Background:While the mHealth and school-based scale-up intervention for salt reduction (EduSaltS) effectively reduced salt intake and blood pressure among adults living with participating schoolchildren, the sustainability of these effects remains uncertain. This study aimed to evaluate whether these effects persisted one year post intervention. Methods: A one-year follow-up of a cluster randomized controlled trial was conducted, involving 524 children and their 524 adult family members from 20 primary schools. At 24 months, 509 children (97.1%) and 486 adults (92.7%) completed the assessment. Mixed linear models were used to analyze the difference in changes in salt intake between the intervention and control groups at 24 months, compared to baseline and 12 months, as measured by consecutive 24 h urinary sodium excretions. Secondary outcomes included the differences in changes in blood pressure and salt-related knowledge, attitudes, and practices (KAP) scores. Results: The adjusted mean difference in changes in salt intake between groups was −0.34 g/24 h (95% CI: −0.94 to 0.26, p = 0.265) for children and −0.72 g/24 h (95% CI: −1.48 to 0.05, p = 0.065) for adults at 24 months versus baseline. The corresponding differences from 12 to 24 months were −0.09 g/24 h (95% CI: −0.69 to 0.51, p = 0.775) for children and 0.29 g/24 h (95% CI: −0.50 to 1.08, p = 0.468) for adults. The adjusted difference in changes in adult blood pressure showed a slight, nonsignificant rebound at 24 months. The intervention group maintained significantly higher KAP scores than the control group at both 12 and 24 months. Conclusions: The effects of EduSaltS on reducing salt intake and blood pressure in adults diminished slightly one year after the intervention ended. However, sustained improvements in salt-related KAP were observed in both children and adults. Ongoing support is vital to sustain long-term salt-reduction behaviors.

A 12-month cluster randomized controlled trial (RCT) demonstrated the effectiveness of an application-based education program in reducing the salt intake and systolic blood pressure (SBP) of schoolchildren’s adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months. Fifty-four schools were randomly assigned to either the intervention or control group. All participants (594 children in grade 3 and 1188 of their adult family members) who completed the baseline survey were contacted again 12 months after the trial. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12 months, measured by the mean two consecutive 24-h urinary sodium excretions. The secondary outcome was the difference in the change of blood pressure and salt-related Knowledge, Attitude, Practice (KAP) score. The difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors was − 0.38 g/day at 24 months versus baseline (95

OBJECTIVE:This study aims to assess the prevalence of cancer risk factors in China's working population and provide evidence for formulating more targeted workplace cancer prevention strategies. DESIGN:A cross-sectional study utilising the baseline data from the Comprehensive Workplace Intervention for Cancer Prevention in China (WECAN) project, a stepped-wedge cluster randomised controlled trial. SETTING:15 workplaces from three cities in China: Wuhai (Northern China), Nanchong (Western China) and Xiangtan (Southern China). PARTICIPANTS:A total of 841 participants (56 employees per workplace) were recruited through stratified sampling based on sex and work type. PRIMARY OUTCOME MEASURES:The prevalence of self-reported cancer risk factors, including smoking, alcohol consumption, physical inactivity, obesity, unhealthy diet, betel quid chewing, exposure to harmful gases or substances, biological screening and vaccination. RESULTS:The study included 841 participants (mean age 40.5±8.9 years; 61.4% male, 57.4% blue-collar workers, 47.3% aged <40 years), with 36.4% reporting family cancer history. The reported cancer risks included smoking (36.9%, male-female OR=40.4 (95% CI 21.6 to 75.7)), alcohol consumption (63.6%, male-female OR=4.3 (95% CI 3.0 to 6.0)), physical inactivity (49.1%), central obesity (36.7%, male-female OR=3.2 (95% CI 2.3 to 4.5)), unhealthy diet (95.8% with two or more of six unhealthy dietary habits), betel quid chewing (18.8%, male-female OR=3.3 (95% CI 1.9 to 5.9), with 97.5% in Xiangtan), preference for hot foods (5.0%, older-younger OR=2.5 (95% CI 1.1 to 5.6)), household air pollution (7.0%, higher risk among lower-educated individuals), unprotected occupational exposure (6.1%, male-female OR=2.8 (95% CI 1.3 to 6.0), blue-white collar OR=2.1 (95% CI 1.0 to 4.5)), no screening for hepatitis B surface antigen (46.4%) and helicobacter pylori (54.9%), and unvaccinated against hepatitis B virus (28.1%) and human papillomavirus (63.5% among females≤45 years). Regional heterogeneity was observed for nearly all risk factors. CONCLUSIONS:The working population faces significant cancer risk factors, with variations across populations and regions highlighting the need for targeted interventions. TRIAL REGISTRATION NUMBER:ChiCTR2200058680.

