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Abstract Background A food environment intervention using nudge tactics was implemented at a hospital convenience store (CVS) in Tokyo to improve employees’ eating habits. The objective of this study was to evaluate its effects on the urinary sodium-to-potassium ratio (Na/K), food intake, eating attitude, and behavior. Methods Using a pre–post design; the intervention incorporated nudge tactics, healthier options, easy-to-pick food placement, and eye-catching information. We also used price incentives. The primary outcomes included changes in Na/K and sodium and potassium excretion assessed using spot urine samples at health checkups. Secondary outcomes were changes in staff food intake, eating attitude, and behavior which were assessed using questionnaire surveys. All outcomes were evaluated statistically. Furthermore, we investigated how the intervention led to outcomes using path analysis. Results A total of 140 participant (52men and 88women) were analyzed. Significant changes were observed in Na/K (3.16 to 2.98 in median, p = 0.02) and potassium excretion (43.4 to 45.2 mmol/day in mean, p = 0.03). However, sodium excretion did not change significantly. The intake of fruits and dairy products increased with improved self-efficacy. The most influential factor for lowering Na/K and increasing potassium excretion was information from the CVS; purchasing “balanced meals” to lower Na/K and salads to increase potassium excretion were second. Conclusions Food environment intervention using nudge tactics can improve staff’s food intake and lower Na/K. Trial registration Registration number: UMIN000049444 (UMIN-CTR). Date of registration: November. 7. 2022.

Abstract Objective: The aim of this study is to conduct a comparative analysis across nations to: (1) identify the determinants influencing knowledge and attitudes related to sodium (Na) intake and (2) to analyse the association between knowledge and attitudes related to Na intake. Design: We utilised a secondary data from a cross-sectional study that was conducted across seven nations. Structural equation modelling (SEM) was utilised to assess the impact of socio-economic and health-related predictors on knowledge and attitudes pertaining to Na intake and further to investigate the relationship between knowledge and attitude. Setting: Indonesia, Brazil, Thailand, Japan, France, the UK and the USA. Participants: 7090 participants aged 15 years and above were included in the study. Results: SEM analysis showed a strong association between knowledge about Na intake and related attitude across all countries, particularly in the UK (2·65, 95 % CI 1·48–3·82), France (2·62, 1·45–3·79) and the USA (1·97, 1·21–2·73). In Brazil, Japan and France, individuals or family members having certain health conditions such as raised blood pressure, heart diseases, strokes or other diseases exhibited a positive attitude towards reducing Na intake. Conversely, socio-economic factors like education and income demonstrated the complexity of influences on knowledge and attitudes about Na intake. Conclusion: The study underscores the need for tailored public health interventions to reduce excessive Na consumption, considering the diverse cultural, social and economic factors. It highlights the complex determinants of knowledge and attitudes towards Na intake, calling for further research in varied populations.