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Article(id=1241329573623812159, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409356, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1727193600000, receivedDateStr=2024-09-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773885633140, onlineDateStr=2026-03-19, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773885633140, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773885633140, creator=13701087609, updateTime=1773885633140, updator=13701087609, issue=Issue{id=1241329570129956900, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773885632307, creator=13701087609, updateTime=1773885763730, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241330121425080472, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241330121425080473, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2379, endPage=2384, ext={EN=ArticleExt(id=1241329573988716630, articleId=1241329573623812159, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Evaluation of salt reduction knowledge, attitude and practice intervention in six provinces of China: a randomized controlled study, columnId=1228016572783063333, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Food Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the effectiveness of salt reduction intervention on knowledge, attitudes, and practices (KAP) regarding salt intake among residents in six provinces of China.

Methods

This cluster randomized controlled trial employed multistage cluster random sampling to select residents aged 18 to 75 years from six provinces (Hebei, Heilongjiang, Jiangxi,Hunan, Sichuan, and Qinghai). A comprehensive salt reduction intervention targeting multiple populations and settings was implemented, followed by questionnaire surveys and physical examinations. Difference-in-differences analysis combined with multilevel logistic regression models was used to assess the net intervention effect.

Results

A total of 2 269 participants were included (control group: 1 096; intervention group: 1 173). The intervention significantly improved knowledge, including awareness of daily salt intake recommendations (OR=6.124), the association between high salt intake and hypertension (OR=2.652), the misconception that low salt intake causes weakness (OR=2.469), awareness of low-sodium salt (OR=1.650), and understanding of salt content on food labels (OR=2.486). Positive attitudes toward salt reduction also increased, including willingness to choose low-salt diets (OR=2.717) and confidence in maintaining low-salt diets (OR=2.067). Behavioral improvements were observed in the use of low-sodium salt (OR=1.774), reduced consumption of pickled foods (OR=1.300), and reduced intake of salty snacks (OR=1.997)(all P < 0.05). Sensitivity analyses yielded consistent results.

Conclusion

The salt reduction intervention effectively enhanced salt-related knowledge and attitudes, while promoting certain salt-reducing behaviors among residents in six provinces.

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目的

评估六省减盐干预对居民减盐知信行产生的影响。

方法

本研究遵循整群随机对照试验设计，运用多阶段整群随机抽样的方法，选取河北、黑龙江、江西、湖南、四川和青海六省18～75岁的居民作为研究对象，实施面向多人群多场所的减盐综合干预措施，并进行问卷调查以及体格检查。采用倍差法结合多水平logistic回归模型，以评价干预净效应。

结果

最终纳入研究对象共2 269名，其中对照组1 096人，干预组1 173人。结果显示，在知识层面，干预净效应显著增加了知晓成人每天盐摄入量（OR=6.124）、知晓吃盐多导致高血压（OR=2.652）、知晓吃盐少不会无力（OR=2.469）、知晓低钠盐（OR=1.650）以及知晓食品标签盐含量（OR=2.486）的比例；在态度层面，干预净效应显著增加了愿意选择低盐饮食（OR=2.717）、认为能做到低盐饮食（OR=2.067）的比例；在行为层面，干预净效应显著增加了使用低钠盐（OR=1.774）、少吃腌制食品（OR=1.300）以及少吃含盐零食（OR=1.997）的比例，均P<0.05。敏感性分析结果基本一致。

结论

六省减盐干预能有效提高人群减盐知识、态度水平，同时促进人群采取某些减盐相关行为。

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徐建伟，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=pv7vrjw3hJBwVJWlFk3uqQ==, magXml=I3fc7+BI/mRXccTqMmvGpg==, pdfUrl=null, pdf=SaHu8v3oVqgmdIOxe2nRBg==, pdfFileSize=629329, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=Swnu0ulsTHt2zTkzJTJSVQ==, mapNumber=null, authorCompany=null, fund=null, authors=

潘宁宁（1998—），女，硕士在读，研究方向：慢性病预防与控制

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潘宁宁（1998—），女，硕士在读，研究方向：慢性病预防与控制

