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Experience with 2 years’ intervention to progressively reduce salt supply to kitchens in elderly care facilities—challenges and further research: post hoc analysis of the DECIDE-Salt randomized clinical trial
BACKGROUND: Progressive reduction of sodium intake is an attractive approach for addressing excessive salt intake, but evidence for this strategy in real practice is limited. We aimed to determine the feasibility, effectiveness, and safety of a progressive sodium intake reduction intervention in rea...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10623877/ https://www.ncbi.nlm.nih.gov/pubmed/37919742 http://dx.doi.org/10.1186/s12916-023-03130-z |
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author | Yuan, Yifang Jin, Aoming Duan, Peifen Cao, La’e Wang, Hongxia Hu, Senke Li, Jiayu Feng, Xiangxian Qiao, Qianku Zhang, Hui Zhang, Ruijuan Li, Huijuan Gao, Pei Xie, Gaoqiang Yuan, Jianhui Cheng, Lili Wang, Sujuan Niu, Wenyi Elliott, Paul Gao, Runlin Labarthe, Darwin Wu, Yangfeng |
author_facet | Yuan, Yifang Jin, Aoming Duan, Peifen Cao, La’e Wang, Hongxia Hu, Senke Li, Jiayu Feng, Xiangxian Qiao, Qianku Zhang, Hui Zhang, Ruijuan Li, Huijuan Gao, Pei Xie, Gaoqiang Yuan, Jianhui Cheng, Lili Wang, Sujuan Niu, Wenyi Elliott, Paul Gao, Runlin Labarthe, Darwin Wu, Yangfeng |
author_sort | Yuan, Yifang |
collection | PubMed |
description | BACKGROUND: Progressive reduction of sodium intake is an attractive approach for addressing excessive salt intake, but evidence for this strategy in real practice is limited. We aimed to determine the feasibility, effectiveness, and safety of a progressive sodium intake reduction intervention in real-world setting. METHODS: We randomized 48 residential elderly care facilities in China, with 1612 participants aged 55 years and older, to either progressive reduction (PR, 24 facilities) or no reduction (NR, 24 facilities) of the supply of study salt to the kitchens of these facilities for 2 years. The primary efficacy outcome was systolic blood pressure (SBP) at any scheduled follow-up visit. Secondary efficacy outcomes included diastolic blood pressure (DBP) at any scheduled follow-up visit, and major adverse cardiovascular events (comprising non-fatal stroke, non-fatal myocardial infarction, hospitalized non-fatal heart failure, or vascular death) and total mortality. The perception of food saltiness, the addition of out-of-study salt in meals, and 24-h urinary sodium excretion were used as process indicators. RESULTS: Pre-specified analysis per randomization found no effect of the intervention on the 2-year overall mean systolic and diastolic blood pressure (SBP, DBP) and any other outcomes. However, post hoc analysis showed that the intervention effect on blood pressure varied over multiple follow-up visits (p for interaction < 0.046) and presented favorable differences at the 24-month visit (SBP = − 3.0 mmHg, 95%CI = − 5.6, − 0.5; p = 0.020; DBP = − 2.0 mmHg, 95%CI − 3.4, − 0.63; p = 0.004). The effect on 24-h sodium was non-significant (− 8.4 mmol, 95%CI = − 21.8 to 4.9, p = 0.216), though fewer participants with NR than with PR reported food tasting bland (odds ratio 0.46; 95%CI 0.29 to 0.73; p = 0.001). Reporting of bland food taste and other process measures indicated that intervention delivery and adherence were not fully achieved as designed. CONCLUSIONS: The experience of this real-world study demonstrated that achieving acceptability and sustainability of the progressive sodium intake reduction strategy among older adults was challenging, but it has shown potential for effectiveness in these and potentially other residential settings if the lessons of DECIDE-Salt are applied in further studies. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03290716). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-023-03130-z. |
format | Online Article Text |
