Background: High levels of dietary sodium are associated with raised blood pressure and adverse cardiovascular health. To determine baseline salt intake, we investigated the average dietary salt intake from 24-hour urinary sodium excretion with a small sample of Yantai adults in the Shandong province of China. Methods: One hundred ninety one adults aged 18–69 years were randomly selected from the Yantai adult population. Blood pressure, anthropometric indices and sodium excretion in a 24-hour urine collection were measured. Consumption of condiments was derived from 3-day weighted records. Completeness of urine collections was verified using creatinine excretion in relation to weight. Results: The mean Na and K outputs over 24 hours were 201.5 ± 77.7 mmol/day and 46.8 ± 23.2 mmol/day, respectively (corresponding to 11.8 g NaCl and 1.8 g K). Overall, 92.1% of the subjects (96.9% of men and 87.1% of women) had intakes of over 6 g salt (NaCl)/d. The main sources of salt intake from weighed condiments records were from home cooking salt (74.7%) followed by soy sauce (15.0%). Salt intake from condiments and salt excretion were weakly correlated((r = 0.20, p = 0.005).A positive linear correlation between salt intake was associated with systolic blood pressure in all adjusted and unadjusted model (r = 0.16, p = 0.01). Each 100 mmol/day increase in sodium intake was associated with a 4.0 mmHg increase in systolic blood pressure. Conclusion: Dietary salt intake in Yantai adults was high. Reducing the intake of table salt and soy sauce used in cooking will be an important strategy to reduce sodium intake among Yantai adults.

Background: Salt intake in China is over twice the maximum recommendation of the World Health Organization. Unlike most developed countries where salt intake is mainly derived from prepackaged foods, around 80% of the salt consumed in China is added during cooking. Objective: Action on Salt China (ASC), initiated in 2017, aims to develop, implement, and evaluate a comprehensive and tailored salt reduction program for national scaling-up. Methods: ASC consists of six programs working in synergy to increase salt awareness and to reduce the amount of salt used during cooking at home and in restaurants, as well as in processed foods. Since September 2018, two health campaigns on health education and processed foods have respectively started, in parallel with four open-label cluster randomized controlled trials (RCTs) in six provinces across China: (1) app-based intervention study (AIS), in which a mobile app is used to achieve and sustain salt reduction in school children and their families; (2) home cook-based intervention study (HIS), in which family cooks receive support in using less salt; (3) restaurant-based intervention study (RIS) targeting restaurant consumers, cooks, and managers; and (4) comprehensive intervention study (CIS), which is a real-world implementation and evaluation of all available interventions in the three other RCTs. To explore the barriers, facilitators, and effectiveness of delivering a comprehensive salt reduction intervention, these RCTs will last for 1 year (stage 1), followed by nationwide implementation (stage 2). In AIS, HIS, and CIS, the primary outcome of salt reduction will be evaluated by 24-hour urinary sodium excretion in 6030 participants, including 5436 adults and 594 school children around 8-9 years old. In RIS, the salt content of meals will be measured by laboratory food analysis of the 5 best-selling dishes from 192 restaurants. Secondary outcomes will include process evaluation; changes in knowledge, attitude, and practice on salt intake; and economic evaluation. Results: All RCTs have been approved by Queen Mary Research Ethics Committee and the Institutional Review Boards of leading institutes in China. The research started in June 2017 and is expected to be completed around March 2021. The baseline investigations of the four RCTs were completed in May 2019. Conclusions: The ASC project is progressing smoothly. The intervention packages and tailored components will be promoted for salt reduction in China, and could be adopted by other countries. Trial Registration: Chinese Clinical Trial Registry. AIS: ChiCTR1800017553; https://tinyurl.com/vdr8rpr. HIS: ChiCTR1800016804; https://tinyurl.com/w8c7x3w. RIS: ChiCTR1800019694; https://tinyurl.com/uqkjgfw. CIS: ChiCTR1800018119; https://tinyurl.com/s3ajldw. International Registered Report Identifier (IRRID): DERR1-10.2196/15933

The association of 24 h urinary Na and potassium excretion with the risk of the metabolic syndrome (MetS) has not been studied in China. The aim of the present study was to examine this association by analysing the data from 1906 study participants living in north China. To this end, 24 h urine samples were collected. Of the 1906 participants, 471 (24·7 %) had the MetS. The mean urinary Na and K excretion was 228·7 and 40·8 mmol/d, respectively. After multivariate adjustment, the odds of the MetS significantly increased across the increasing tertiles of urinary Na excretion (1·00, 1·40 and 1·54, respectively). For the components of the MetS, the odds of central obesity, elevated blood pressure and elevated TAG, but not the odds of low HDL-cholesterol and elevated fasting glucose, significantly increased with the successive tertiles of urinary Na excretion. Furthermore, for every 100 mmol/d increase in urinary Na excretion, the odds of the MetS, central obesity, elevated blood pressure and elevated TAG was significantly increased by 29, 63, 22 and 21 %, respectively. However, urinary K excretion was not significantly associated with the risk of the MetS. These findings suggest that high Na intake might be an important risk factor for the MetS in Chinese adults.

