title: Salt reduction in China: a state-of-the-art review.
abstract: OBJECTIVE
  This study aimed to reveal the latest evidence on salt reduction initiatives in China in order to identify the contextual cost-effective interventions, as well as the barriers encountered during China's long march to reach its population salt reduction goal.
  
  
  BACKGROUND
  Population-based salt reduction has been considered as one of the most cost-effective strategies in the world for the prevention and control of noncommunicable diseases. China, along with its sustained economic growth, faces increasing burdens from chronic diseases such as cardiovascular and kidney diseases. With policy support and cross-sector collaboration, various salt reduction initiatives have been adopted in China in order to reduce such dietary risk, especially since the beginning of this millennium.
  
  
  METHODS
  This study conducted structured literature reviews in both English and Chinese databases and synthesized the latest evidence on the association of salt intake and health, as well as salt intake among Chinese and population-based salt reduction strategies in China and around the world.
  
  
  RESULTS
  Dietary salt restriction has been found to contribute to the reduction of blood pressure among both the normotensives and hypertensives bringing associated reduced disease burdens and great public health benefits. With gender, ethnic, and regional variations, salt intake levels in the population in China are well above the recommended threshold and physiological need. Admittedly, excessive salt intake precipitates the high prevalence of hypertension and cardiovascular disease among the Chinese. Considering that the majority of the dietary salt is added during cooking in China, salt substitutes, salt restriction tools, and health education are the most common salt reduction initiatives with varying levels of effectiveness and acceptability among the Chinese population.
  
  
  CONCLUSIONS
  Overwhelming evidence is in support of a well-coordinated nationwide salt restriction initiative as a key public health strategy for the prevention and control of hypertension and its related diseases. Orchestrated efforts from the government, industries, academia, health professionals, and the general public are required to achieve China's long-term goal for salt reduction.
authors.affiliation: Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Duke Global Health Institute.
authors.forename: Shuai
authors.initials: S
authors.lastname: Shao
authors.affiliation: School of Economics, Duke University, Durham, NC, USA.
authors.forename: Yechu
authors.initials: Y
authors.lastname: Hua
authors.affiliation: Department of Public Health, Wuhan University, Wuhan, Hubei.
authors.forename: Ying
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Liu
authors.affiliation: Depatment of Accounting, School of Business and Management, The Hong Kong University of Science and Technology, Kowloon, Hong Kong.
authors.forename: Jingruo
authors.initials: J
authors.lastname: Fan
authors.affiliation: Department of Statistics and Applied Probability, National University of Singapore, Singapore.
authors.forename: An
authors.initials: A
authors.lastname: Zhang
authors.affiliation: School of Business, Sichuan University, Chengdu, Sichuan.
authors.forename: Jingling
authors.initials: J
authors.lastname: Xiang
authors.affiliation: Department of Public Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Mingjing
authors.initials: M
authors.lastname: Li
authors.affiliation: Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Duke Global Health Institute.
authors.forename: Lijing L
authors.initials: LL
authors.lastname: Yan
keywords: Chinese population; chronic disease; health policy; hypertension; salt reduction