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Current epidemiology of adult hypertension in China[J] . Chinese Journal of Cardiovascular Medicine, 2020, 25(6): 513-515.(In Chinese), articleTitle=Current epidemiology of adult hypertension in China, refAbstract=null), Reference(id=1241329776389050453, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, doi=null, pmid=null, pmcid=null, year=2022, volume=44, issue=2, pageStart=132, pageEnd=137, url=null, language=null, rfNumber=[21], rfOrder=29, authorNames=张晓帆, 李园, 杜文雯, journalName=营养学报, refType=null, unstructuredReference=张晓帆，李园，杜文雯，等.餐馆减盐干预对消费者减盐知信行的影响[J] .营养学报，2022，44（2）：132-137., articleTitle=餐馆减盐干预对消费者减盐知信行的影响, refAbstract=null), Reference(id=1241329776481325145, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, doi=null, pmid=null, pmcid=null, year=2022, volume=44, issue=2, pageStart=132, pageEnd=137, url=null, language=null, rfNumber=[21], rfOrder=30, authorNames=Zhang XF, Li Y, Du WW, journalName=Acta Nutrimenta Sinica, refType=null, unstructuredReference=Zhang XF, Li Y, Du WW, et al. Influence of restaurant salt reduction intervention on salt related knowledge, attitude and behavior of consumers[J] . Acta Nutrimenta Sinica, 2022, 44(2): 132-137.(In Chinese), articleTitle=Influence of restaurant salt reduction intervention on salt related knowledge, attitude and behavior of consumers, refAbstract=null), Reference(id=1241329776577794141, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, doi=null, pmid=null, pmcid=null, year=2024, volume=41, issue=1, pageStart=57, pageEnd=72, url=null, language=null, rfNumber=[22], rfOrder=31, authorNames=Armas AJM, Aranda JAE, Arcos HS, journalName=Journal of Community Health Nursing, refType=null, unstructuredReference=Armas AJM, Aranda JAE, Arcos HS, et al. Assessing dietary salt intake and Pilot-Testing a Home-Based intervention to lower salt intake among filipino college students[J] . Journal of Community Health Nursing, 2024, 41(1): 57-72., articleTitle=Assessing dietary salt intake and Pilot-Testing a Home-Based intervention to lower salt intake among filipino college students, refAbstract=null), Reference(id=1241329776657485920, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, doi=null, pmid=null, pmcid=null, year=2022, volume=17, issue=5, pageStart=497, pageEnd=500, url=null, language=null, rfNumber=[23], rfOrder=32, authorNames=曾婧, 任研, 何邱平, journalName=健康教育与健康促进, refType=null, unstructuredReference=曾婧，任研，何邱平，等.行为改变理论在大学生营养与食品类课程中的应用[J] .健康教育与健康促进，2022，17（5）：497-500., articleTitle=行为改变理论在大学生营养与食品类课程中的应用, refAbstract=null), Reference(id=1241329776800092263, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, doi=null, pmid=null, pmcid=null, year=2022, volume=17, issue=5, pageStart=497, pageEnd=500, url=null, language=null, rfNumber=[23], rfOrder=33, authorNames=Zeng J, Ren Y, He QP, journalName=Health Education and Health Promotion, refType=null, unstructuredReference=Zeng J, Ren Y, He QP, et al. Application of behavior change theory in college students' nutrition and food courses[J] . Health Education and Health Promotion, 2022, 17(5): 497-500.(In Chinese), articleTitle=Application of behavior change theory in college students' nutrition and food courses, refAbstract=null)], funds=[Fund(id=1241329768050774961, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, awardId=16/136/77, language=CN, fundingSource=英国国立健康研究院资助中英减盐项目(16/136/77), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241329762937918001, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, xref=1., ext=[AuthorCompanyExt(id=1241329762946306611, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, companyId=1241329762937918001, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China), AuthorCompanyExt(id=1241329762954695220, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, companyId=1241329762937918001, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.中国疾病预防控制中心慢性非传染性疾病预防控制中心，北京 100050)]), AuthorCompany(id=1241329763059552834, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, xref=2., ext=[AuthorCompanyExt(id=1241329763067941443, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, companyId=1241329763059552834, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.北京大学医学部乔治健康研究所，北京 100088)])], figs=[ArticleFig(id=1241329766758929250, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=EN, label=Table 1, caption=

Basic characteristics of respondents [（），n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体 (n=2 269)对照组 (n=1 096)干预组 (n=1 173)t或χ2值P值
年龄（岁）48.07±12.6147.34±12.8148.74±12.38-2.640.008
性别0.140.709
男性1 094(48.22)524(47.81)570(48.59)
女性1 175(51.78)572(52.19)603(51.41)
文化水平3.870.144
小学及以下984(43.37)454(41.43)530(45.18)
初中840(37.02)413(37.68)427(36.41)
高中及以上445(19.61)229(20.89)216(18.41)
吸烟0.110.736
是647 (28.53)316(28.86)331(28.22)
否1 621(71.47)779(71.14)842(71.78)
饮酒1.560.458
是911(40.17)426(38.90)485(41.35)
否1 357(59.83)669(61.10)688(58.65)
经常锻炼1.670.196
是921(40.59)460(41.97)461(39.30)
否1 348(59.41)636(58.03)712(60.70)
地区49.87<0.001
南方1 266(55.80)695(63.41)571(48.68)
北方1 003(44.20)401(36.59)602(51.32)
BMI（kg/m2）24.81±3.5924.76±3.6624.86 ± 3.53-0.710.478
高血压8.500.004
是791(34.86)349(31.84)442(37.68)
否1 478(65.14)747(68.16)731(62.32)
), ArticleFig(id=1241329766859592554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=CN, label=表1, caption=

