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

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

Abstract

Background: 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.

Objective: We sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China.

Design: 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.

Results: 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).

Conclusion: 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.

Trial registration: Clinicaltrials.gov identifier: NCT01259700.

Conflict of interest statement

Bruce Neal is the Chair of Australian Division of World Action on Salt and Health. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Study CONSORT Flow Diagram.
Fig 1. Study CONSORT Flow Diagram.

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