Salt reduction in China: from evidence to action

Background Salt intake in China is high. The Chinese Government has included salt reduction as one of the key components of China's health development agenda (Healthy China 2030). Action on Salt China (ASC) has been established since 2017. ASC aims to develop and implement an effective national salt reduction programme to help China achieve the WHO target of 30% reduction in salt intake by 2025. Methods ASC's strategic plan includes a salt awareness campaign, encouraging self-monitoring of salt reduction at home, and reducing salt in restaurant and processed food. Four cluster randomised controlled trials will be done in six provinces in China from September, 2018, to test four salt reduction intervention packages targeting different populations: the Application-based Intervention Study (AIS), which uses a mobile application to reinforce and maintain lower salt intake in schoolchildren and their families; the Restaurant-based Intervention Study (RIS), targeting consumers, cooks, and managers in restaurants; the Housewife-based Intervention study (HIS), which facilitates family chefs to use less salt while cooking at home; and the Comprehensive Intervention Study (CIS), which will evaluate all the aforementioned interventions in real-world administrative areas. These randomised controlled trials will last for 1 year, followed by a nation-wide implementation in China if the results of these four studies are significant. The effects will be mainly evaluated by a 24-h urinary sodium test among 5560 participants. Findings ASC has already received strong support from the Chinese Central and Provincial Governments, non-governmental organisations, academia, and food industries. All activities have been designed to influence policy formulation and ensure sustainability. Interpretation The evidence-based and government-supported salt reduction packages will benefit the Chinese population, by preventing unnecessary cardiovascular diseases, and contribute to global health development. Funding UK National Institute for Health Research (16/136/77).