调查对象的基本特征[（），n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体 (n=2 269)对照组 (n=1 096)干预组 (n=1 173)t或χ2值P值
年龄（岁）48.07±12.6147.34±12.8148.74±12.38-2.640.008
性别0.140.709
男性1 094(48.22)524(47.81)570(48.59)
女性1 175(51.78)572(52.19)603(51.41)
文化水平3.870.144
小学及以下984(43.37)454(41.43)530(45.18)
初中840(37.02)413(37.68)427(36.41)
高中及以上445(19.61)229(20.89)216(18.41)
吸烟0.110.736
是647 (28.53)316(28.86)331(28.22)
否1 621(71.47)779(71.14)842(71.78)
饮酒1.560.458
是911(40.17)426(38.90)485(41.35)
否1 357(59.83)669(61.10)688(58.65)
经常锻炼1.670.196
是921(40.59)460(41.97)461(39.30)
否1 348(59.41)636(58.03)712(60.70)
地区49.87<0.001
南方1 266(55.80)695(63.41)571(48.68)
北方1 003(44.20)401(36.59)602(51.32)
BMI（kg/m2）24.81±3.5924.76±3.6624.86 ± 3.53-0.710.478
高血压8.500.004
是791(34.86)349(31.84)442(37.68)
否1 478(65.14)747(68.16)731(62.32)
), ArticleFig(id=1241329766972838771, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=EN, label=Table 2, caption=

Evaluation of the intervention effect of knowledge related to salt reduction

, figureFileSmall=null, figureFileBig=null, tableContent=
知识变量干预组对照组干预净效应
［OR（95%CI）］		P值
干预前(%)干预后(%)OR（95%CI）干预前(%)干预后(%)OR（95%CI）
知晓成人每天盐摄入量210(17.90)808(68.88)12.905(10.428～15.971)267(24.36)430(39.23)2.298(1.875～2.815)6.124(4.599～8.155)<0.001
知晓吃盐多导致高血压849(72.38)1 077(91.82)4.423(3.452～5.668)836(76.28)923(84.22)1.733(1.386～2.167)2.652(1.903～3.696)<0.001
知晓吃盐少不会无力319(27.20)638(54.39)3.395(2.841～4.058)307(28.01)379(34.58)1.374(1.141～1.655)2.469(1.910～3.191)<0.001
知晓低钠盐319(27.20)685(58.40)5.067(4.152～6.184)270(24.64)493(44.98)3.267(2.644～4.035)1.650(1.245～2.185)<0.001
知晓食品标签盐含量435(37.08)1 054(89.86)3.758(3.086～4.576)464(42.34)889(81.11)1.588(1.297～1.945)2.486(1.884～3.278)<0.001
), ArticleFig(id=1241329767044141948, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=CN, label=表2, caption=

减盐相关知识干预效果评价

, figureFileSmall=null, figureFileBig=null, tableContent=
知识变量干预组对照组干预净效应
［OR（95%CI）］		P值
干预前(%)干预后(%)OR（95%CI）干预前(%)干预后(%)OR（95%CI）
知晓成人每天盐摄入量210(17.90)808(68.88)12.905(10.428～15.971)267(24.36)430(39.23)2.298(1.875～2.815)6.124(4.599～8.155)<0.001
知晓吃盐多导致高血压849(72.38)1 077(91.82)4.423(3.452～5.668)836(76.28)923(84.22)1.733(1.386～2.167)2.652(1.903～3.696)<0.001
知晓吃盐少不会无力319(27.20)638(54.39)3.395(2.841～4.058)307(28.01)379(34.58)1.374(1.141～1.655)2.469(1.910～3.191)<0.001
知晓低钠盐319(27.20)685(58.40)5.067(4.152～6.184)270(24.64)493(44.98)3.267(2.644～4.035)1.650(1.245～2.185)<0.001
知晓食品标签盐含量435(37.08)1 054(89.86)3.758(3.086～4.576)464(42.34)889(81.11)1.588(1.297～1.945)2.486(1.884～3.278)<0.001
), ArticleFig(id=1241329767153193854, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=EN, label=Table 3, caption=

