title: Dietary salt reduction in rural patients with albuminurea using family and community support: the Mima study.
abstract: BACKGROUND
  Residents of rural communities are often more socially connected compared to urban dwellers. Using family and community support to motivate health behavior change may be useful in rural settings. The objective of this study was to pilot a salt reduction (SR) intervention for rural albuminuria patients using support from family and neighborhood residents compared to a usual care condition. The primary outcome was change in urine albumin-creatinine ratio (ACR).
  
  
  METHODS
  All consecutive outpatients with an ACR >= 30 mg/gCr were recruited from the Koyadaira Clinic. Patients self-selected their participation in the intervention group (IG) or the control group (CG) because the rural population expressed concern about not being treated at the same time. In the IG, patients and their families were educated in SR for 30 minutes in their home by experienced dieticians. In addition, patients, families and neighborhood residents were also educated in SR for 2 hours at a public town meeting hall, with educational content encouraging reduction in salt intake through interactive activity. The CG received conventional treatment, and ACR and blood pressure (BP) were measured after 3 months.
  
  
  RESULTS
  Of the 37 subjects recruited (20 male, 16 female, mean age; 72.8 +/- 9.2 years), 36 completed the 3-month follow up and were analyzed. In the IG, ACR decreased significantly from baseline (706 +/- 1,081 to 440 +/- 656; t = 2.28, p = 0.04) and was reduced compared to the CG (213 +/- 323 to 164 +/- 162; F = 3.50, p = 0.07), a treatment effect approaching significance. Systolic BP in the IG (145 +/- 14 to 131 +/- 13 mmHg; t = 3.83, p = 0.002) also decreased significantly compared to the CG (135 +/- 13 to 131 +/- 14; F = 4.40, p = 0.04).
  
  
  CONCLUSIONS
  Simultaneous education of patients, their families and neighborhood residents may be important in rural areas for treatments and interventions requiring health behavior change.
  
  
  BACKGROUND
  UMIN000001972.
authors.affiliation: Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukuihata-cho, Fushimi-ku, Kyoto 612-8555, Japan. nsakane@kyotolan.hosp.go.jp.
authors.forename: Shinji
authors.initials: S
authors.lastname: Fujiwara
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kotani
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Brantley
authors.forename: Kokoro
authors.initials: K
authors.lastname: Tsuzaki
authors.forename: Yukiyo
authors.initials: Y
authors.lastname: Matsuoka
authors.forename: Masayuki
authors.initials: M
authors.lastname: Domichi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Sano
authors.forename: Eiji
authors.initials: E
authors.lastname: Kajii
authors.forename: Naoki
authors.initials: N
authors.lastname: Sakane