北京大学健康科学中心乔治全球健康研究院Puhong Zhang团队研究了基于app的教育计划减少中国学龄儿童及其家庭盐摄入量的效果。这一研究成果于2022年2月10日发表在《英国医学杂志》上。
为了确定基于智能手机app的教育计划能否降低学龄儿童及其家庭的盐摄入量，2018年9月15日至2019年12月27日，研究组在中国北部、中部和南部三省的54所小学进行了一项平行、整群随机对照试验，将学校按1：1随机分配到干预组或对照组。
共招募了592名儿童，其中男童308名（52.0%），小学3年级的平均年龄为8.58岁，每个学校大约有11名儿童。共涉及1184名成年家庭成员，其中551名（46.5%）为男性，平均年龄为45.80岁。
在该app的支持下，干预组的孩子们接受了关于减少盐摄入量的教育，并布置了家庭作业，以鼓励他们的家人参与减少盐摄入量的活动。主要观察指标是干预组和对照组在12个月随访时盐摄入量变化（通过24小时尿钠排泄量测量）的差异。
经基线评估后，297名儿童和594名成年家庭成员（来自27所学校）被分配到干预组，295名儿童和590名成年家庭成员（来自27所学校）被分配到对照组。在试验期间，27名（4.6%）儿童和112名（9.5%）成年人因儿童搬到另一所学校或成年人无法参加后续评估而失去了随访。
干预组的其余287名儿童和546名成人（来自27所学校）以及对照组的278名儿童和526名成人（来自27所学校）完成了12个月的随访评估。干预组的儿童和成人在基线检查时的平均盐摄入量分别为5.5和10.0克/天，对照组的儿童和成人在基线检查时分别为5.6和10.0克/天。
在研究期间，干预组和对照组的儿童盐摄入量都有所增加，但干预组的盐摄入量增加幅度较小。干预组和对照组的成年人盐摄入量均下降，但干预组的盐摄入量下降幅度更大，组间差异显著。儿童的收缩压平均降低0.76 mmHg，成人平均降低1.64 mmHg。
研究结果表明，这项基于app的教育计划通过儿童到家长的方式，在小学期间进行，在降低成人盐摄入量和收缩压方面是有效的，但在儿童中效果不显著。尽管这种新方法可能会扩大到更多人群，但该计划需进一步加强，以减少包括学龄儿童在内的整个人群的盐摄入量。
附：英文原文
Title: App based education programme to reduce salt intake (AppSalt) in schoolchildren and their families in China: parallel, cluster randomised controlled trial
Author: Feng J He, Puhong Zhang, Rong Luo, Yuan Li, Yuewen Sun, Fengge Chen, Yuhong Zhao, Wei Zhao, Daoxi Li, Hang Chen, Tianyong Wu, Jianyun Yao, Changxing Lou, Siyuan Zhou, Le Dong, Yu Liu, Xian Li, Jing He, Changqiong Wang, Monique Tan, Jing Song, Graham A MacGregor
Issue&Volume: 2022/02/10
Abstract:
Objective To determine whether a smartphone application based education programme can lower salt intake in schoolchildren and their families.
Design Parallel, cluster randomised controlled trial, with schools randomly assigned to either intervention or control group (1:1).
Setting 54 primary schools from three provinces in northern, central, and southern China, from 15 September 2018 to 27 December 2019.
Participants 592 children (308 (52.0%) boys; mean age 8.58 (standard deviation 0.41) years) in grade 3 of primary school (about 11 children per school) and 1184 adult family members (551 (46.5%) men; mean age 45.80 (12.87) years).
Intervention Children in the intervention group were taught, with support of the app, about salt reduction and assigned homework to encourage their families to participate in activities to reduce salt consumption.
Main outcome measures Primary outcome was the difference in salt intake change (measured by 24 hour urinary sodium excretion) at 12 month follow-up, between the intervention and control groups.
Results After baseline assessment, 297 children and 594 adult family members (from 27 schools) were allocated to the intervention group, and 295 children and 590 adult family members (from 27 schools) were allocated to the control group. During the trial, 27 (4.6%) children and 112 (9.5%) adults were lost to follow-up, owing to children having moved to another school or adults unable to attend follow-up assessments. The remaining 287 children and 546 adults (from 27 schools) in the intervention group and 278 children and 526 adults (from 27 schools) in the control group completed the 12 month follow-up assessment. Mean salt intake at baseline was 5.5 g/day (standard deviation 1.9) in children and 10.0 g/day (3.5) in adults in the intervention group, and 5.6 g/day (2.1) in children and 10.0 g/day (3.6) in adults in the control group. During the study, salt intake of the children increased in both intervention and control groups but to a lesser extent in the intervention group (mean effect of intervention after adjusting for confounding factors 0.25 g/day, 95% confidence interval 0.61 to 0.12, P=0.18). In adults, salt intake decreased in both intervention and control groups but to a greater extent in the intervention group (mean effect 0.82 g/day, 1.24 to 0.40, P<0.001). The mean effect on systolic blood pressure was 0.76 mm Hg (2.37 to 0.86, P=0.36) in children and 1.64 mm Hg (3.01 to 0.27, P=0.02) in adults.
Conclusions The app based education programme delivered through primary school, using a child-to-parent approach, was effective in lowering salt intake and systolic blood pressure in adults, but the effects were not significant in children. Although this novel approach could potentially be scaled up to larger populations, the programme needs further strengthening to reduce salt intake across the whole population, including schoolchildren.
DOI: 10.1136/bmj-2021-066982
Source: https://www.bmj.com/content/376/bmj-2021-066982
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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本期文章：《英国医学杂志》：Online/在线发表
