Protocol for the implementation and evaluation of a community-based intervention seeking to reduce dietary salt intake in Lithgow, Australia

Mary-Anne Land, Paul Jeffery, Jacqui Webster, Michelle Crino, John Chalmers, Mark Woodward, Caryl Nowson, Wayne Smith, Victoria Flood, Bruce Neal, Mary-Anne Land, Paul Jeffery, Jacqui Webster, Michelle Crino, John Chalmers, Mark Woodward, Caryl Nowson, Wayne Smith, Victoria Flood, Bruce Neal

Abstract

Background: Excess dietary salt is a leading risk for health. Multiple health, government, industry and community organisations have identified the need to reduce consumption of dietary salt. This project seeks to implement and evaluate a community-based salt reduction intervention.

Methods: The study comprises a baseline assessment followed by a targeted intervention and then an evaluation of efficacy. The study location is Lithgow, a regional town in New South Wales, Australia. The salt reduction intervention is based upon the Communication for Behavioural Impact framework which utilises an integrated communication model to enact community advocacy and impact by providing tools that enable the translation of knowledge into behavioural change. The duration of the intervention will be between 6 and 12 months. The primary evaluation will be through measurement of 24-hr urinary sodium excretion in independent population samples aged>20 years, drawn before and after the intervention period. The study is designed to detect a difference in mean sodium excretion of 0.7 grams per day or greater with 80% power and p=0.05.

Discussion: This study will provide a robust evaluation of the effectiveness of a community-based intervention seeking to reduce dietary salt intake using the Communication for Behavioural Impact framework. The results will provide important new evidence to inform the design and implementation of current and future salt reduction policies in Australia. The results will also have important international implications because, following the recent World Health Organization recommendations for the control of non-communicable diseases, many countries are now seeking to achieve a reduction in average population salt consumption.

Trial registration: ClinicalTrials.gov, NCT02105727.

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Figure 1
Project design.

