title: The Effects of a Community-Based Sodium Reduction Program in Rural China - A Cluster-Randomized Trial.
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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT01259700.
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.|The George Institute for Global Health, Sydney, Australia.|Sydney Medical School, the University of Sydney, Sydney, Australia.
authors.forename: Nicole
authors.identifier: http://orcid.org/0000-0002-0873-7328
authors.initials: N
authors.lastname: Li
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.|Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America.
authors.forename: Lijing L
authors.initials: LL
authors.lastname: Yan
authors.affiliation: School of Public Health, Peking University Health Science Center, Beijing, China.
authors.forename: Wenyi
authors.initials: W
authors.lastname: Niu
authors.affiliation: Peking University Clinical Research Institute, Beijing, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Yao
authors.affiliation: Changzhi Medical College, Changzhi, Shanxi, China.
authors.forename: Xiangxian
authors.initials: X
authors.lastname: Feng
authors.affiliation: Hebei Province Center for Disease Prevention and Control, Shijiazhuang, Hebei, China.
authors.forename: Jianxin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: First Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Jingpu
authors.initials: J
authors.lastname: Shi
authors.affiliation: Ningxia Medical University, Yinchuan, Ningxia, China.
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Xi'an Jiaotong University, Xi'an, Shaanxi, China.
authors.forename: Ruijuan
authors.initials: R
authors.lastname: Zhang
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Zhixin
authors.initials: Z
authors.lastname: Hao
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.|School of Public Health, Peking University Health Science Center, Beijing, China.
authors.forename: Hongling
authors.initials: H
authors.lastname: Chu
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Xian
authors.initials: X
authors.lastname: Li
authors.affiliation: Peking University Clinical Research Institute, Beijing, China.
authors.forename: Jianhong
authors.initials: J
authors.lastname: Pan
authors.affiliation: Changzhi Medical College, Changzhi, Shanxi, China.
authors.forename: Zhifang
authors.initials: Z
authors.lastname: Li
authors.affiliation: Hebei Province Center for Disease Prevention and Control, Shijiazhuang, Hebei, China.
authors.forename: Jixin
authors.initials: J
authors.lastname: Sun
authors.affiliation: First Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhou
authors.affiliation: Ningxia Medical University, Yinchuan, Ningxia, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Xi'an Jiaotong University, Xi'an, Shaanxi, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yu
authors.affiliation: United States Centers for Disease Control and Prevention, Beijing, China.
authors.forename: Michael
authors.initials: M
authors.lastname: Engelgau
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America.
authors.forename: Darwin
authors.initials: D
authors.lastname: Labarthe
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jixiang
authors.initials: J
authors.lastname: Ma
authors.affiliation: The George Institute for Global Health, Sydney, Australia.|Sydney Medical School, the University of Sydney, Sydney, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: MacMahon
authors.affiliation: Imperial College London, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.|School of Public Health, Peking University Health Science Center, Beijing, China.|Peking University Clinical Research Institute, Beijing, China.
authors.forename: Yangfeng
authors.initials: Y
authors.lastname: Wu
authors.affiliation: The George Institute for Global Health, Sydney, Australia.|Sydney Medical School, the University of Sydney, Sydney, Australia.|Imperial College London, United Kingdom.|Royal Prince Alfred Hospital, Sydney.
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D016000:Cluster Analysis; D004039:Diet, Sodium-Restricted / Q000009:adverse effects / Q000379:methods*; D004244:Dizziness / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011188:Potassium / Q000008:administration & dosage; D012423:Rural Health / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012964:Sodium / Q000652:urine; D012982:Sodium, Dietary / Q000008:administration & dosage; D011795:Surveys and Questionnaires
chemical_list: D012982:Sodium, Dietary; D012964:Sodium; D011188:Potassium