Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial
Abstract Background A 12-month cluster randomized controlled trial (RCT) demonstrated the effectiveness of an application-based education program in reducing the salt intake and systolic blood pressure (SBP) of schoolchildren’s adult family members. This study aimed to assess whether the effect at 1...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12916-025-03868-8 |
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| author | Yuan Li Puhong Zhang Feng J. He Rong Luo Jing Song Changqiong Wang Fengge Chen Wei Zhao Yuhong Zhao Hang Chen Tianyong Wu Xiaoyan Wang Hui Zhou Zhi Han Jie Zhang |
| author_facet | Yuan Li Puhong Zhang Feng J. He Rong Luo Jing Song Changqiong Wang Fengge Chen Wei Zhao Yuhong Zhao Hang Chen Tianyong Wu Xiaoyan Wang Hui Zhou Zhi Han Jie Zhang |
| author_sort | Yuan Li |
| collection | DOAJ |
| description | Abstract Background A 12-month cluster randomized controlled trial (RCT) demonstrated the effectiveness of an application-based education program in reducing the salt intake and systolic blood pressure (SBP) of schoolchildren’s adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months. Methods Fifty-four schools were randomly assigned to either the intervention or control group. All participants (594 children in grade 3 and 1188 of their adult family members) who completed the baseline survey were contacted again 12 months after the trial. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12 months, measured by the mean two consecutive 24-h urinary sodium excretions. The secondary outcome was the difference in the change of blood pressure and salt-related Knowledge, Attitude, Practice (KAP) score. Results The difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors was − 0.38 g/day at 24 months versus baseline (95% CI − 0.81 to 0.05, p = 0.09), following the − 0.83 g/day (95% CI − 1.25 to − 0.41, p < 0.001) at 12 months. The adjusted difference in SBP change was − 2.19 mm Hg (95% CI − 3.63 to − 0.76, p = 0.003) at 24 months versus baseline, following the − 1.80 mm Hg (95% CI − 3.19 to − 0.40, p = 0.01) at 12 months. The intervention group had a higher KAP score than the control group both at 12 months and at 24 months versus baseline. No significant changes were found in children. Conclusions The effect of the education program on adults’ salt intake faded, but the SBP lowering effect and the improvement of KAP score remained 12 months after the completion of the RCT. Continuous efforts are needed to maintain the salt reduction effects in real-world settings. Trial registration ChiCTR1800017553. Registered on August 3, 2018. |
| format | Article |
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| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Medicine |
| spelling | doaj-art-85def50336724caa80fb550a28f2ab6a2025-02-02T12:28:17ZengBMCBMC Medicine1741-70152025-01-0123111210.1186/s12916-025-03868-8Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trialYuan Li0Puhong Zhang1Feng J. He2Rong Luo3Jing Song4Changqiong Wang5Fengge Chen6Wei Zhao7Yuhong Zhao8Hang Chen9Tianyong Wu10Xiaoyan Wang11Hui Zhou12Zhi Han13Jie Zhang14The George Institute for Global HealthThe George Institute for Global HealthWolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of LondonThe George Institute for Global HealthWolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of LondonWolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of LondonShijiangzhuang Centre for Disease Control and PreventionShijiangzhuang Centre for Disease Control and PreventionCentre for Disease Control and PreventionLuzhou Centre for Disease Control and PreventionLuzhou Centre for Disease Control and PreventionLuzhou Centre for Disease Control and PreventionYueyang Centre for Disease Control and PreventionYueyang Centre for Disease Control and PreventionYueyang Centre for Disease Control and PreventionAbstract Background A 12-month cluster randomized controlled trial (RCT) demonstrated the effectiveness of an application-based education program in reducing the salt intake and systolic blood pressure (SBP) of schoolchildren’s adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months. Methods Fifty-four schools were randomly assigned to either the intervention or control group. All participants (594 children in grade 3 and 1188 of their adult family members) who completed the baseline survey were contacted again 12 months after the trial. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12 months, measured by the mean two consecutive 24-h urinary sodium excretions. The secondary outcome was the difference in the change of blood pressure and salt-related Knowledge, Attitude, Practice (KAP) score. Results The difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors was − 0.38 g/day at 24 months versus baseline (95% CI − 0.81 to 0.05, p = 0.09), following the − 0.83 g/day (95% CI − 1.25 to − 0.41, p < 0.001) at 12 months. The adjusted difference in SBP change was − 2.19 mm Hg (95% CI − 3.63 to − 0.76, p = 0.003) at 24 months versus baseline, following the − 1.80 mm Hg (95% CI − 3.19 to − 0.40, p = 0.01) at 12 months. The intervention group had a higher KAP score than the control group both at 12 months and at 24 months versus baseline. No significant changes were found in children. Conclusions The effect of the education program on adults’ salt intake faded, but the SBP lowering effect and the improvement of KAP score remained 12 months after the completion of the RCT. Continuous efforts are needed to maintain the salt reduction effects in real-world settings. Trial registration ChiCTR1800017553. Registered on August 3, 2018.https://doi.org/10.1186/s12916-025-03868-8Salt reductionBlood pressureFollow-upPersistent effect |
| spellingShingle | Yuan Li Puhong Zhang Feng J. He Rong Luo Jing Song Changqiong Wang Fengge Chen Wei Zhao Yuhong Zhao Hang Chen Tianyong Wu Xiaoyan Wang Hui Zhou Zhi Han Jie Zhang Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial BMC Medicine Salt reduction Blood pressure Follow-up Persistent effect |
| title | Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial |
| title_full | Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial |
| title_fullStr | Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial |
| title_full_unstemmed | Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial |
| title_short | Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial |
| title_sort | persistent effect of salt reduction in schoolchildren and their families 1 year follow up after an application based cluster randomized controlled trial |
| topic | Salt reduction Blood pressure Follow-up Persistent effect |
| url | https://doi.org/10.1186/s12916-025-03868-8 |
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