add to my food per day I would say it was
none 1/2tsp
1tsp
3tsp
4tsp
5tsp or more
29% 41.4%
19.5%
4.9%
30. Does the water you drink have softeners added
yes 73.2%
no 14.6%
31. Do you or a family member prepare your own food
yes 4.9%
no 85.4%
37
Appendix B
Dietary Behavioral Questionnaire
38
Dietary Behavior Questionnaire
1. I add salt to my meals at the table
frequently
occasionally
seldom
never
2. I add salt during the cooking and preparation of foods
frequently
occasionally
seldom
never
3. I eat frozen "TV" dinners, frozen entrees, pot pies and pizza
frequently
occasionally
seldom
never
4. When cooking foods such as pasta, hot cereal, potatoes etc., I routinely add salt to the boiling
water
frequently
occasionally
seldom
never
5. When buying foods I read food labels and avoid foods high in salt, Monosodium
glutamate(MSG), or other sodium containing items
frequently
occasionally
seldom
never
6. I use salt substitutes such as Mrs. Dash, Lemon pepper, Herb's in place of salt
frequently
occasionally
seldom
never
7. I use soy sauce and Worcestershire sauce when preparing foods
frequently
occasionally
seldom
never
8. When choosing food I look for products labeled sodium free, low sodium, or reduced sodium
frequently
occasionally
seldom
never
9. I use meat tenderizers when preparing meats
frequently
occasionally
seldom
never
10. I season meat, fish, poultry and eggs with salt
frequently
occasionally
seldom
never
11. I use a low sodium cookbook when preparing meals
frequently
occasionally
seldom
never
12. I have heartburn and use baking soda or other antacids for indigestion or heartburn
frequently
occasionally
seldom
never
13. Use a baking soda toothpaste
frequently
occasionally
seldom
never
14. I omit salt in recipes that I prepare at home
frequently
occasionally
seldom
never
39
15. I add salt to foods before I taste them
frequently
occasionally
seldom
never
16. I add salt to food after I taste them and find them lacking flavor
frequently
occasionally
seldom
never
17. I look at the sodium content of foods before I decide which foods to buy
frequently
occasionally
seldom
never
18. Many foods I eat taste too salty
frequently
occasionally
seldom
never
19. In preparing recipes I follow the no added salt or low salt directions
frequently
occasionally
seldom
never
20. If reduced salt foods were available at a reasonable price I would buy them
frequently
occasionally
seldom
never
21. I limit how much I eat of salty foods such as pickles, pretzels, ham and bacon
frequently
occasionally
seldom
never
22. Reduced salt foods are consumed by other members in my household
frequently
occasionally
seldom
never
23. Fresh foods such as dairy products, meat, cheese, fruits and vegetable spoil before I have a
chance to prepare and eat them
frequently
occasionally
seldom
never
24. I feel that I have a loss in taste perception
frequently
occasionally
seldom
never
25. I feel that I have a loss in sense of smell
frequently
occasionally
seldom
never
26. I eat meals away from home
frequently
occasionally
seldom
never
27. In preparing meals would you most likely eat
prepackaged foods
meals prepared from fresh foods
meals prepared from
cannedlboxed foods
28. If eating spaghetti which would you most likely use for spaghetti sauce
prepared mix
homemade with salt
homemade with low salt
40
29. In estimating the amount of salt I add to my food per day I would say it was
none 1/2tsp
Itsp
3tsp
4tsp
30. Does the water you drink have softeners added
yes
no
31. Do you or a family member prepare your own food
yes
no
5 tsp or more
41
Appendix C
Frequency of Responses to Dietary Behavior Questionnaire
\
42
Frequency of Responses to the Dietary Behavior Questionnaire
(the percentage does not add to 100 since not all persons answered each question)
1. I add salt to my meals at the table
frequently
occasionally
17%
37%
seldom
22%
never
19%
2. I add salt during the cooking and preparation of foods
frequently
occasionally
seldom
9.7%
21.9%
31.7%
never
31.7%
3. I eat frozen "TV" dinners, frozen entrees, pot pies and pizza
frequently
occasionally
seldom
9.7%
34.1%
41.4%
never
9.76%
4. When cooking foods such as pasta, hot cereal, potatoes etc., I routinely add salt to the boiling
water
frequently
occasionally
seldom
never
26%
21.9%
19.5%
26.8%
5. When buying foods I read food labels and avoid foods high in salt, Monosodium
glutamate(MSG), or other sodium containing items
frequently
occasionally
seldom
never
31.7%
19.5%
17%
26.8%
6. I use salt substitutes such as Mrs. Dash, Lemon pepper, Herb's in place of salt
frequently
occasionally
seldom
never
39%
19.5%
19.5%
17%
7. I use soy sauce and Worcestershire sauce when preparing foods
frequently
occasionally
seldom
never
9.7%
36.6%
39%
9.7%
8. When choosing food I look for products labeled sodium free, low sodium, or reduced sodium
frequently
occasionally
seldom
never
31.7%
24.4%
12%
26.8%
9. I use meat tenderizers when preparing meats
frequently
occasionally
seldom
60.9%
24.4%
9.7%
10. I season meat, fish, poultry and eggs with salt
frequently
occasionally
seldom
21.9%
12.2%
21.9%
never
never
39%
\.