Evaluation of the intervention effect of attitude related to salt reduction

, figureFileSmall=null, figureFileBig=null, tableContent=
态度变量干预组对照组干预净效应
［OR（95%CI）］		P值
干预前(%)干预后(%)OR（95%CI）干预前(%)干预后(%)OR（95%CI）
愿意选择低盐饮食936(79.80)1 103(94.03)4.266(3.200～5.686)876(79.93)940(85.77)1.555(1.233～1.962)2.717(1.882～3.910)<0.001
认为能做到低盐饮食874(74.51)1 054(89.86)3.188(2.517～4.03)812(74.09)889(81.11)1.545(.252～1.907)2.067(1.508～2.806)<0.001
), ArticleFig(id=1241329767262245768, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=CN, label=表3, caption=

减盐相关态度干预效果评价

, figureFileSmall=null, figureFileBig=null, tableContent=
态度变量干预组对照组干预净效应
［OR（95%CI）］		P值
干预前(%)干预后(%)OR（95%CI）干预前(%)干预后(%)OR（95%CI）
愿意选择低盐饮食936(79.80)1 103(94.03)4.266(3.200～5.686)876(79.93)940(85.77)1.555(1.233～1.962)2.717(1.882～3.910)<0.001
认为能做到低盐饮食874(74.51)1 054(89.86)3.188(2.517～4.03)812(74.09)889(81.11)1.545(.252～1.907)2.067(1.508～2.806)<0.001
), ArticleFig(id=1241329767392269197, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=EN, label=Table 4, caption=

Evaluation of the intervention effect of practice related to salt reduction

, figureFileSmall=null, figureFileBig=null, tableContent=
行为变量干预组对照组干预净效应
［OR（95%CI）］		P值
干预前(%)干预后(%)OR（95%CI）干预前(%)干预后(%)OR（95%CI）
使用低钠盐114(9.72)414(35.29)3.516(2.726～4.535)86(7.85)150(13.69)2.052(1.519～2.773)1.774(1.202～2.621)0.004
少吃腌制食品674(57.46)736(62.75)1.289(1.079～1.541)599(54.65)596(54.38)0.988(0.827～1.180)1.300(1.011～1.667)0.041
少吃含盐零食976(83.21)1 054(89.86)1.277(1.015～1.606)893(81.48)812(74.09)0.636(0.516～0.78)1.997(1.467～2.179)<0.001
), ArticleFig(id=1241329767488738193, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=CN, label=表4, caption=

减盐相关行为干预效果评价

, figureFileSmall=null, figureFileBig=null, tableContent=
行为变量干预组对照组干预净效应
［OR（95%CI）］		P值
干预前(%)干预后(%)OR（95%CI）干预前(%)干预后(%)OR（95%CI）
使用低钠盐114(9.72)414(35.29)3.516(2.726～4.535)86(7.85)150(13.69)2.052(1.519～2.773)1.774(1.202～2.621)0.004
少吃腌制食品674(57.46)736(62.75)1.289(1.079～1.541)599(54.65)596(54.38)0.988(0.827～1.180)1.300(1.011～1.667)0.041
少吃含盐零食976(83.21)1 054(89.86)1.277(1.015～1.606)893(81.48)812(74.09)0.636(0.516～0.78)1.997(1.467～2.179)<0.001
), ArticleFig(id=1241329767568429974, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=EN, label=Table 5, caption=

Evaluation of the intervention effect of KAP related to salt reduction after multiple imputation

, figureFileSmall=null, figureFileBig=null, tableContent=
变量干预净效应［OR（95%CI）］P值
知识变量
知晓成人每天盐摄入量4.632(3.600～5.959)<0.001
知晓吃盐多导致高血压2.231(1.700～2.929)<0.001
知晓吃盐少不会无力2.141(1.699～2.699)<0.001
知晓低钠盐1.571(1.233～2.003)<0.001
知晓食品标签盐含量2.072(1.642～2.614)<0.001
态度变量
愿意选择低盐饮食2.235(1.642～3.041)<0.001
认为能做到低盐饮食2.022(1.535～2.66)<0.001
行为变量
使用低钠盐1.463(1.040～2.060)0.029
少吃腌制食品1.199(0.955～1.506)0.117
少吃含盐零食1.803(1.360～2.391)<0.001
), ArticleFig(id=1241329767681676193, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329573623812159, language=CN, label=表5, caption=