id | pubmed-10623877 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-106238772023-11-04 Experience with 2 years’ intervention to progressively reduce salt supply to kitchens in elderly care facilities—challenges and further research: post hoc analysis of the DECIDE-Salt randomized clinical trial Yuan, Yifang Jin, Aoming Duan, Peifen Cao, La’e Wang, Hongxia Hu, Senke Li, Jiayu Feng, Xiangxian Qiao, Qianku Zhang, Hui Zhang, Ruijuan Li, Huijuan Gao, Pei Xie, Gaoqiang Yuan, Jianhui Cheng, Lili Wang, Sujuan Niu, Wenyi Elliott, Paul Gao, Runlin Labarthe, Darwin Wu, Yangfeng BMC Med Research Article BACKGROUND: Progressive reduction of sodium intake is an attractive approach for addressing excessive salt intake, but evidence for this strategy in real practice is limited. We aimed to determine the feasibility, effectiveness, and safety of a progressive sodium intake reduction intervention in real-world setting. METHODS: We randomized 48 residential elderly care facilities in China, with 1612 participants aged 55 years and older, to either progressive reduction (PR, 24 facilities) or no reduction (NR, 24 facilities) of the supply of study salt to the kitchens of these facilities for 2 years. The primary efficacy outcome was systolic blood pressure (SBP) at any scheduled follow-up visit. Secondary efficacy outcomes included diastolic blood pressure (DBP) at any scheduled follow-up visit, and major adverse cardiovascular events (comprising non-fatal stroke, non-fatal myocardial infarction, hospitalized non-fatal heart failure, or vascular death) and total mortality. The perception of food saltiness, the addition of out-of-study salt in meals, and 24-h urinary sodium excretion were used as process indicators. RESULTS: Pre-specified analysis per randomization found no effect of the intervention on the 2-year overall mean systolic and diastolic blood pressure (SBP, DBP) and any other outcomes. However, post hoc analysis showed that the intervention effect on blood pressure varied over multiple follow-up visits (p for interaction < 0.046) and presented favorable differences at the 24-month visit (SBP = − 3.0 mmHg, 95%CI = − 5.6, − 0.5; p = 0.020; DBP = − 2.0 mmHg, 95%CI − 3.4, − 0.63; p = 0.004). The effect on 24-h sodium was non-significant (− 8.4 mmol, 95%CI = − 21.8 to 4.9, p = 0.216), though fewer participants with NR than with PR reported food tasting bland (odds ratio 0.46; 95%CI 0.29 to 0.73; p = 0.001). Reporting of bland food taste and other process measures indicated that intervention delivery and adherence were not fully achieved as designed. CONCLUSIONS: The experience of this real-world study demonstrated that achieving acceptability and sustainability of the progressive sodium intake reduction strategy among older adults was challenging, but it has shown potential for effectiveness in these and potentially other residential settings if the lessons of DECIDE-Salt are applied in further studies. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03290716). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-023-03130-z. BioMed Central 2023-11-03 /pmc/articles/PMC10623877/ /pubmed/37919742 http://dx.doi.org/10.1186/s12916-023-03130-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Yuan, Yifang Jin, Aoming Duan, Peifen Cao, La’e Wang, Hongxia Hu, Senke Li, Jiayu Feng, Xiangxian Qiao, Qianku Zhang, Hui Zhang, Ruijuan Li, Huijuan Gao, Pei Xie, Gaoqiang Yuan, Jianhui Cheng, Lili Wang, Sujuan Niu, Wenyi Elliott, Paul Gao, Runlin Labarthe, Darwin Wu, Yangfeng Experience with 2 years’ intervention to progressively reduce salt supply to kitchens in elderly care facilities—challenges and further research: post hoc analysis of the DECIDE-Salt randomized clinical trial |
title | Experience with 2 years’ intervention to progressively reduce salt supply to kitchens in elderly care facilities—challenges and further research: post hoc analysis of the DECIDE-Salt randomized clinical trial |
title_full | Experience with 2 years’ intervention to progressively reduce salt supply to kitchens in elderly care facilities—challenges and further research: post hoc analysis of the DECIDE-Salt randomized clinical trial |
title_fullStr | Experience with 2 years’ intervention to progressively reduce salt supply to kitchens in elderly care facilities—challenges and further research: post hoc analysis of the DECIDE-Salt randomized clinical trial |
title_full_unstemmed | Experience with 2 years’ intervention to progressively reduce salt supply to kitchens in elderly care facilities—challenges and further research: post hoc analysis of the DECIDE-Salt randomized clinical trial |
title_short | Experience with 2 years’ intervention to progressively reduce salt supply to kitchens in elderly care facilities—challenges and further research: post hoc analysis of the DECIDE-Salt randomized clinical trial |
title_sort | experience with 2 years’ intervention to progressively reduce salt supply to kitchens in elderly care facilities—challenges and further research: post hoc analysis of the decide-salt randomized clinical trial |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10623877/ https://www.ncbi.nlm.nih.gov/pubmed/37919742 http://dx.doi.org/10.1186/s12916-023-03130-z |
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