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Randomized Controlled Trial
. 2015 Mar 18:350:h770.
doi: 10.1136/bmj.h770.

School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial

Feng J He  1 , Yangfeng Wu  2 , Xiang-Xian Feng  3 , Jun Ma  4 , Yuan Ma  5 , Haijun Wang  4 , Jing Zhang  6 , Jianhui Yuan  3 , Ching-Ping Lin  7 , Caryl Nowson  8 , Graham A MacGregor  9
Affiliations
Randomized Controlled Trial

School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial

Feng J He et al. BMJ. .

Abstract

Objective: To determine whether an education programme targeted at schoolchildren could lower salt intake in children and their families.

Design: Cluster randomised controlled trial, with schools randomly assigned to either the intervention or control group.

Setting: 28 primary schools in urban Changzhi, northern China.

Participants: 279 children in grade 5 of primary school, with mean age of 10.1; 553 adult family members (mean age 43.8).

Intervention: Children in the intervention group were educated on the harmful effects of salt and how to reduce salt intake within the schools' usual health education lessons. Children then delivered the salt reduction message to their families. The intervention lasted for one school term (about 3.5 months).

Main outcome measures: The primary outcome was the difference between the groups in the change in salt intake (as measured by 24 hour urinary sodium excretion) from baseline to the end of the trial. The secondary outcome was the difference between the two groups in the change in blood pressure.

Results: At baseline, the mean salt intake in children was 7.3 (SE 0.3) g/day in the intervention group and 6.8 (SE 0.3) g/day in the control group. In adult family members the salt intakes were 12.6 (SE 0.4) and 11.3 (SE 0.4) g/day, respectively. During the study there was a reduction in salt intake in the intervention group, whereas in the control group salt intake increased. The mean effect on salt intake for intervention versus control group was -1.9 g/day (95% confidence interval -2.6 to -1.3 g/day; P<0.001) in children and -2.9 g/day (-3.7 to -2.2 g/day; P<0.001) in adults. The mean effect on systolic blood pressure was -0.8 mm Hg (-3.0 to 1.5 mm Hg; P=0.51) in children and -2.3 mm Hg (-4.5 to -0.04 mm Hg; P<0.05) in adults.

Conclusions: An education programme delivered to primary school children as part of the usual curriculum is effective in lowering salt intake in children and their families. This offers a novel and important approach to reducing salt intake in a population in which most of the salt in the diet is added by consumers.Trial registration ClinicalTrials.gov NCT01821144. .

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: FJH is a member of Consensus Action on Salt and Health (CASH) and World Action on Salt and Health (WASH). Both CASH and WASH are non-profit charitable organisations and FJH does not receive any financial support from CASH or WASH. GAM is chairman of Blood Pressure UK (BPUK), chairman of CASH, WASH, and Action on Sugar. BPUK, CASH, WASH, and Action on Sugar are non-profit charitable organisations. GAM does not receive any financial support from any of these organisations. CN is a member of WASH and AWASH (Australian division of World Action on Salt and Health) and does not receive any financial support from these organisations. CN has received remuneration from Meat and Livestock Australia, Nestle Health Science, and Dairy Health Consortium. These payments are unrelated to the submitted work. YM was sponsored by the China Scholarship Council while she was carrying out statistical analysis for this study at the Wolfson Institute of Preventive Medicine, Queen Mary University of London.

Figures

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Fig 1 Trial profile of school based education programme to reduce salt intake in children and their families
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Fig 2 Amount of salt used in intervention group according to weight of salt containers
See this image and copyright information in PMC

Comment in

References

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