多重插补后减盐相关知识、态度及行为干预效果评价

, figureFileSmall=null, figureFileBig=null, tableContent=
变量干预净效应［OR（95%CI）］P值
知识变量
知晓成人每天盐摄入量4.632(3.600～5.959)<0.001
知晓吃盐多导致高血压2.231(1.700～2.929)<0.001
知晓吃盐少不会无力2.141(1.699～2.699)<0.001
知晓低钠盐1.571(1.233～2.003)<0.001
知晓食品标签盐含量2.072(1.642～2.614)<0.001
态度变量
愿意选择低盐饮食2.235(1.642～3.041)<0.001
认为能做到低盐饮食2.022(1.535～2.66)<0.001
行为变量
使用低钠盐1.463(1.040～2.060)0.029
少吃腌制食品1.199(0.955～1.506)0.117
少吃含盐零食1.803(1.360～2.391)<0.001
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我国六省居民减盐知信行干预效果评价——一项随机对照研究
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潘宁宁 1 , 李晴 1 , 刘敏 1 , 李园 2 , 张普洪 2 , 白雅敏 1 , 徐建伟 1
现代预防医学 | 营养与食品卫生 2025,52(13): 2379-2384
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现代预防医学 | 营养与食品卫生 2025, 52(13): 2379-2384
我国六省居民减盐知信行干预效果评价——一项随机对照研究
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潘宁宁1, 李晴1, 刘敏1, 李园2, 张普洪2, 白雅敏1, 徐建伟1
作者信息
  • 1.中国疾病预防控制中心慢性非传染性疾病预防控制中心，北京 100050
  • 2.北京大学医学部乔治健康研究所，北京 100088

    • 潘宁宁（1998—），女，硕士在读，研究方向：慢性病预防与控制

通讯作者:

徐建伟，E-mail:
Evaluation of salt reduction knowledge, attitude and practice intervention in six provinces of China: a randomized controlled study
Ning-ning PAN1, Qing LI1, Min LIU1, Yuan LI2, Pu-hong ZHANG2, Ya-min BAI1, Jian-wei XU1
Affiliations
  • National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
出版时间: 2025-07-10 doi: 10.20043/j.cnki.MPM.202409356
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摘要
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目的

评估六省减盐干预对居民减盐知信行产生的影响。

方法

本研究遵循整群随机对照试验设计，运用多阶段整群随机抽样的方法，选取河北、黑龙江、江西、湖南、四川和青海六省18～75岁的居民作为研究对象，实施面向多人群多场所的减盐综合干预措施，并进行问卷调查以及体格检查。采用倍差法结合多水平logistic回归模型，以评价干预净效应。

结果

最终纳入研究对象共2 269名，其中对照组1 096人，干预组1 173人。结果显示，在知识层面，干预净效应显著增加了知晓成人每天盐摄入量（OR=6.124）、知晓吃盐多导致高血压（OR=2.652）、知晓吃盐少不会无力（OR=2.469）、知晓低钠盐（OR=1.650）以及知晓食品标签盐含量（OR=2.486）的比例；在态度层面，干预净效应显著增加了愿意选择低盐饮食（OR=2.717）、认为能做到低盐饮食（OR=2.067）的比例；在行为层面，干预净效应显著增加了使用低钠盐（OR=1.774）、少吃腌制食品（OR=1.300）以及少吃含盐零食（OR=1.997）的比例，均P<0.05。敏感性分析结果基本一致。

结论

六省减盐干预能有效提高人群减盐知识、态度水平，同时促进人群采取某些减盐相关行为。

随机对照研究  /  知信行  /  净效应  /  减盐
Objective

To evaluate the effectiveness of salt reduction intervention on knowledge, attitudes, and practices (KAP) regarding salt intake among residents in six provinces of China.

Methods

This cluster randomized controlled trial employed multistage cluster random sampling to select residents aged 18 to 75 years from six provinces (Hebei, Heilongjiang, Jiangxi,Hunan, Sichuan, and Qinghai). A comprehensive salt reduction intervention targeting multiple populations and settings was implemented, followed by questionnaire surveys and physical examinations. Difference-in-differences analysis combined with multilevel logistic regression models was used to assess the net intervention effect.

Results

A total of 2 269 participants were included (control group: 1 096; intervention group: 1 173). The intervention significantly improved knowledge, including awareness of daily salt intake recommendations (OR=6.124), the association between high salt intake and hypertension (OR=2.652), the misconception that low salt intake causes weakness (OR=2.469), awareness of low-sodium salt (OR=1.650), and understanding of salt content on food labels (OR=2.486). Positive attitudes toward salt reduction also increased, including willingness to choose low-salt diets (OR=2.717) and confidence in maintaining low-salt diets (OR=2.067). Behavioral improvements were observed in the use of low-sodium salt (OR=1.774), reduced consumption of pickled foods (OR=1.300), and reduced intake of salty snacks (OR=1.997)(all P < 0.05). Sensitivity analyses yielded consistent results.