43
11. I use a low sodium cookbook when preparing meals
frequently
occasionally
seldom
80.5%
4.9%
4.9%
never
4.9%
12. I have heartburn and use baking soda or other antacids for indigestion or heartburn
frequently
occasionally
seldom
never
46.3%
19.5%
19.5%
9.8%
13. Use a baking soda toothpaste
frequently
occasionally
51.2%
12.2%
seldom
14.6%
never
14.6%
14. I omit salt in recipes that I prepare at home
frequently
occasionally
seldom
31.7%
24.4%
19.5%
never
17.1%
15. I add salt to foods before I taste them
frequently
occasionally
41.5%
26.8%
never
9.8%
seldom
17.1%
16. I add salt to food after I taste them and find them lacking flavor
frequently
occasionally
seldom
never
12.2%
9.7%
43.9%
29.3%
17. I look at the sodium content of foods before I decide which foods to buy
frequently
occasionally
seldom
never
43.9%
19.5%
9.8%
21.9%
18. Many foods I eat taste too salty
frequently
occasionally
2.4%
48.8%
seldom
29.3%
never
14.6%
19. In preparing recipes I follow the no added salt or low salt directions
frequently
occasionally
seldom
never
46.3%
14.6%
9.7%
19.5%
20. Ifreduced salt foods were available at a reasonable price I would buy them
frequently
occasionally
seldom
never
9.7%
29.3%
21.9%
29.3%
21. I limit how much I eat of salty foods such as pickles, pretzels, ham and bacon
frequently
occasionally
seldom
never
19.5%
19.5%
26.8%
29.3%
44
22. Reduced salt foods are consumed by other members in my household
frequently
occasionally
seldom
never
26.8%
21.9%
21.9%
21.9%
23. Fresh foods such as dairy products, meat, cheese, fruits and vegetable spoil before I have a
chance to prepare and eat them
frequently
occasionally
seldom
never
14.6%
58.5%
2.4%
19.5%
24. I feel that I have a loss in taste perception
frequently
occasionally
seldom
68.3%
19.5%
7.3%
25. I feel that I have a loss in sense of smell
frequently
occasionally
seldom
63.4%
14.6%
9.76%
26. I eat meals away from home
frequently
occasionally
2.4%
56.1%
seldom
36.6%
27. In preparing meals would you most likely eat
frequently
occasionally
seldom
4.8%
70.7%
17.1%
never
never
4.8%
never
never
28. If eating spaghetti which would you most likely use for spaghetti sauce
frequently
occasionally
seldom
never
43.9%
34.1%
17.1%
29. In estimating the amount of salt I add to my food per day I would say it was
none 1/2tsp
1tsp
3tsp
4tsp
5tsp or more
29% 41.4%
19.5%
4.9%
30. Does the water you drink have softeners added
yes 73.2%
no 14.60/0
31. Do you or a family member prepare your own food
yes 4.9%
no 85.4%
45
Appendix D
Internal Review Board Approval Form
~
".Vashington State Cniversity
:J'Jlllnan. VvA 99164-3140
509·335 ·9661
-;AX 509-335-1676
-' ~_; .. :~: t1~'. ~:. 2·.>.;~'::: ." .~ . .;i;i! 2~ _~ ~.::-~sarc~ Oevelooment
_
January 30, 1996
MEMORANDUM
TO:
Linda Massey and Diane Walker, FSHN-WSU Spokane (0399)
FROM:
Dr. Paul Whitney, Chair, Institutional Review Board
SUBJECT:
Review of Human Subjects. Protocol Modification
(4820)
fyv
Your Human Subject Review Summary Form and additional information provided to modify the
proposal, entitled Amendment to 'Reduction of Oxalate Excretion by Milk
Supplementation'" OGRD #NF was reviewed for the protection of the subjects participating
in the study. Based on the information received from you, the IRB has app~oved your modified
human subjects protocol on January 30, 1996.