References

    1. World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Geneva; 2013. .
    1. World Health Organization. Global status report on noncommunicable diseases. Geneva; 2010. .
    1. What is cardiovascular disease? .
    1. Australian Institute of Health and Welfare. Health expenditure Australia 2007–08. Canberra; 2009. .
    1. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH. DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001;344(1):3–10. doi: 10.1056/NEJM200101043440101.
    1. Keogh JB, Clifton PM. Salt intake and health in the Australian population. Med J Aust. 2008;189(9):526.
    1. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand. Department of Health and Ageing; 2006. .
    1. World Health Organization. 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. Geneva; 2008. .
    1. The World Health Organization. Formal Meeting of Member States to Conclude the Work on the Comprehensive Global Monitoring Framework, Including Indicators, and a set of Voluntary Global Targets for the Prevention and Control of Noncommunicable Diseases Geneva, 5–7 November 2012. Geneva; 2012. .
    1. Food and Health Dialogue Website. .
    1. Schiavo R. Health Communication: From Theory to Practice. In., edn. San Francisco: Jossey-Bass; 2007.
    1. 2011 census quickstats Lithgow New South Wales. .
    1. World Health Organization and Pan American Health Organization Regional Expert Group for Cardiovascular Disease Prevention through Population-wide Dietary Salt Reduction (Sub-group for research and surveillance) Protocol for Population level Sodium Determination in 24-Hour Urine Samples. 2010.
    1. Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation. 1993;88(5 Pt 1):2460–2470.
    1. Moshfegh AJ, Rhodes DG, Baer DJ, Murayi T, Clemens JC, Rumpler WV, Paul DR, Sebastian RS, Kuczynski KJ, Ingwersen LA, Staples RC, Cleveland LE. The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes. Am J Clin Nutr. 2008;88(2):324–332.
    1. Food Standards Australia and New Zealand (FSANZ) Australian Food, Supplement & Nutrient Database 2007 for estimation of population nutrient intakes. 2008. .
    1. Hosein E, Parks W, Schiavo R. In: Emerging Theories in Health Promotion Practice and Research. 2. DiClemente R, Crosby R, Kegler M, editor. Jossey-Bass; 2009. Communication for Behavoiral Impact; an Integrated Model for Health and Social Change.
    1. Salt for life.
    1. FoodSwitch. .
    1. National Academy of Sciences. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Washington, DC; 2001. .
    1. World Health Organization. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. 3. Geneva; 2007. .
    1. Webster JL, Dunford EK, Hawkes C, Neal BC. Salt reduction initiatives around the world. J Hypertens. 2011;29(6):1043–1050. doi: 10.1097/HJH.0b013e328345ed83.
    1. World Health Organization. Mapping salt reduction initiatives in the WHO European Region. Copenhagen; 2013. .
    1. Land MA, Webster J, Christoforou A, Praveen D, Jeffery P, Chalmers J, Smith W, Woodward M, Barzi F, Nowson C, Flood V, Neal B. Salt intake assessed by 24 h urinary sodium excretion in a random and opportunistic sample in Australia. BMJ Open. 2014;4(1):e003720. doi: 10.1136/bmjopen-2013-003720.
    1. Brown IJ, Dyer AR, Chan Q, Cogswell ME, Ueshima H, Stamler J, Elliott P. Estimating 24-hour urinary sodium excretion from casual urinary sodium concentrations in Western populations: the INTERSALT study. Am J Epidemiol. 2013;177(11):1180–1192. doi: 10.1093/aje/kwt066.
    1. Ribic CH, Zakotnik JM, Vertnik L, Vegnuti M, Cappuccio FP. Salt intake of the Slovene population assessed by 24 h urinary sodium excretion. Public Health Nutr. 2010;13(11):1803–1809. doi: 10.1017/S136898001000025X.
    1. Chappuis A, Bochud M, Glatz N, Vuistiner P, Paccaud F, Burnier M. Swiss survey on salt intake: main results. Lausanne; 2011. .
    1. Ortega RM, Lopez-Sobaler AM, Ballesteros JM, Perez-Farinos N, Rodriguez-Rodriguez E, Aparicio A, Perea JM, Andres P. Estimation of salt intake by 24 h urinary sodium excretion in a representative sample of Spanish adults. Br J Nutr. 2011;105(5):787–794. doi: 10.1017/S000711451000423X.
    1. Webster JL, Dunford EK, Neal BC. A systematic survey of the sodium contents of processed foods. Am J Clin Nutr. 2010;91(2):413–420. doi: 10.3945/ajcn.2009.28688.
    1. Kumanyika S. Behavioral aspects of intervention strategies to reduce dietary sodium. Hypertension. 1991;17(1 Suppl):I190–I195.
    1. The World Health Organization. European Regional Technical Consultation on Noncommunicable Disease Surveillance, Monitoring and Evaluation. Copenhagen; 2012. .
    1. Kawasaki T, Itoh K, Uezono K, Sasaki H. A simple method for estimating 24 h urinary sodium and potassium excretion from second morning voiding urine specimen in adults. Clin Exp Pharmacol Physiol. 1993;20(1):7–14. doi: 10.1111/j.1440-1681.1993.tb01496.x.
    1. Toft U, Cerqueira C, Andreasen AH, Thuesen BH, Laurberg P, Ovesen L, Perrild H, Jørgensen T. Estimating salt intake in a Caucasian population: can spot urine substitute 24-hour urine samples? Eur J Prev Cardiol. in press.
    1. Tanaka T, Okamura T, Miura K, Kadowaki T, Ueshima H, Nakagawa H, Hashimoto T. A simple method to estimate populational 24-h urinary sodium and potassium excretion using casual urine specimen. J Hum Hypertens. 2002;16(2):97. doi: 10.1038/sj.jhh.1001307.
    1. Elliott P, Brown IJ, Dyer AR, Chan Q, Ueshima H, Stamler J. on behalf of the INTERSALT Co-operative Research Group. Elliott et al. respond to “Quantifying Urine Sodium Excretion”. Am J Epidemiol. 2013;177(11):1196–1198. doi: 10.1093/aje/kwt065.
    1. Huang L, Crino M, Jeffery P, Woodward M, Barzi F, McLean R, Land M, Neal B. Can Spot Urine be Used to Replace 24-Hour Urine for Monitoring Population Salt Intake? 2014. [abstract]. Journal of Hypertension, in press.
    1. Campbell NR, Dary O, Cappuccio FP, Neufeld LM, Harding KB, Zimmermann MB. Need for coordinated programs to improve global health by optimizing salt and iodine intake. Rev Panam Salud Publica. 2012;32(4):281–286. doi: 10.1590/S1020-49892012001000006.
    1. International Council for Control of Iodine Deficiency Disorders. Salt iodization for the elimination of iodine deficiency. 1995. .
    1. World Health Organization. Salt Reduction and Iodine Fortification Strategies in Public Health. Geneva; 2014. .

Source: PubMed

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