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World Action on Salt. Sugar & Health

October 2018

Below is a summary of the ASC October 2018 newsletter. To view the full newsletter, please click here

Overview of Progress

Pilot Studies

During June-July, pilot studies were successfully carried out for the ASC program in Luzhou city of Sichuan Province, Renxian county of Hebei Province and Zhaodong city of Heilongjing Province; and enabled researchers to improve protocols and implementation plans. Each study focuses around different intervention methods: app-based using the AppSalt app (AIS), home cooking based (HIS) and community-based intervention (CIS), respectively.

Early October, another pilot study occurred, the National Institute for Nutrition and Health (NINH) of China CDC collaborated with Sichuan Tourist Institution, Sichuan CDC and Wuhou District CDC to pilot “Restaurant-based intervention” salt reduction (RIS) in 4 Chengdu city restaurants – study protocol will be improved from the pilot.

Study Protocols Approved By Independent Steering Committee

Committee members from all different organisations and institutes gathered in Beijing for the Independent Steering Committee, where RCT protocols, progress and more were presented. The committee members approved and also hoped that the RCTs could be implemented immediately. Overall, the members anticipated that the program will have substantial impact on China’s salt reduction and can be scaled up at the national level in the next phase. 

ASC RCTs Launched in Study Sites

Signed agreements permitted the RCTs implementation and since September, the three RCTs (AIS, HIS, and CIS) launched in the provinces and cities. Multiple updates suggest strong governmental support across all levels and wide local media coverage; yielding encouraging insight into the level of readiness for implementation. By late October, all materials and tools supporting the four RCTs were developed and ready for use.

Commentary on ASC Published in the Lancet

The Lancet reviewed China’s recent salt reduction action and introduced ASC program, in a published article – “Action on Salt China”. The passage denotes ASC is designed and implemented by many research institutes and government agencies and receives support from many sources ranging from NGOs to the catering industry; and, will improve China’s population health but also contribute to improved global health development.  

ASC Website Online

The ASC website, launched in September, is the main outlet of ASC updates and information, and through cooperation with World Action on Salt & Health, the ASC program insights can be outputted to the world. 

Updates from Each Partner

Development of Health Education Materials on Salt Reduction

The Chinese Centre for Health Education (CCHE) consulted with designers and ASC partners to create various health education materials to increase China’s salt awareness, including physical and digital media. The media will be used in the four RCTs and the scale-up stages later. . A popular, young actress has been invited to partake in the process of making the media. Other tools were made, such as salt containers and desk tags in restaurants, in order to target different populations at different settings with the key salt reduction message.

Information management system

Beihang University has finalized their information management system – ASCloud – used for each RCTs data capture process, required in the ASC program. The mhealth tools have been improved via pilot sites and are now used for the RCTs in study sites.

The RCTs

Comprehensive Intervention Study (CIS)

CIS, led by NCD Centre of China CDC, has completed the pilot study, been revised and had necessary staff and local investigators trained. Some provinces involved have carried out a baseline survey.

AppSalt-based Intervention Study (AIS)

AIS, led by TGI and QMUL, has launched successfully and has been met with unwavering commitment and support from both cities, including all individuals and staff involved. Baseline surveys have been carried out and, since mid-October, the two cities are undergoing the one-year AppSalt intervention phase.

Household Intervention Study (HIS)

The HIS, led by the Division of NCD and community health, China CDC, completed the pilot study and was revised before provincial training occurred in late August. By October, local investigators were trained, and after the training stages some study sites carried out baseline surveys. 

Restaurant Intervention Study (RIS) and Food Industry’s Action on Salt

RIS has completed the pilot study in 4 various Chengdu city restaurants, the next step involves revising the protocol then completing the training, baseline survey and intervention. Salt reduction training materials for restaurant cooks will be made, to help and engage the industry.

Improving Nutrition Labelling of Pre-packaged Foods

National food safety standards posted onto the National Health Commission webpage have received numerous requests petitioning for salt reduction and other relevant measures in school meals, meanwhile in formula categories the upper sodium limit has been raised.

Following a consultation meeting to revise pre-packaged food’s nutrition labelling rules in Beijing, food industry representatives across various food categories showed great engagement, demonstrating the necessity for improvements.

Two papers researched by National Center for Food Safety Risk Assessment members have been published, both tropicalized around nutrition claims on China’s pre-packaged foods. 

Next Steps (Nov 2018 – Jan 2019)

Conducting baseline surveys for each RCTs will be the top priority, supervised visits from ASC and lead agencies will occur to ensure correct data monitoring and quality control meet implementation standards. Post baseline survey, all RCTs will enter the one-year intervention phase which will include periodical monitoring and supervision. ASC progress, partner agencies engagement, fund management and other issues will be reviewed by the Department of Health and Social Care (DHSC) via a visit to TGI in November, whereby all national partners of ASC program will attend. A capacity building workshop will occur early December, with the objective to review the RCT progress and build the capacity of knowledge and financial management.

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