II
The IRB approval indicates the IRB's belief that the Human Subjects protocol as presented in the
Human Subjects Review Summary Form by the investigator, is designed to adequately protect
the subjects participating in the study. This approval does not relieve the investigator from the
responsibility of providing continuing attention to ethical considerations involved in the
utilization of human subjects participating in the protocol. This approval is valid for one year
from today's date. If any significant changes are anticipated in the study please notify the
IRB before implementation.
In accordance with federal regulations, this approval must be kept by the
researcher for THREE years il.11H completion of research.
47
Appendix E
Dietary Behavior Questionnaire Totaled Scores
Along with 24-hour urine NA, 24-hour dietary record NA and FFQ NA record
BEHAVIOR QUESTIONNAIRE SCORES
DIETARY BEHAVIOR QUESTIONNAIRE SCORES TOTALED AND COMPARED WITH DIETARY SODIUM AND URINE SODIUM LEVELS
QUESTIONS 1-26 FROM DIETARY BEHAVIOR QUESTIONNAIRE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Total score urine
-3
1 0
0
2
0.0
0
3 -3
2
0
1
0
3
0
0 -3
2 -3
901
1
1
0
1 -3 -2
1 0
13.0
0
3
1
2
2 -1
0 -1 -1
0
2
0
0
0
0
0
2
1 0
0
0 -1
902
2
1
1
1
3.0
0
0
1
3 -3
2 -1 -3 -3 -1
1
1
0
0
0 -1
2
2
2
1 -2
903
3 -3
0
(9.0)
1 0
0
3
0
2 -2
2 -3 -3 -2 -2
1 0 -3
0
0 -2
1
1
2
1 -3 -3
2 -2
904
2
19.0
2
0
0
1
2
1
0 -1
0
0
0
0 -1
2
0
0
3
0
0
905
1
3
1 3
0
0
(5.0)
2
0
2
0
1
1 -2
1 -2 -2 -2 -1
0
0
0
0
2 -1
1 -2
1 0 -2 -2
906
0
0
13.0
1 0
0
2
1
1 0
1 2
0
0 -1 -1 -1
0
2
0
0
2 -1
907
1
3
1 0 -3
3
1 0
0
2
24.0
0
1
3
0
1
0 -1 -1
1
0
2
0
0
2
0
0
1
0
3
908
3
3
3
1 2
23.0
2
3
2 -1 -2 -2 -1
1
1 -1
3 -1
1
3
0
3
1 -1
0
1 -1
909
3
3
3
1
2
15.0
-2 -2 -2
2
1 o3
0
2
0 -2
3
0
911
1
1
1 0
0
3
0
0
3
2
1
2
(8.0)
1
2
3 -3
0
0 -2
2 -3 -3 -3 -3
912
2
2 -3
2
0 -3
0
0
0 -2 -2
18.0
1
1
1
2
0
0
1 -1
2
0
1 -3 -1
1
0
2
3
0
0
3
2
913
1
2
2 -1 -1
3
3
3
14.0
3 -2 -3 -3 -3
3
1 -2
1
3 -1
0
2
0
3
3 -2
914
1
2
2
2 -2 -3
1
22.0
1 2
0
0
0
2
2
0
0
0
0
1 0
0
915
0
0
2
0
2
0
3
2
2
2
2
(6.0)
3 -2 -3 -3 -3
0
0
3
1 -3
0
0
3
o0
2 -3
0
916
1
1
0
0 -2 -3
1
1
1 2
(8.0)
0
0 -3
3 -3 -3 -3 -3
2
1 -3
1 0 -2
3 -3
917
2
2
0
0 -3 -1
0
3
12.0
0
0
2 -1 -1 -3 -2
2 -1
1 -1
0
0
0
3
0
0
918
2
2
0 -2
2
3
3
0-1
1
0
2
18.0
1
0
0
2
0
2
3 -1
1 -2
0
3
0
2
919
3
2
3
0 -3
0
0
0
0
(3.0)
2 -3
1 -3 -3 -3 -3
3
3
0
0
0 -2
0
920
2
2
1 -3
