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Salt intake in China is very high, which increases the risk of hypertension and cardiovascular disease. This study aimed to assess the levels of salt-related knowledge, attitudes, and behaviors (KABs) and the factors that influence them and to explore the relationship between the scores of salt-related KAB and 24-h urinary sodium excretion. In 2018, we collected data from 5453 individuals aged 18–75 years from six provinces in China. A face-to-face survey was carried out, focusing on the KAB related to salt reduction. All participants were asked to collect one 24-h urine sample. Of the 5453 participants, 5352 completed urine collection. The mean score for overall KAB was 31.27 (SD = 9.18), which was composed of three elements: knowledge 4.80 (SD = 5.14), attitude 9.33 (SD = 3.93), and behavior 17.14 (SD = 4.43). The average 24-h urinary sodium excretion was 187.70 (SD = 77.48) mmol, which was equivalent to a urinary sodium excretion of 4.32 (SD = 1.78) g/d. We found that salt-related knowledge, attitude, behavior, and overall KAB scores were all inversely associated with 24-h urinary sodium excretion. For every one-point increase in the KAB score, the 24-h urinary sodium excretion decreased by 0.851 mmol (95% CI: −1.095, −0.602). We also found that location (rural/urban), sex, age, and education are associated with salt-related KAB scores. These results suggest that large-scale health education is needed to reduce salt intake in the Chinese population. In particular, efforts should be focused on reaching those who live in rural areas with low educational levels and older people.

Restaurant food is one of the important sources of sodium intake in China. We aimed to determine whether a restaurant-based comprehensive intervention program may induce lower sodium content in restaurant food. A randomized controlled trial was implemented between 2019 and 2020 in 192 restaurants in China. After baseline assessment, the restaurants were randomly assigned to either an intervention or a control group (1:1). Comprehensive activities designed for intervention restaurants were conducted for one year. The primary outcome was the difference in change of sodium content estimated by the mean values of five best-selling dishes for each restaurant, from baseline to the end of the trial between groups. In total, 66 control restaurants and 80 intervention restaurants completed the follow-up assessment. The average sodium content of dishes at baseline was 540.9 ± 176.8 mg/100 g in control and 551.9 ± 149.0 mg/100 g in intervention restaurants. The mean effect of intervention after adjusting for confounding factors was −43.63 mg/100 g (95% CI: from −92.94 to 5.66, p = 0.08), representing an 8% reduction in sodium content. The restaurant-based intervention led to a modest but not significant reduction in the sodium content of restaurant food. There is great urgency for implementing effective and sustainable salt reduction programs, due to the rapid increase in the consumption of restaurant food in China.

This cross-sectional study aimed to assess 24-h urinary sodium and potassium excretion in children and the relationships with their family excretion. Using the baseline data of a randomized trial conducted in three cities of China in 2018, a total of 590 children (mean age 8.6 ± 0.4 years) and 1180 adults (mean age 45.8 ± 12.9 years) from 592 families had one or two complete 24-h urine collections. The average sodium, potassium excretion and sodium-to-potassium molar ratio of children were 2180.9 ± 787.1 mg/d (equivalent to 5.5 ± 2.0 g/d of salt), 955.6 ± 310.1 mg/d and 4.2 ± 1.7 respectively, with 77.1% of the participants exceeding the sodium recommendation and 100% below the proposed potassium intake. In mixed models adjusting for confounders, every 1 mg/d increase in sodium excretion of adult family members was associated with a 0.11 mg/d (95% CI: 0.06 to 0.16, p &lt, 0.0001) increase in sodium excretion of children. The family-child regression coefficient corresponds to 0.20 mg/d (95% CI: 0.15 to 0.26, p &lt, 0.0001) per 1 mg/d in potassium and to 0.36 (95% CI: 0.26 to 0.45, p &lt, 0.0001) in sodium-to-potassium molar ratio. Children in China are consuming too much sodium and significantly inadequate potassium. The sodium, potassium excretion and sodium-to-potassium ratio of children are associated with their family excretions in small to moderate extent. Efforts are warranted to support salt reduction and potassium enhancement in children through comprehensive strategies engaging with families, schools and food environments.

In China, few people are aware of the amount and source of their salt intake. We conducted a survey to investigate the consumption and sources of dietary salt using the “one-week salt estimation method” by weighing cooking salt and major salt-containing food, and estimating salt intake during dining out based on established evidence. Nine hundred and three families (1981 adults and 971 children) with students in eight primary or junior high schools in urban and suburban Beijing were recruited. On average, the daily dietary salt intake of family members in Beijing was 11.0 (standard deviation: 6.2) g for children and adolescents (under 18 years old), 15.2 (9.1) g for adults (18 to 59 years old), and 10.2 (4.8) g for senior citizens (60 years old and over), respectively. Overall, 60.5% of dietary salt was consumed at home, and 39.5% consumed outside the home. Approximately 90% of the salt intake came from cooking (household cooking and cafeteria or restaurant cooking), while less than 10% came from processed food. In conclusion, the dietary salt intake in Beijing families far surpassed the recommended amounts by World Health Organization, with both household cooking and dining-out as main sources of salt consumption. More targeted interventions, especially education about major sources of salt and corresponding methods for salt reduction should be taken to reduce the risks associated with a high salt diet.

The objective of this study was to develop a new method named the “one-week salt estimation method” that could estimate an individual’s salt intake and the sources of salt in the diet, and to evaluate this new method with a 24-h urine collection. The new method estimates salt intake from: (1) household cooking by weighing the family salt container and other high-salt condiments or sauces at the beginning and end of a week, (2) processed food according to established China food composition figures, and (3) cafeteria or restaurant meals using the results of previous studies. Consumption of salt additives and major salt contained foods and salt intake related eating habits were collected using a structured simple seven-day questionnaire. In order to validate the method, we studied 37 individuals from 11 families using the new method and 26 of these participants collected seven concurrent 24-h urine samples. The average salt intake for the 26 participants was 15.6 ± 5.5 g/person/day (mean ± standard deviation) by the 24-h urine collection and 13.7 ± 6.5 g/person/day by the new method. The difference was 1.8 ± 4.2 g/day/person (p = 0.037). The Pearson correlation coefficient was 0.762 (p &lt, 0.001) and the partial correlation coefficient was 0.771 (p &lt, 0.001) when adjusted for family code. Bland-Altman Plot showed the average of the difference between the two methods was −1.83, with 95% limits of −10.1 to 6.5 g/person/day. The new method showed that 43.7% of salt intake came from household cooking (33.5% from cooking salt, 10.2% from other condiments and sauces), 12.9% from processed food, and 43.4% from eating out. In conclusion, despite its limitations of underestimating salt intake, the “one-week salt estimation method” is easier for people to implement and is likely to provide useful information that highlights the excessively high intake of salt and its sources, and in turn is helpful in guiding dietary salt reduction.