A school-based education programme to reduce salt intake in children and their families

心血管疾病（即中风、心脏病发作和心力衰竭）是全世界死亡和残疾的主要原因。血压升高是心血管疾病的主要原因，占中风的62%和心脏病发作的49%。饮食中盐的摄入是导致血压升高的主要因素，也是导致血压随年龄增长而升高的主要原因。虽然心血管事件最常发生在40岁以后，儿童中高血压的患病率很低，但高血压和心血管疾病的起源发生在儿童时期。因此，减少这些情况的最大长期潜力是在青年中开展预防活动。这种旨在预防或减缓血压上升进程的公共卫生策略将带来巨大的好处。先前的研究表明，盐的摄入在调节儿童血压方面起着重要作用。儿童低盐饮食可以预防以后患高血压和心血管疾病。尽管有上述证据，但目前还没有可靠的数据表明儿童现在吃了多少盐，也没有关于如何让儿童保持低盐摄入量的策略。我们建议开展一项横断面研究，采用金标准法，即测量24小时尿钠，来确定儿童目前的盐摄入量。此外，我们将进行一项随机试验，以确定针对在校儿童的教育计划是否可以降低儿童及其家庭的盐摄入量。我们的研究将在中国进行，中国是世界上最大的低收入和中等收入国家。我们研究的成功完成将是全国减盐计划的开始，该计划将减少儿童和成人的盐摄入量。此外，许多其他低收入和中等收入国家也可以采用我们的减盐方案。在整个人口中适度减少盐摄入量将降低人口血压，每年预防成千上万的中风、心脏病发作和心力衰竭，并为个人、家庭和卫生服务节省大量费用。

Cardiovascular disease (i.e. strokes, heart attacks and heart failure) is the leading cause of death and disability worldwide. Raised blood pressure is a major cause of cardiovascular disease, accounting for 62% of strokes and 49% of heart attacks. Dietary salt intake is the major factor that increases blood pressure and is largely responsible for the rise in blood pressure with age. Although cardiovascular events occur most frequently after the age of 40 years and the prevalence of hypertension is very low in children, the origins of hypertension and cardiovascular disease occur in childhood. Accordingly, the greatest long-term potential to reduce these conditions is to initiate prevention activities in youth. Such a public heath strategy aimed at preventing or slowing the progression of rising blood pressure altogether would have enormous benefits. Previous studies have demonstrated that salt intake plays an important role in regulating blood pressure in children. A lower salt diet in children could prevent the development of hypertension and cardiovascular disease later in life. Despite the evidence above, there is no reliable data on how much salt children are eating now and no strategy on how to keep children on a low salt intake. We propose to carry out a cross-sectional study to determine the current salt intake in children by using the gold standard method, i.e. measuring 24-h urinary sodium. Furthermore, we will carry out a randomised trial to determine whether an education programme targeted at school children can lower salt intake in children and their families. Our study will be carried out in China which is the largest low- and middle-income country in the world. The successful completion of our study will be the start of a national salt reduction programme which will reduce salt intake both in children and in adults. Furthermore, our salt reduction programme could be adopted by many other low- and middle-income countries. A modest reduction in salt intake across the whole population will lower population blood pressure and prevent many thousands of strokes, heart attacks and heart failure each year, and also lead to major cost-savings to individuals, their families and the health services.