Journal Article

The Effects of a Community-Based Sodium Reduction Program in Rural China – A Cluster-Randomized Trial

Hao, Zhixin, Yao, Chen, Feng, Xiangxian, Zhang, Ruijuan, Pan, Jianhong, Li, Xian, Zhao, Yi, Zhang, Yuhong, Engelgau, Michael, Zhang, Jianxin, Zhang, Jing, Li, Zhifang, MacMahon, Stephen, Niu, Wenyi, Elliott, Paul, Neal, Bruce, Wu, Yangfeng, Yan, Lijing L., Ma, Jixiang, Shi, Jingpu, Labarthe, Darwin, Zhou, Bo, Sun, Jixin, Li, Nicole, Yu, Yan, Chu, Hongling

2016

Overview

Average sodium intake and stroke mortality in northern China are both among the highest in the world. An effective, low-cost strategy to reduce sodium intake in this population is urgently needed. We sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China. This study was a cluster-randomized trial done over 18 months in 120 townships (one village from each township) from five provinces. Sixty control villages were compared to 60 intervention villages that were given access to a reduced-sodium, added-potassium salt substitute in conjunction with a community-based health education program focusing on sodium reduction. The primary outcome was the difference in 24-hour urinary sodium excretion between randomized groups. Among 1,903 people with valid 24-hour urine collections, mean urinary sodium excretion in intervention compared with control villages was reduced by 5.5% (-14mmol/day, 95% confidence interval -26 to -1; p = 0.03), potassium excretion was increased by 16% (+7mmol/day, +4 to +10; p<0.001), and sodium to potassium ratio declined by 15% (-0.9, -1.2 to -0.5; p<0.001). Mean blood pressure differences were -1.1 mm Hg systolic (-3.3 to +1.1; p = 0.33) and -0.7 mm Hg diastolic (-2.2 to +0.8, p = 0.35) and the difference in the proportion with hypertension was -1.3% (-5.1 to 2.5, p = 0.56). There were clear differences in population sodium and potassium intake between villages that were most likely a consequence of increased use of salt substitute. The absence of effects on blood pressure reflects the moderate changes in sodium and potassium intake achieved. Clinicaltrials.gov identifier: NCT01259700.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Access control / Adult / Aged / Biology and Life Sciences / Blood / Blood pressure / China / Cluster Analysis / Clusters / Collaboration / Confidence intervals / Consent / Diet, Sodium-Restricted - adverse effects / Diet, Sodium-Restricted - methods / Disease control / Disease prevention / Dizziness - etiology / Excretion / Female / Follow-Up Studies / Headache - etiology / Health care / Health Education - methods / Hospitals / Humans / Hypertension / Intervention / Male / Medicine and Health Sciences / Mercury / Middle Aged / Outcome Assessment, Health Care - methods / Outcome Assessment, Health Care - statistics & numerical data / People and Places / Physical Sciences / Potassium / Potassium - administration & dosage / Pressure effects / Preventive medicine / Public health / Rural areas / Rural communities / Rural Health - statistics & numerical data / Rural Population - statistics & numerical data / Salt / Salts / Science / Sodium / Sodium - urine / Sodium salts / Sodium, Dietary - administration & dosage / Stroke / Substitutes / Surveys and Questionnaires / Towns / Urine / Villages