Conclusion

The salt reduction intervention effectively enhanced salt-related knowledge and attitudes, while promoting certain salt-reducing behaviors among residents in six provinces.

Randomized controlled trial  /  Knowledge, attitudes, and practices  /  Net effect  /  Salt reduction
潘宁宁, 李晴, 刘敏, 李园, 张普洪, 白雅敏, 徐建伟. 我国六省居民减盐知信行干预效果评价——一项随机对照研究. 现代预防医学, 2025 , 52 (13) : 2379 -2384 . DOI: 10.20043/j.cnki.MPM.202409356
Ning-ning PAN, Qing LI, Min LIU, Yuan LI, Pu-hong ZHANG, Ya-min BAI, Jian-wei XU. Evaluation of salt reduction knowledge, attitude and practice intervention in six provinces of China: a randomized controlled study[J]. Modern Preventive Medicine, 2025 , 52 (13) : 2379 -2384 . DOI: 10.20043/j.cnki.MPM.202409356
正文
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盐摄入过多是多种慢性病的一个危险因素[1]。研究显示，我国人均每日烹调用盐为9.3 g，显著高于世界卫生组织的推荐摄入值[2]。知信行（knowledge, attitude, practice）是一种健康促进模式，通过增加健康知识，强化健康意识，从而促使公众采取科学的行为，以实现预防疾病的目标[3]。国内外研究表明，通过提升人群的减盐知信行水平，能有效降低人群的盐摄入量，进而降低多种慢性病的发生风险[4-14]。研究显示，综合性减盐干预能够更全面地提升人群的减盐知信行水平[15]。然而，我国已有的减盐干预行动，多针对单一人群或场所开展[3,5-6,8,9-13]。六省减盐干预是面向我国多人群多场所开展的一项随机对照研究，涉及了东部、中部以及西部地区，并采取了多种干预措施[16]。本研究分析干预后，该减盐干预对六省居民减盐知信行产生的影响，为我国减盐干预工作提供思路，使更多人群受益。
1　对象与方法
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1.1　对象
本研究的数据来源于2018—2021年的“中英减盐行动-基于社区的中国居民减盐综合干预整群随机对照研究”项目[16]。该项目在河北、黑龙江、江西、湖南、四川和青海省开展。每个省选择2个项目县（区），其中一个作为干预县，一个作为对照县。采用多阶段整群随机抽样的方法：（1）一级抽样单位为街道、乡镇，随机抽取4个乡镇（街道）；（2）二级抽样单位为居委会、村委会，随机抽取2个村（居委会）；（3）第三阶段：以成年常住人口为抽样人群，按照性别和年龄随机抽取28人。样本量计算公式如下[16]：
其中，Zα为α=0.05水平的标准正态离差，即1.96；Zβ为β=0.1水平的标准正态离差，即Zβ=1.28。s为主要指标：24 h尿钠排泄量的标准差，参考相关文献[16]，其值取73 mmol/d；d为干预组与对照组相比24 h尿钠值预期降低值，该值定为25 mmol/L。同时考虑到25%的失访率，最终一个项目县（区）实际需要样本数为224人，故每个村（居委会）需要样本量为28人。
2018年10—12月开展基线调查，实施干预1年后，于2019年11月—2020年1月开展了中期调查，再随访2年后，于2021年9—10月开展了终末调查，所有调查对象均已签署知情同意书。本研究剔除了终末调查时失访的424人（未完成问卷调查），最终纳入2 269名研究对象。中国疾病预防控制中心慢性非传染性疾病预防控制中心伦理委员会已通过对该项目的审批（批号：201807），所有调查对象均知情同意[16]。
1.2　方法
1.2.1　纳入和排除标准
研究对象的纳入标准：（1）成年人群；（2）每个家庭只纳入一位家庭成员；（3）居住半年以上的常住居民，且近二年内没有搬迁计划；（4）签署知情同意书。研究对象的排除标准：（1）孕妇或哺乳期妇女；（2）正在参与任何其它研究；（3）可能会影响研究开展的严重疾病。
1.2.2　干预措施
