ACTION ON SALT CHINA (ASC): RATIONALE AND DESIGN

Abstract

Objective: Salt intake in China is high, over twice the maximum WHO recommendation. Unlike in most developed countries where salt intake mainly comes from pre-packaged food, the salt consumed in China is mainly (around 80%) added during cooking. Initiated in 2017, Action on Salt China (ASC) aims to develop, implement and evaluate a comprehensive and tailored salt reduction programme, for national scaling-up. Design and method: ASC consists of six programmes working in synergy to increase salt awareness and to reduce the amount of salt used during cooking at home and in restaurants, as well as in processed foods. Since September 2018 in six provinces across China, two health campaigns on health education and processed foods, respectively have started, in parallel with four cluster randomised controlled trials (RCTs): (1) Application-based Intervention Study (AIS), where a mobile application is used to achieve and sustain salt reduction in schoolchildren and their families; (2) Housewife-based Intervention study (HIS), where family chefs receive support in using less salt in home cooking; (3) Restaurant-based Intervention Study (RIS), targeting restaurants consumers, cooks, and managers; and (4) Comprehensive Intervention Study (CIS), which is a real-world implementation and evaluation of all available interventions in the three other RCTs. To explore the experience, barriers, facilitators and effectiveness of delivering a comprehensive salt reduction intervention, these RCTs will last for one year (stage 1), followed by nation-wide implementation (stage 2). In AIS, HIS and CIS, the primary outcome of salt reduction will be evaluated by 24-h urinary sodium excretion in more than 6030 participants. In RIS, the salt reduction in restaurant-provided dishes will be measured by laboratory food analysis of the five best-selling dishes from each of the 192 restaurants. Secondary outcomes will consist of process evaluation, changes in knowledge, attitude and practice (KAP) on salt intake, and economic evaluation (Figure 1). Results: The baseline investigation of the four RCTs in ASC were completed before December 2018. After about one-year intervention, the mid-term follow-up investigation has already been initiated at some sites. As scheduled, the mid-term evaluation can be completed before June 2020.