BackgroundGlobally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)– and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. ObjectiveWe evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). MethodsA parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention’s effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. ResultsOf 524 children (boys: n=288, 54.96%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48%) children and 47 (8.97%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren’s salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were –0.24 g/day (95% CI –0.82 to 0.33), –0.68 mm Hg (95% CI –2.32 to 0.95), and –1.37 mm Hg (95% CI –2.79 to 0.06), respectively. For adults, the intervention group’s salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were –1.06 g/day (95% CI –1.81 to –0.30), –2.26 mm Hg (95% CI –4.26 to –0.26), and –2.33 mm Hg (95% CI –3.84 to –0.82), respectively. ConclusionsThe EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial RegistrationChinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2

Objectives Global efforts to reduce sodium intake are slow, especially where discretionary salt use is the main source. Few structural approaches have been developed and evaluated for effectiveness and scalability. This study assesses an mHealth-based primary school health education program delivered via the school-student-family (SSF) route. Study design Pooled analysis of two trials plus one scaling-up cohort. Methods The evaluated SSF intervention is an mHealth-based school health education programme focused on salt reduction, featuring weekly cartoon-style lessons via parents' smartphones, abundant core/extended online/offline activities, and automated performance evaluation for schools, students and families. Guided by a framework for assessing health innovation scalability, data from two 1:1 cluster-randomized controlled trials (AppSalt and EduSaltS-Trial) collected at baseline, 12 months and 24 months (one-year post-intervention) were pooled to evaluate its effectiveness and sustained effects in reducing salt intake and blood pressure (BP). Linear mixed models were used to assess differences in salt intake (24-h urinary sodium) and systolic/diastolic blood pressure (SBP/DBP) between groups. Data from EduSaltS, a scaling-up initiative implemented across 308 schools with 72,498 children and parents, assessed its reach and acceptability. A random sample of 770 children and 721 adults from EduSaltS was assessed for pre-post improvements in knowledge, attitudes, and practices (KAP). Results The pooled trials (74 schools, 1114 students, 1708 parents) showed a 0.3 g/day (95 % CI: 0.0 to 0.7; 5 %) and 1.0 g/day (95 % CI: 0.6 to 1.3; 10 %) reduction in salt intake, with SBP/DBP decreases of 0.9/1.2 mmHg and 2.0/1.2 mmHg in children and adults, respectively. Sustainability analyses indicated halved salt intake reductions and maintained BP decreases in adults. EduSaltS improved salt-related KAP by 25.4 % in children and 14.3 % in adults, with high feasibility (100 % school participation, 98 % family registration, 84 % cloud-lesson completion). Conclusions The mHealth SSF strategy effectively reduces salt intake and BP, offering a scalable model for structurally implementing salt reduction initiatives, especially in regions with high discretionary salt use. Trial registration AppSalt: Chinese Clinical Trial Registry ChiCTR1800017553; EduSaltS: ChiCTR2000039767; EduSaltS-Trial: ChiCTR2400079893.

