Effects of a community-based salt reduction program in a regional Australian population

Abstract

BackgroundSalt reduction is a public health priority but there are few studies testing the efficacy of plausible salt reduction programs.MethodsA multi-faceted, community-based salt reduction program using the Communication for Behavioral Impact framework was implemented in Lithgow, Australia. Single 24-h urine samples were obtained from 419 individuals at baseline (2011) and from 572 at follow-up (2014). Information about knowledge and behaviors relating to salt was also collected.ResultsSurvey participants were on average 56 years old and 58 % female. Mean salt intake estimated from 24-h urine samples fell from 8.8 g/day (SD = 3.6 g/day) in 2011 to 8.0 (3.6) g/day in 2014 (−0.80, 95 % confidence interval −1.2 to −0.3;p < 0.001). There were significant increases in the proportion of participants that knew the recommended upper limit of salt intake (18 % vs. 29 %; p < 0.001), knew the importance of salt reduction (64 % vs. 78 %; p < 0.001) and reported changing their behaviors to reduce their salt intake by using spices (5 % vs. 28 %; p < 0.001) and avoiding eating out (21 % vs. 34 %; p < 0.001). However, the proportions that checked food labels (30 % vs. 25 %; p = 0.02) fell, as did the numbers avoiding processed foods (44 % vs. 35 %; p = 0.006). Twenty-six percent reported using salt substitute at the end of the intervention period and 90 % had heard about the program. Findings were robust to multivariable adjustment.ConclusionsImplementation of this multi-faceted community-based program was associated with a ~10 % reduction in salt consumption in an Australian regional town. These findings highlight the potential of well-designed health promotion programs to compliment other population-based strategies to bring about much-needed reductions in salt consumption.Clinical trial registrationNCT02105727.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3064-3) contains supplementary material, which is available to authorized users.

State-level and community-level salt reduction initiatives: a systematic review of global programmes and their impact

“…Evaluation of the programme showed a significant reduction in sodium intake, and decreases in systolic blood pressure in the intervention community 40. Similar results were seen in a multicomponent salt reduction programme, including the promotion of low-sodium salt, implemented in Lithgow, Australia 41. On the basis of the Communication for Behavioural Impact (COMBI) framework, the programme significantly reduced mean salt intake over a 3-year period with a corresponding significant increase in the proportion of participants aware of the recommended salt intake level.…”

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

“…Risk of bias assessments for the four studies are included in Appendix S1. The studies were conducted in Australia, 8 Canada, 9 Spain 10 (high-income countries), and Iran 11 (an upper middle-income country); none were conducted in low-or lower middle-income countries. Two studies measured the effects of a multicomponent intervention (ie, advocacy, community mobilization, awareness campaigns, and salt substitution in Australia, and awareness campaigns and food reformulation in Iran)…”

“…conducted at a community level, 8,11 one assessed the impact of salt substitution in breads employed at a community level, 10 and one evaluated the changes in sodium levels in foods achieved through voluntary sodium reduction targets implemented at a national level.…”

“…showing that the Australian study, 8 which collected 24-hour urine samples, had very low baseline participation and follow-up rates, while the Iranian study, 11 which collected spot urine samples, had very good baseline participation and follow-up rates. While spot urine collections are not considered acceptable to assess individual intake, studies have shown that they can provide an acceptable estimate of mean population salt consumption levels.…”

“…Ultimately, a total of 40 studies met the inclusion criteria: four studies evaluated the impact of salt reduction interventions, 21 were surveillance or monitoring studies, five were modeling studies relating to salt reduction, and 10 other studies related to the implementation of salt reduction interventions (Figure 1). conducted at a community level, 8,11 one assessed the impact of salt substitution in breads employed at a community level, 10 and one evaluated the changes in sodium levels in foods achieved through voluntary sodium reduction targets implemented at a national level. …”