0
3
3 -3
0
1 0
0
2
(12.0)
0 -3
3 -3 -2 -3 -1
0
0
0
3
0 -3
0
0 -3
921
0
0
0
0 -3
0
1 0
0
2
21.0
0
2
3
0
1
0
0
0
0
2
0
2 -1
0
3
0
0
0
922
3
1
3 -1
1
1
1
3
27.0
1 2
0
2
3
0
2
0 -1 -2 -2
0
2
0
1 3
0
923
3
3
2
3 -1
0
0
0
2
4.0
1
1 0 -2
1
3 -1
1
0 -1 -2 -2
2 -1
0 -1
924
2
2
1 0 -1 -1
1 0
0
3
(11.0)
3 -3 -3 -3 -2
2
2 -3
0
0 -3
2 -3
0
0 -3
925
0
1
2
2 -3 -3
2
0
0
2
0.0
1 2 -2
1 2 -3
2 -2 -2 -2 -2
0
2
0
1 -3 -2
2 -3
926
1
2
1
1 0
(4.0)
0
3
0
0
0
0
3 -3
0
0 -3
3
0 -3 -2 -3
927
1
2
0 -3
0
3 -3
0
1 0
0
3
18.0
0
0
1
1
0
1
3
0
0
2
0
2
0 -1
1
0
928
1
1
1 2
0 -1
1 0
0
3
7.0
0
2
0
2
0 -2
0
0
2 -1
0
0
0
0
0 -1
929
1
1
1 -1 -2
1
1 0
0
2
5.0
2
2 -1
1 -1 -1 -1 -1
2 -1
2
1 0 -2 -2
0
2
0
0
0 -1
930
1
17.0
0
0
0
0
3
0
1 2
0
1
931
1
3
0 -1
1 -1
2
2
0
2
0
0 -2 -1
2
2
1 3
3
2
11.0
1
2 -3 -3 -1 -3
3 -3
3
0
2
3 -2
3
3 -2
932
2
3
0
0 -3 -3
2
2
0
0
20.0
0
2
0
1
0
1 0
0
3
0
0
0
3
0 -1
0 -3
933
3
3
1
3
0
1 0
0
8.0
2
1
1 -1
1
1 0
1 -1 -2 -2 -1
1 -1
934
1 2
1 -1
1
3 2 -1 -1
1 0
1
28.0
3
2
1
2
0
2
2
0
1
0 -1 -1
0
3
0
3
0
2
3 -1 -1
935
3
3
1 0
2
(2.0)
2
0
0
1 -1 -3 -3 -3
2
0 -3
1 -3
0
2
0
0 -2
0
3
936
2
0
0
1 0
0
3
18.0
0
1 0
1
0
0
0
0
2
938
1
2
2
0
0
0
0
3
0
0
0 -1
3
1
1
1
2
1.0
2 -1
1 -1
0
1
0
0
0 -1
0
0
0 -2 -2 -2
1 -2 -1
939
2
0
1
0
3
2
2
13.0
1
0
0
1
0
0
3
0
0
2
0
1
0 -3 -3
0
940
1
1
3
3 -2 -2
2
1 2
2
13.0
0
2
0
2
0 -1 -2 -2
0
0
3
0
0
941
1
2
1 2
0
0
0
0 -2
Mean
8.6
SD
10.0
Median
12.0
Mode
13.0
---
NaFFQ
2,403.0
4,877.0
3,407.0
2,186.0
3,680.0
1,898.0
3,198.0
3,512.0
14,105.0
2,835.0
2,365.0
2,710.0
5,958.0
Na mm
136.7
205.5
96.7
107.6
258.0
150.4
220.9
97.6
90.5
163.7
117.7
178.3
216.7
109.9
127.0
163.1
164.6
189.5
198.4
102.2
276.2
139.3
84.5
117.7
183.5
235.7
193.0
148.1
143.0
105.0
311.9
160.4
240.6
149.1
114.1
164.9
236.9
79.8
168.3
162.7
45.0
160.4
117.7
Na 24hrdiet
2,834.0
3,040.0
2,872.0
4,615.0
3,902.0
5,265.0
3,123.0
3,071.0
3,513.0
1,847.0
5,646.0
3,186.0
3,044.0
3,369.0
2,624.0
2,041.0
2,660.0
3,606.0
1,480.0
2,680.0
2,945.0
2,857.0
3,191.0
3,054.0
4,412.0
1,882.0
3,692.0
1,261.0
2,954.0
7,445.0
3,664.0
4,270.0
3,250.0
2,428.0
2,027.0
13,649.0
2,036.0
4,136.0
3,515.0
1,164.3
3,062.5
#N/A
1,640.0
3,025.0
3,217.0
2,144.0
1,797.0
7,173.0
1,673.0
3,786.0
2,491.0
3,816.0
4,284.0
1,354.0
2,191.0
2,588.0
3,989.0
3,599.0
3,297.0
2,547.0
2,018.0
3,022.0
3,746.0
3,247.0
2,367.0
2,462.0
3,367.8
1,197.4
3,022.0
#N/A