从河北、黑龙江、江西、湖南、四川和青海省各选择两个项目县（区），需满足经济条件、城市化和人口情况相似等标准[16]。其中一个县（区）被指定为干预组，另一个则作为对照组，对照组不施加干预措施。干预组实施面向多人群多场所开展减盐综合干预措施[16]，包括：（1）减盐大众干预，主要措施为减盐主题宣传活动和媒体宣传；（2）基于社区的减盐干预，主要措施为开展减盐宣传教育，建设社区减盐环境；（3）基于学校的减盐干预，主要措施为开展减盐专题讲座和校园多渠道宣传；（4）基于餐厅的减盐干预，主要措施为餐馆内减盐相关海报、桌贴以及短视频宣传；（5）基于医疗卫生机构的减盐干预，主要措施为医师减盐培训以及公共场所减盐卫生宣教。
1.2.3　调查内容和方法
（1）问卷调查：由培训合格的调查员采用电子数据采集系统进行现场问卷调查。问卷内容主要包括减盐知识、行为以及态度相关问题、基本情况（年龄、性别、教育程度等）和健康行为（吸烟、饮酒、身体活动情况等）。其中，减盐相关知识问题有五道、减盐相关态度问题有二道、减盐相关行为问题有三道，Cronbach α=0.781，具有良好的信效度。问卷内容通过手机端电子数据采集系统（electronic data capture，EDC）实时上传至数据平台，避免再次录入导致的问卷错误，可靠性高；（2）体格检查：采用身高计、体重秤以及皮尺测量身高、体重以及腰围。计算身体质量指数（body mass index,BMI）=体重（kg）/身高的二次方（m）2[17]。采用HEM-7120型电子血压计测量坐位右上臂血压，连续测量3次，每次间隔为1 min，取后两次的平均值。
1.2.4　质量控制
调查开始前对调查人员进行了统一培训。调查员进行询问后填写调查问卷，并非由调查对象自行填写。核查人员可通过问卷环节的随机录音评估调查员的现场表现，及时识别存在的问题。体格测量均采用统一标准的设备测量，重复测量血压三次，每次至少间隔一分钟。同时，调查员通过EDC会拍照上传调查对象的姿势以及血压、心率测量结果，实现远程质量控制[16]。
1.3　指标定义
（1）经常锻炼：中高强度身体活动达到每周3 d及以上，每次运动时达到30 min及以上[18]。（2）吸烟：调查前3个月内吸过烟[18]。（3）地区：按照国家南北方区域划分标准，对12个区县进行划分[19]；（4）高血压：收缩压≥140 mm Hg（1 mm Hg =0.133 kPa）或舒张压≥90 mm Hg以及现在仍在服用降压药[20]。
1.4　统计学分析
采用SAS 9.6软件进行数据分析。计量资料采用（）表示，组间比较采用t检验；计数资料采用例数、构成比和率表示，组间比较采用χ2检验。采用倍差法结合多水平logistic回归模型进行干预效果分析。检验水准α=0.05。构建时间-个体两水平模型，以解决由于整群随机抽样和重复测量数据所带来的数据嵌套问题，以减盐知信行情况作为因变量，自变量包括组（对照组和干预组）、时间以及时间*组交互项，其中交互项是指干预组和对照组在干预前后减盐知信行变化的差异，从而评价干预净效应。敏感性分析对终末问卷缺失数据进行多重插补后，对完整数据集进行上述分析，以确定研究结果的稳定性。
2　结果
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2.1　基本情况
最终纳入研究对象共2 269名，年龄为（48.07±12.61）岁，男性占48.22%。其中对照组1 096人（48.30%），干预组1 173人（51.70%）。干预组与对照组在性别、文化水平、吸烟、饮酒、经常锻炼和BMI上的差异均无统计学意义。见表1。
2.2　减盐相关知识干预效果评价
干预后，干预组知晓成人每天盐摄入量的比例增加了50.98%；知晓吃盐多导致高血压的比例增加了19.44%；知晓吃盐少不会无力的比例增加了27.19%；知晓低钠盐的比例增加了31.20%；知晓食品标签盐含量的比例增加了52.78%，差异均有统计学意义（P<0.05）。
以减盐知识情况作为因变量，采用倍差法结合多水平logistic回归模型，校正基线年龄、性别、文化程度、BMI、地区、吸烟、饮酒、经常锻炼、高血压后，结果显示，相比于对照组，干预净效应显著增加了知晓成人每天盐摄入量（OR=6.124，95%CI：4.599～8.155，P<0.001）、知晓吃盐多导致高血压（OR=2.652，95%CI：1.903～3.696，P<0.001）、知晓吃盐少不会无力（OR=2.469，95%CI：1.910～3.191，P<0.001）、知晓低钠盐（OR=1.650，95%CI：1.245～2.185，P<0.001）以及知晓食品标签盐含量（OR=2.486，95%CI：1.884～3.278，P<0.001）的比例。见表2
2.3　减盐相关态度干预效果评价
干预后，干预组愿意选择低盐饮食的比例增加了14.23%；认为能做到低盐饮食人群比例增加了15.35%，差异均有统计学意义（p<0.05）。
以减盐态度情况作为因变量，采用倍差法结合多水平logistic回归模型，校正基线年龄、性别、文化程度、BMI、地区、吸烟、饮酒、经常锻炼、高血压后，结果显示，相比于对照组，干预净效应显著增加了愿意选择低盐饮食（OR=2.717，95%CI：1.882～3.910，P<0.001）、认为能做到低盐饮食（OR=2.067，95%CI：1.508～2.806，P<0.001）的比例。见表3。