Background: Global cancer burden is growing rapidly, and the risk of cancer significantly increases in aged 40 and above, primarily the working population. This study aims to assess the status quo of cancer risk factors among the working population to develop targeted intervention strategies for workplace cancer prevention. Methods: We utilized the baseline data of a randomized controlled trial “Comprehensive Workplace Intervention for Cancer Prevention in China (WECAN)” to conduct the cross-sectional analysis. 937 employees from three cities in China were surveyed on demographics, lifestyle, exposures, disease history, cancer family history, women's reproductive history, and anthropometrics. Findings: The mean age was 40.4±8.9 years and 61.1% were males. 57.2% were blue-collars (from production workshops), while 42.8% were white-collars (from offices). The proportions of participants with junior high school or below, high school, junior college, and bachelor's degree or higher were 13.1%, 20.9%, 31.0%, and 35.0%, respectively. Overall smoking rate is 37.7%, with significantly higher rates among aged 40 and above (42.8% versus 32.1%, p<0.0001), males (59.2% versus 3.9%, p<0.0001), blue-collars (45.9% versus 26.7%, p<0.0001). Smoking rates notably increased as educational levels decreased (p<0.0001). Overall alcohol consumption rate was 62.9%, with an average alcohol intake of 12.7±20.4 g/day. Males reported a higher rate (74.7% versus 44.2%, p<0.0001) and alcohol intake (15.9±22.1 g/day versus 4.4±11.6 g/day, p<0.0001). Employees aged 40 or older consumed more alcohol (15.2±22.9 g/day versus 10.1±17.0 g/day, p=0.0020). As educational levels rose, drinking rate significantly increased (p<0.0001), while alcohol intake substantially reduced (p=0.0012). The proportion of employees who achieved 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity per week was 51.9% and the average amount was 1740.2±2390.1 Mets·min. Overweight (BMI=24∼27.9 kg/m2) and obesity (BMI≥28 kg/m2) rates were 36.0% and 23.9%, with males significantly higher (40.1% versus 29.4%, 28.6% versus 16.5%, p<0.0001). Obesity increased with lower education (p=0.0007). Central obesity affected 56.0%, particularly males (66.8% versus 39.0%, p<0.0001), blue-collars (61.8% versus 48.4%, p<0.0001), aged 40 or older (61.7% versus 49.8%, p=0.0002), and lower education (p<0.0001). Daily average dietary intakes were: whole grains 48.0±80.2 g, tubers 37.8±47.3 g, vegetables 284.2±209.3 g, fruits 127.0±126.2 g, red meat 129.2±99.0 g, and processed meat 7.5±15.9 g. Males (98.4±104.2 g versus 172.0±143.6 g, p<0.0001), blue-collars (114.3±112.5 g versus 144.0±140.7 g, p=0.0005) consumed less fruits. Males (140.9±106.2 g vs 110.6±83.5 g, p<0.0001) and aged under 40 (141.2±113.7 g versus 118.2±82.2 g, p=0.0005) ate more red meat. Hepatitis B virus and helicobacter pylori virus infection rates were 3.7% and 9.8%, while the reported hepatitis B vaccination rate was 70.2%. 38.0% of the population had an exposure history to occupational hazards. Women with breastfeeding history averaged 11.0±5.5 months of cumulative breastfeeding. The cervical cancer vaccination rate is 26.7%. Interpretation: The situation regarding cancer risk factors among working populations is severe, with high smoking and drinking rate, lack of physical activity, overweight/obesity, unhealthy diet and low vaccination rates for cervical cancer and hepatitis B. Significant disparities across demographic groups were found. These findings highlight areas for cancer prevention through targeted approaches in the workplace.

An mHealth-based school health education platform (EduSaltS) was promoted in real-world China to reduce salt intake among children and their families. This progress evaluation explores its implementation process and influencing factors using mixed methods. The mixed-methods process evaluation employed the RE-AIM framework. Quantitative data were collected from a management website monitoring 54,435 third-grade students across two cities. Questionnaire surveys (n = 27,542) assessed pre- and post-education effectiveness. Mixed-effects models were used to control cluster effects. Qualitative interviews (23 individuals and 8 focus groups) identified program performance, facilitators, and barriers. Findings were triangulated using the RE-AIM framework. The program achieved 100