THIS TABLE DISPLAYS EACH INDIVIDUAL'S ANSWERS TO THE BEHAVIOR QUESTIONNAIRE. THE INDIVIDUAL ANSWERS HAVE BEEN CONVERTED TO A
4 POINT LIKERT SCALE AlilD ADJUSTED FOR NEGATIVE VALUES. THE SCORES ARE TOTALED FOR EACH INDIVIDUAL AND COMPARED WITH THE
.- _ ..
•
. . - " .• " -
_
•• -
-
_ _. • • - - . _ '
I~
~8o
•
I
_.~~ ..
M"~
"~n.....,.nn
I
I
I
I
I
I
I
I
49
Appendix F
Individuals who were between 75 and 125% RDA for Kilocalories
50
Kilocalories Measured From the FFQ Between 75 and 125 % RDA (accounts for 61 % of the FFQ)
CODE
URINENAMM
KCAL
% OFRDA
FFQNA MG
901
903
905
907
908
912
913
917
920
924
925
926
927
929
930
931
932
933
934
936
937
938
939
941
137
97
116
221
98
118
178
163
198
85
118
184
236
148
143
105
312
160
241
114
118
165
237
168
1650
2445
78
111
96
110
117
113
76
109
98
92
96
112
108
75
92
109
116
92
124
97
97
100
94
91
1690
3407
3680
3198
3512
2365
2710
3025
2144
3786
2491
3816
4284
2191
2588
3989
3599
3297
2547
3022
3210
3401
2609
2215
2523
2256
2676
2208
2824
3139
1654
2036
3161
2672
1761
2866
2134
2903
2184
2103
3746
3247
2462
51
Appendix G
Adjusted Sodium for RDA
52
ADJUSTED DIETARY SODIUM (DIET NA MG/ % RDA KCAL)
CODE
FFQNA MG
ADJUSTEDNA
FFQ
24-H DIETARY
RECORDNAMG
901
902
903
904
905
906
907
908
909
911
912
913
914
915
916
917
918
919
920
921
922
923
924
925
926
927
928
929
930
931
932
933
934
935
936
937
938
939
940
941
1802
4877
3407
3273
2310
3318
3069
4676
2834
3040
2872
ADJUSTEDNA
24-H DIETARY
RECORD
2778
3619
3730
4615
3902
5265
3123
3071
3513
1847
5646
3186
3044
3369
2624
2041
2660
3606
1480
2680
2945
2857
3191
3054
4412
1882
3692
1261
2954
7445
3664
4270
3250
2428
2634
2027
13649
2036
4136
3118
2636
9573
2974
3839
3513
3930
5429
2896
4476
3622
3200
2032
5320
2885
1947
2602
2887
3968
3324
3054
211
2941
4923
3076
6422
6768
4211
3882
3736
2856
4878
2472
8478
3181
4015
1898
3198
3512
14105
2835
2365
2710
5958
3163
2907
3002
5092
2181
2093
3565
3152
1640
3025
3217
2447
2775
2144
1797
7173
1673
3786
2491
3816
4284
1354
2191
2588
3989
3599
3297
2547
2018
3022
2188
2643
3188
2694
4115
2595
3128
3967
1991
2921
2813
3660
3103
3584
2054
4805
3115
3746
3247
2367
2462
3746
3454
1864
2705
53
AppendixH
Sample Characteristics
54
SAMPLE CHARACTERISTICS
age
sex
68
M
M
F
M
F
F
M
M
M
M
M
M
F
M
M
M
F
M
M
M
F
M
M
M
M
M
M
F
F
M
M
F
M
M
F
M
30
42
61
47
27
33
45
50
65
76
45
46
66
61
69
44
46
66
76
49
68
31
64
67
46
44
23
37
44
61
55
55
29
37
33
MEAN
STANDARD DEV.
