Technology-supported behavior change interventions for reducing sodium intake in adults: a systematic review and meta-analysis

Abstract

The effects of technology-supported behavior change interventions for reducing sodium intake on health outcomes in adults are inconclusive. Effective intervention characteristics associated with sodium reduction have yet to be identified. A systematic review and meta-analysis were conducted, searching randomized controlled trials (RCTs) published between January 2000 and April 2023 across 5 databases (PROSPERO: CRD42022357905). Meta-analyses using random-effects models were performed on 24-h urinary sodium (24HUNa), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Subgroup analysis and meta-regression of 24HUNa were performed to identify effective intervention characteristics. Eighteen RCTs involving 3505 participants (51.5% female, mean age 51.6 years) were included. Technology-supported behavior change interventions for reducing sodium intake significantly reduced 24HUNa (mean difference [MD] -0.39 gm/24 h, 95% confidence interval [CI] -0.50 to -0.27; I² = 24%), SBP (MD -2.67 mmHg, 95% CI -4.06 to -1.29; I² = 40%), and DBP (MD -1.39 mmHg, 95% CI -2.31 to -0.48; I² = 31%), compared to control conditions. Interventions delivered more frequently (≤weekly) were associated with a significantly larger effect size in 24HUNa reduction compared to less frequent interventions (>weekly). Other intervention characteristics, such as intervention delivery via instant messaging and participant-family dyad involvement, were associated with larger, albeit non-significant, effect sizes in 24HUNa reduction when compared to other subgroups. Technology-supported behavior change interventions aimed at reducing sodium intake were effective in reducing 24HUNa, SBP, and DBP at post-intervention. Effective intervention characteristics identified in this review should be considered to develop sodium intake reduction interventions and tested in future trials, particularly for its long-term effects.

Fig. 1. PRISMA flow chart of study selection.

The flow chart, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, illustrates the detailed process of study search and selection.

Fig. 2. Forest plot of 24-h urinary sodium.

The unit of 24-h urinary sodium (24HUNa) was ‘gm/24 h’. The ‘Mean’ (change score or change from baseline) of 24HUNa within each group was calculated by subtracting the baseline mean from the post-intervention mean. The ‘Mean Difference’ refers to the comparison of mean values between two groups. Post-intervention data was used in the meta-analysis as the majority of studies did not assess outcomes during follow-up periods.

Fig. 3. Forest plot of systolic blood pressure.

The unit of systolic blood pressure (SBP): mmHg. The ‘Mean’ (change score or change from baseline) of SBP within each group was calculated by subtracting the baseline mean from the post-intervention mean. The ‘Mean Difference’ refers to the comparison of mean values between two groups. Post-intervention data was used in the meta-analysis as the majority of studies did not assess outcomes during follow-up periods.

Fig. 4. Forest plot of diastolic blood pressure.

The unit of diastolic blood pressure (DBP): mmHg. The ‘Mean’ (change score or change from baseline) of DBP within each group was calculated by subtracting the baseline mean from the post-intervention mean. The ‘Mean Difference’ refers to the comparison of mean values between two groups. Post-intervention data was used in the meta-analysis as the majority of studies did not assess outcomes during follow-up periods.