Objective: The Niigata prefecture's salt intake and age-adjusted cerebrovascular mortality rate have historically been above the national average. Against this background, the prefectural government launched a new campaign in 2009 called the "Niigata Gen-en (salt reduction) Renaissance Movement", which has continued for 10 years. This campaign sought to implement effective nutrition measures by applying the plan-do-check-act (PDCA) cycle in the areas of nutrition and dietary habits. Methods: We identified high-priority health issues and factors related to nutrition-and dietary habits underlying these. We then determined the necessary measures to improve these factors and thereby achieve our goals. Further, we developed an evaluation framework to determine how each specific measure contributed to the achievement of the goals. This framework was designed to clarify both the qualitative and quantitative effects of each measure, and consisted of progress evaluation, impact evaluation, and outcome evaluation. Results: The progress evaluation showed an increase in the number of measures implemented by municipalities and related organizations. The impact evaluation showed significant improvement in prefectural residents' dietary behaviors associated with high salt intake. The outcome evaluation showed decreases in salt intake, systolic blood pressure, and the number of deaths due to cerebrovascular disease and ischemic heart disease. Conclusion: By implementing measures based on the PDCA cycle, developing an evaluation framework that facilitates the achievement of dietary and nutrition-related goals, and objectively evaluating the effects of the measures through the framework, we were able to determine how each measure contributed to the achievement of the campaign's goals.
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