MODE
MEDIAN
RANGE
DISTRIBUTION
51.4
12.9
61
49
23-76
10 F/29 M
55
Appendix I
Correlation coefficients between individual questions from the DBQ
and 24-hour urine Na, FFQ Na, and 24-hour dietary record Na
CORRELATION COEFFICIENTS BETWEEN INDIVIDUAL QUESTIONS FROM THE DIETARY BERAVIOR
QUESTIONNAIRE AND 24-HOUR URINE Na, FFQ Na, AND 24-HOUR DIETARY RECORD Na
QUESTIONS FROM THE DIETARY DEHAVIOR QUESTIONNAIRE
* indicates a significance at the 0.05 level
1. I add salt to my meals at the table
2. I add salt during the cooking and preparation of foods
3. I eat frozen "TV" dinners, frozen entrees, pot pies and pizza
4. When cooking foods such as pasta, hot cereal, potatoes etc., I routinely add salt to the boiling water
5. When buying foods I read food labels and avoid foods high in salt, Monosodium glutamate(MSG), or other sodium
containing items
6. I use salt substitutes such as Mrs. Dash, Lemon pepper, Herb's in place of salt
7. I use soy sauce and Worcestershire sauce when preparing foods
8. When choosing food I look for products labeled sodium free, low sodium, or reduced sodium
9. I use meat tenderizers when preparing meats
10. I season meat, fish, poultry and eggs with salt
11. I use a low sodium cookbook when preparing meals
12. I have heartburn and use baking soda or other antacids for indigestion or heartburn
13. Use a baking soda toothpaste
14. I omit salt in recipes that I prepare at home
15. I add salt to foods before I taste them
16. I add salt to food after I taste them and find them lacking flavor
.17. I look at the sodium content of foods before I decide which foods to buy
18. Many foods I eat taste too salty
19. In preparing recipes I follow the no added salt or low salt directions
20. If reduced salt foods were available at a reasonable price I would buy them
21. I limit how much I eat of salty foods such as pickles, pretzels, ham and bacon
22. Reduced salt foods are consumed by other members in my household
23. Fresh foods such as dairy products, meat, cheese, fruits and vegetable spoil before I have a chance to prepare and
eat them
24. I feel that I have a loss in taste perception
25. I feel that I have a loss in sense of smell
26. I eat meals away from home
27. In preparing meals would you most likely eat
28. If eating spaghetti which would you most likely use for spaghetti sauce
29. In estimating the amount of salt I add to my food per day I would say it was
30. Does the water you drink have softeners added
31. Do you or a family member prepare your own food
24-H
URINE
Na
FFQ Na
24-H
diet
record Na
-0.06
0.088
-0.079
-0.057
-0.015
* 0.304
0.242
* 0.301
-0.062
-0.067
0.144
-0.171
-0.069
-0.098
0.09
0.045
0.045
-0.156
0.21
-0.194
-0.149
0
-0.079
0.209
0.081
-0.064
-0.165
-0.06
-0.14
* -0.389
0.144
0.096
-0.174
0.068
0.008
-0.011
* 0.274
-0.151
-0.026
-0.09
-0.073
* 0.447
* 0.316
-0.007
0.055
-0.078
-0.015
-0.037
-0.064
0.37
0.058
0.056
-0.02
-0.012
0.044
-0.141
-0.159
-0.153
-0.044
0.105
0.129
-0.042
* -0.362
-0.073
0.078
-0.131
0.163
0.023
0.1
0.016
0.032
0.126
-0.091
0.022
-0.212
-0.106
0.14
0.262
0.032
0.126
-0.091
0.022
-0.212
-0.109
0.225
0.201
-0.169
0.039
-0.216
0.03
-0.089
0.047
* 0.391