App based education programme to reduce salt intake (AppSalt) in schoolchildren and their families in China: parallel, cluster randomised controlled trial.
App based education programme to reduce salt intake (AppSalt) in schoolchildren and their families in China: parallel, cluster randomised controlled trial.
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DOI：
10.1136/bmj-2021-066982
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发表时间：
2022-02-09
期刊：
影响因子：
--
通讯作者：
MacGregor GA
中科院分区：
文献类型：
--
作者：
He FJ;Zhang P;Luo R;Li Y;Sun Y;Chen F;Zhao Y;Zhao W;Li D;Chen H;Wu T;Yao J;Lou C;Zhou S;Dong L;Liu Y;Li X;He J;Wang C;Tan M;Song J;MacGregor GA
确定基于智能手机应用程序的教育计划是否可以降低学童及其家庭的盐摄入量。平行、整群随机对照试验，学校被随机分配到干预组或对照组（1：1）。2018年9月15日至2019年12月27日，来自中国北方、中部和南部三个省份的54所小学。592名小学三年级儿童（308名（52.0%）男孩;平均年龄8.58岁（标准差0.41）岁）（约每所学校11名儿童）和1 184名成年家庭成员（551名（46.5%）男子;平均年龄45.80岁（12.87）岁）。在应用程序的支持下，干预组的儿童接受了关于减少盐摄入的教育，并分配了家庭作业，以鼓励他们的家人参加减少盐摄入的活动。主要结果是在12个月随访时，干预组和对照组之间盐摄入量变化的差异（通过24小时尿钠排泄量测量）。基线评估后，297名儿童和594名成年家庭成员（来自27所学校）被分配到干预组，295名儿童和590名成年家庭成员（来自27所学校）被分配到对照组。在试验期间，27名（4.6%）儿童和112名（9.5%）成人因儿童转学或成人无法参加后续评估而失去随访。干预组的287名儿童和546名成人（来自27所学校）以及对照组的278名儿童和526名成人（来自27所学校）完成了12个月的随访评估。干预组儿童基线平均盐摄入量为5.5 g/天（标准差1.9），成人为10.0 g/天（3.5），对照组儿童为5.6 g/天（2.1），成人为10.0 g/天（3.6）。在研究期间，干预组和对照组儿童的盐摄入量都有所增加，但干预组的程度较小（调整混杂因素后的平均干预效果为-0.25 g/天，95%置信区间为-0.61至0.12，P=0.18）。在成人中，干预组和对照组的盐摄入量都有所下降，但干预组的下降程度更大（平均效应为-0.82 g/天，-1.24至-0.40，P<0.001）。对收缩压的平均影响在儿童中为-0.76 mm Hg（-2.37至0.86，P=0.36），在成人中为-1.64 mm Hg（-3.01至0.27，P=0.02）。通过小学提供的基于应用程序的教育计划，使用儿童对家长的方法，有效地降低了成人的盐摄入量和收缩压，但对儿童的影响并不显著。虽然这种新方法有可能扩大到更大的人群，但该方案需要进一步加强，以减少包括学童在内的整个人口的盐摄入量。中国临床试验注册中心ChiCTR 1800017553。
To determine whether a smartphone application based education programme can lower salt intake in schoolchildren and their families. Parallel, cluster randomised controlled trial, with schools randomly assigned to either intervention or control group (1:1). 54 primary schools from three provinces in northern, central, and southern China, from 15 September 2018 to 27 December 2019. 592 children (308 (52.0%) boys; mean age 8.58 (standard deviation 0.41) years) in grade 3 of primary school (about 11 children per school) and 1184 adult family members (551 (46.5%) men; mean age 45.80 (12.87) years). Children in the intervention group were taught, with support of the app, about salt reduction and assigned homework to encourage their families to participate in activities to reduce salt consumption. Primary outcome was the difference in salt intake change (measured by 24 hour urinary sodium excretion) at 12 month follow-up, between the intervention and control groups. After baseline assessment, 297 children and 594 adult family members (from 27 schools) were allocated to the intervention group, and 295 children and 590 adult family members (from 27 schools) were allocated to the control group. During the trial, 27 (4.6%) children and 112 (9.5%) adults were lost to follow-up, owing to children having moved to another school or adults unable to attend follow-up assessments. The remaining 287 children and 546 adults (from 27 schools) in the intervention group and 278 children and 526 adults (from 27 schools) in the control group completed the 12 month follow-up assessment. Mean salt intake at baseline was 5.5 g/day (standard deviation 1.9) in children and 10.0 g/day (3.5) in adults in the intervention group, and 5.6 g/day (2.1) in children and 10.0 g/day (3.6) in adults in the control group. During the study, salt intake of the children increased in both intervention and control groups but to a lesser extent in the intervention group (mean effect of intervention after adjusting for confounding factors −0.25 g/day, 95% confidence interval −0.61 to 0.12, P=0.18). In adults, salt intake decreased in both intervention and control groups but to a greater extent in the intervention group (mean effect −0.82 g/day, −1.24 to −0.40, P<0.001). The mean effect on systolic blood pressure was −0.76 mm Hg (−2.37 to 0.86, P=0.36) in children and −1.64 mm Hg (−3.01 to −0.27, P=0.02) in adults. The app based education programme delivered through primary school, using a child-to-parent approach, was effective in lowering salt intake and systolic blood pressure in adults, but the effects were not significant in children. Although this novel approach could potentially be scaled up to larger populations, the programme needs further strengthening to reduce salt intake across the whole population, including schoolchildren. Chinese Clinical Trial Registry ChiCTR1800017553.
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影响因子：
2.9
作者：
He FJ;Pombo-Rodrigues S;Macgregor GA
通讯作者：
Macgregor GA
影响因子：
4
作者：
Payne HE;Moxley VB;MacDonald E
通讯作者：
MacDonald E
影响因子：
5.9
作者：
Zhang L;Zhao F;Zhang P;Gao J;Liu C;He FJ;Lin CP
通讯作者：
Lin CP
影响因子：
37.8
作者：
Burke LE;Ma J;Azar KM;Bennett GG;Peterson ED;Zheng Y;Riley W;Stephens J;Shah SH;Suffoletto B;Turan TN;Spring B;Steinberger J;Quinn CC;American Heart Association Publications Committee of the Council on Epidemiology and Prevention, Behavior Change Committee of the Council on Cardiometabolic Health, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, Council on Quality of Care and Outcomes Research, and Stroke Council
通讯作者：
American Heart Association Publications Committee of the Council on Epidemiology and Prevention, Behavior Change Committee of the Council on Cardiometabolic Health, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, Council on Quality of Care and Outcomes Research, and Stroke Council
影响因子：
--
作者：
Anderson CA;Appel LJ;Okuda N;Brown IJ;Chan Q;Zhao L;Ueshima H;Kesteloot H;Miura K;Curb JD;Yoshita K;Elliott P;Yamamoto ME;Stamler J
通讯作者：
Stamler J