The Effects of a Community-Based Sodium Reduction Program in Rural China - A Cluster-Randomized Trial.

Journal Article (Multicenter Study;Journal Article)


Average sodium intake and stroke mortality in northern China are both among the highest in the world. An effective, low-cost strategy to reduce sodium intake in this population is urgently needed.


We sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China.


This study was a cluster-randomized trial done over 18 months in 120 townships (one village from each township) from five provinces. Sixty control villages were compared to 60 intervention villages that were given access to a reduced-sodium, added-potassium salt substitute in conjunction with a community-based health education program focusing on sodium reduction. The primary outcome was the difference in 24-hour urinary sodium excretion between randomized groups.


Among 1,903 people with valid 24-hour urine collections, mean urinary sodium excretion in intervention compared with control villages was reduced by 5.5% (-14mmol/day, 95% confidence interval -26 to -1; p = 0.03), potassium excretion was increased by 16% (+7mmol/day, +4 to +10; p<0.001), and sodium to potassium ratio declined by 15% (-0.9, -1.2 to -0.5; p<0.001). Mean blood pressure differences were -1.1 mm Hg systolic (-3.3 to +1.1; p = 0.33) and -0.7 mm Hg diastolic (-2.2 to +0.8, p = 0.35) and the difference in the proportion with hypertension was -1.3% (-5.1 to 2.5, p = 0.56).


There were clear differences in population sodium and potassium intake between villages that were most likely a consequence of increased use of salt substitute. The absence of effects on blood pressure reflects the moderate changes in sodium and potassium intake achieved.

Trial registration identifier: NCT01259700.

Full Text

Duke Authors

Cited Authors

  • Li, N; Yan, LL; Niu, W; Yao, C; Feng, X; Zhang, J; Shi, J; Zhang, Y; Zhang, R; Hao, Z; Chu, H; Zhang, J; Li, X; Pan, J; Li, Z; Sun, J; Zhou, B; Zhao, Y; Yu, Y; Engelgau, M; Labarthe, D; Ma, J; MacMahon, S; Elliott, P; Wu, Y; Neal, B

Published Date

  • January 2016

Published In

Volume / Issue

  • 11 / 12

Start / End Page

  • e0166620 -

PubMed ID

  • 27935977

Pubmed Central ID

  • PMC5147834

Electronic International Standard Serial Number (EISSN)

  • 1932-6203

International Standard Serial Number (ISSN)

  • 1932-6203

Digital Object Identifier (DOI)

  • 10.1371/journal.pone.0166620


  • eng