Effects of a community-based salt reduction program in a regional Australian population

Mary-Anne Land, Jason H Y Wu, Adriana Selwyn, Michelle Crino, Mark Woodward, John Chalmers, Jacqui Webster, Caryl Nowson, Paul Jeffery, Wayne Smith, Victoria Flood, Bruce Neal, Mary-Anne Land, Jason H Y Wu, Adriana Selwyn, Michelle Crino, Mark Woodward, John Chalmers, Jacqui Webster, Caryl Nowson, Paul Jeffery, Wayne Smith, Victoria Flood, Bruce Neal

Abstract

Background: Salt reduction is a public health priority but there are few studies testing the efficacy of plausible salt reduction programs.

Methods: A multi-faceted, community-based salt reduction program using the Communication for Behavioral Impact framework was implemented in Lithgow, Australia. Single 24-h urine samples were obtained from 419 individuals at baseline (2011) and from 572 at follow-up (2014). Information about knowledge and behaviors relating to salt was also collected.

Results: Survey participants were on average 56 years old and 58 % female. Mean salt intake estimated from 24-h urine samples fell from 8.8 g/day (SD = 3.6 g/day) in 2011 to 8.0 (3.6) g/day in 2014 (-0.80, 95 % confidence interval -1.2 to -0.3;p < 0.001). There were significant increases in the proportion of participants that knew the recommended upper limit of salt intake (18 % vs. 29 %; p < 0.001), knew the importance of salt reduction (64 % vs. 78 %; p < 0.001) and reported changing their behaviors to reduce their salt intake by using spices (5 % vs. 28 %; p < 0.001) and avoiding eating out (21 % vs. 34 %; p < 0.001). However, the proportions that checked food labels (30 % vs. 25 %; p = 0.02) fell, as did the numbers avoiding processed foods (44 % vs. 35 %; p = 0.006). Twenty-six percent reported using salt substitute at the end of the intervention period and 90 % had heard about the program. Findings were robust to multivariable adjustment.

Conclusions: Implementation of this multi-faceted community-based program was associated with a ~10 % reduction in salt consumption in an Australian regional town. These findings highlight the potential of well-designed health promotion programs to compliment other population-based strategies to bring about much-needed reductions in salt consumption.

Clinical trial registration: NCT02105727 .

Keywords: 24-hour urine; Cardiovascular disease prevention; Salt; Sodium.

Figures

Fig. 1
Fig. 1
Flow chart. Flow chart shows the research design and recruitment of individuals
Fig. 2
Fig. 2
Effect of intervention on urinary salt excretion. Data presented are mean 24-hour urinary salt g/day (95% confidence interval) for continuous characteristics, paired and unpaired t-test for matched and unmatched subjects. Results were then pooled by inverse variance weighted meta-analysis as calculated using a fixed effect inverse-variance weighted method

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