Background/Aims: High sodium intake and low intake of potassium can increase blood pressure (BP) and risk of developing hypertension. Few studies have examined the association between 24-h urinary sodium and potassium excretion and BP or risk of hypertension in China, and most used only a single 24-h urinary sample. Methods: We analyzed data on 2281 participants aged 18-69 years by using two 24-h urinary sodium and potassium excretions from the supplemental baseline survey of the Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH) project. We used measurement error models to estimate usual intakes, multivariable linear regression to assess their association with B P, and logistic regression to estimate the risk of hypertension. Results: The average usual intakes of sodium and potassium, and the mean sodium-potassium ratio, were 166.9 mmol/day, 25.3 mmol/day, and 6.8, respectively. All three measures were significantly associated with systolic BP (SBP) and diastolic BP (DBP), with an increase of 1.39 mmHg (95% confidence interval [CI] 0.44─2.34) in SBP and 0.94 mmHg (95% CI 0.34─1.55) in DBP for a 1-standard deviation (SD) (25.6mmol/day) increase in sodium intake, a decrease of 1.42 mmHg (95% CI -2.37─ -0.47) in SBP and 0.91 mmHg (95% CI -1.52─ -0.30) in DBP for a 1-SD (3.4 mmol/day) increase in potassium intake, and an increase of 0.97 mmHg (95% CI 0.36─1.58) in SBP and of 0.65 mmHg (95% CI 0.26─1.04) in DBP per unit increase in the sodium-to-potassium ratio. The adjusted odds ratios comparing the risk of hypertension among adults in the highest with those in the lowest quintile differ significantly for potassium (0.51; 95% CI 0.29─0.88) and sodium-to-potassium ratio (1.40; 95% CI 1.01─1.94). Conclusions: Our results suggested that higher sodium and lower potassium intakes are associated with increased BP and risk of hypertension in the Shandong and Jiangsu adults.

This study examined the impact of overweight/obesity on sodium, potassium, and blood pressure associations using the Shandong‐Ministry of Health Action on Salt Reduction and Hypertension (SMASH) project baseline survey data. Twenty‐four–hour urine samples were collected in 1948 Chinese adults aged 18 to 69 years. The observed associations of sodium, potassium, sodium‐potassium ratio, and systolic blood pressure (SBP) were stronger in the overweight/obese population than among those of normal weight. Among overweight/obese respondents, each additional standard deviation (SD) higher of urinary sodium excretion (SD=85 mmol) and potassium excretion (SD=19 mmol) was associated with a 1.31 mm Hg (95% confidence interval, 0.37–2.26) and −1.43 mm Hg (95% confidence interval, −2.23 to −0.63) difference in SBP, and each higher unit in sodium‐potassium ratio was associated with a 0.54 mm Hg (95% confidence interval, 0.34–0.75) increase in SBP. The association between sodium, potassium, sodium‐potassium ratio, and prevalence of hypertension among overweight/obese patients was similar to that of SBP. Our study indicated that the relationships between BP and both urinary sodium and potassium might be modified by BMI status in Chinese adults.

Objective: To examine the association of 24 h urinary Na excretion and Na:K with obesity in Chinese adults.Design: Population-based cross-sectional study using a four-stage stratified sampling strategy.Setting: Shandong Province, China.Subjects: Chinese adults (n 1906) aged 18–69 years who provided complete 24 h urine samples.Results: Odds of obesity increased significantly across increasing quartiles of urinary Na excretion (1·00, 1·54, 1·69 and 2·52, respectively, for overweight; 1·00, 1·20, 1·50, and 2·03, respectively, for obesity; 1·00, 1·44, 1·85 and 2·53, respectively, for abdominal obesity (assessed by waist circumference); and 1·00, 1·28, 1·44 and 1·75, respectively, for abdominal obesity (assessed by waist-to-height ratio); P for linear trend <0·001 for all). In addition, odds of abdominal obesity, but not odds of overweight and obesity, increased significantly with successive Na:K quartiles. Additionally, for each increment in urinary Na excretion of 100 mmol, odds of overweight, obesity, abdominal obesity (by waist circumference) and abdominal obesity (by waist-to-height ratio) increased significantly by 46 %, 39 %, 55 % and 33 %, respectively. Similarly, with a 1 sd increase in Na:K, odds of abdominal obesity (by waist circumference) and abdominal obesity (by waist-to-height ratio) increased significantly by 12 % and 15 %, respectively.Conclusions: These findings suggest that 24 h urinary Na excretion and Na:K might be important risk factors for obesity in Chinese adults.