2.4　减盐相关行为干预效果评价
干预后，干预组使用低钠盐的比例增加了25.57%；少吃腌制食品的比例增加了5.29%，少吃含盐零食的比例增加了6.65%，差异均有统计学意义（P<0.05）。
以减盐行为情况作为因变量，采用倍差法结合多水平logistic回归模型，校正基线年龄、性别、文化程度、BMI、地区、吸烟、饮酒、经常锻炼、高血压后，结果显示，相比于对照组，干预净效应显著增加了使用低钠盐（OR=1.774，95%CI：1.202～2.621，P=0.004）、少吃腌制食品（OR=1.300，95%CI：1.011～1.667，P=0.041）、少吃含盐零食（OR=1.997，95%CI：1.467～2.179，P<0.001）的比例。见表4。
2.5　敏感性分析
对缺失数据进行多重插补后，分析结果显示，除少吃腌制食品的干预净效应不显著外，其它结果均与上述结果保持一致。见表5。
3　讨论
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本研究是一项面向多人群多场所开展减盐干预的大规模随机对照研究。结果显示，相比于对照组，人群的减盐知信行得到了有效改善。
在知识层面，相比于对照组，干预净效应表明，该干预对居民减盐知识产生了良好效果。国内外大多减盐干预在减盐知晓率改善方面也均呈现了良好的效果[4-14]。在我国山东省开展的多项减盐干预表明，结果显示干预后，人群的减盐知晓率和意愿率显著改善[10-13]。一项在济南市槐荫区开展的为期五年的减盐干预显示，干预后，人群的每人每天6 g盐、少吃盐降血压、低钠盐的知晓率和减盐意愿率均改善[14]。然而一些研究显示减盐干预后，人群的减盐知识水平没有明显改善[21-22]。张晓帆等人[21]的一项研究结果表明，减盐干预对减盐知识的改善效果不佳。一项在菲律宾开展的为期一个月的减盐干预表明，干预后减盐知识水平没有显著提高[22]，这可能与干预时间较短有关。这一结果表明，较长的干预时长对提高减盐知识水平至关重要。
在态度层面，相比于对照组，干预组拥有正确减盐态度的比例显著增加。基线结果显示，“愿意选择低盐饮食”和“认为能做到低盐饮食”的意愿率均大于70%，表明我国居民的减盐态度良好，这与国内已有研究结果相似[10-14]。国内外研究结果也显示，减盐干预能有效提升态度意愿率[4,7,10-14]。这一结果提示，我国减盐干预研究应积极探索将居民良好的减盐态度转化为实际行动的关键途径。
在行为层面，干预组居民少吃腌制食品、少吃含盐零食的比例均有所增加，特别是低钠盐的使用率。干预净效应也表明该干预能有效提高居民减盐行为的执行率。后续敏感性分析显示，干预净效应对少吃腌制食品的改善不显著，这可能与干预前后少吃腌制食品的人群比例增加不多有关，提示促使更多人群采取减盐行为需要更长的时间和更持久的干预，这符合行为转变的分阶段模式[23]。
本研究是一项覆盖中国东部、中部和西部地区的大规模减盐干预研究，采用了严格且标准化的研究设计和方法，所获数据具有可靠性。不过，本研究也存在一定局限性：研究中存在失访人群，导致部分问卷数据缺失。但本研究通过多重插补法对完整数据集进行评估，在一定程度上弥补了这一不足。
综上所述，面向多人群多场所的综合性减盐干预能够有效提高居民的减盐相关知识与态度水平，促进人群采取某些减盐相关行为，可考虑全面推广，让更多人群受益。
基金
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  • 英国国立健康研究院资助中英减盐项目(16/136/77)
文献
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2025年第52卷第13期
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doi: 10.20043/j.cnki.MPM.202409356
  • 接收时间：2024-09-25
  • 首发时间：2026-03-19
  • 出版时间：2025-07-10
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  • 收稿日期：2024-09-25
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英国国立健康研究院资助中英减盐项目(16/136/77)
作者信息
    1.中国疾病预防控制中心慢性非传染性疾病预防控制中心，北京 100050
    2.北京大学医学部乔治健康研究所，北京 100088

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
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