Objective: A previous 12-month randomised controlled trial (RCT) demonstrated the effectiveness of an application-based education program, conducted through schoolchildren, in reducing the salt intake and systolic blood pressure of their adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months. Design and method: As a follow-up survey of a cluster RCT with 54 schools randomly assigned to either the intervention or control group, all participants who completed the baseline survey were contacted again at 24 months, following a 12-month non-intervention period after the RCT. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12-month follow-up, measured by the mean two consecutive 24-hour urinary sodium excretions. The secondary outcome was the difference in blood pressure change. Results: At 24 months, 542 children and 974 adults were followed up, accounting for 91.6% and 82.3% of the participants, respectively. The mean salt intake in adults at baseline, 12 months and 24 months was 10.0 g/day (standard deviation 3.5), 8.9 g/day (standard deviation 3.2) and 9.4 g/day (standard deviation 3.5) in the intervention group and 10.0 g/day (standard deviation 3.6), 9.8 g/day (standard deviation 3.9) and 9.8 g/day (standard deviation 3.9) in the control group. The mean difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors is -0.38 g/day at 24 months versus baseline (95% confidence interval -0.81 to 0.05, P=0.086), and 0.45 g/day at 24 months versus 12 months (95% confidence interval 0.01 to 0.85, P=0.046). The mean difference in systolic blood pressure change after adjusting for confounding factors is -2.19 mm Hg (95% confidence interval -3.63 to -0.76, P=0.003) at 24 months versus baseline and -0.40 mm Hg (95% confidence interval -1.86 to 1.07, P=0.596) at 24 months versus 12 months. Conclusions: The effect of the education program on adults’ salt intake faded, but the systolic blood pressure lowering effect remained 12 months after the RCT. Continuous salt reduction education is recommended to maintain the effect.

BackgroundHigh-salt diet is an important risk factor for several non-communicable diseases. School-based health education has been found effective in reducing salt intake among children and their families in China. However, no such interventions have been scaled up in the real world. For this purpose, a study was launched to support the development and scale-up of an mHealth-based system (EduSaltS) that integrated routine health education and salt reduction and was delivered through primary schools. This study aims to elaborate the framework, development process, features, and preliminary scaling-up of the EduSaltS system.MethodsThe EduSaltS system evolved from previously successfully tested interventions to reduce family salt intake by empowering schoolchildren through school health education. EduSaltS was designed by following the WHO’s conceptual framework for developing a scaling-up strategy which accounted for the nature of the innovation, the capacity of the implementing organizations, the characteristics of the environment, the resources available, and type of scaling up. The system was then developed step by step from determination of online platform architecture, definition of component interventions and activities, development of specific educational materials and tools, to the development of the online/offline hybridized system. The system was tested and refined by a pilot in two schools and a preliminary scale-up in two cities in China.ResultsEduSaltS was developed as an innovative health education system, including an online WeChat-based education platform, a set of offline activities, and an actual administrative website showing the progress and setting the system. The WeChat platform could be installed on users’ smartphones to automatically deliver 20 sessions of five-minute well-structured cartoon video classes, followed by other online interactive activities. It also helps support project implementation and real-time performance evaluation. As a first-stage roll-out, a one-year course has been successfully implemented among 54,538 children and their families from 209 schools in two cities, and the average course completion rate was 89.1%.ConclusionAs an innovative mHealth-based health education system, EduSaltS was developed based on successfully tested interventions and an appropriate framework for scaling up. The early-stage roll-out has shown its preliminary scalability, and further evaluation is ongoing.

INTRODUCTION:Cancer is the second leading cause of death across the globe with the majority of deaths occurring in low-income and middle-income countries. Evidence has shown that the cancer burden can be substantially reduced by avoiding behavioural risk factors through comprehensive intervention strategies, including workplace health promotion, which has shown to be cost-effective in developed countries while rarely conducted in developing countries. This study aims to explore a feasible and sustainable approach to the prevention and control of cancer in China by developing an evidence-based comprehensive workplace health model equipped with a smartphone application for implementation.METHODS AND ANALYSIS:This study is designed as a stepped-wedge, cluster-randomised controlled trial. We will recruit 15 workplaces from three cities in China. A total of 750 employees will be randomly selected for evaluation that includes five rounds of survey conducted every 6 months. After the second evaluation, workplaces will be randomly allocated to start the intervention sequentially every 6 months in three steps with five workplaces per step. A mobile application 'Healthy Workplace' will be developed to support the intervention. On-line and off-line health-related activities will be carried out among employees. Employers will provide supportive policies, environment and benefits to facilitate the adoption of healthy behaviours. The primary outcome is the change of Healthy Lifestyle Index Score, which consists of five components including smoking, alcohol drinking, physical activity, diet and body mass index.ETHICS AND DISSEMINATION:The study has been approved by Queen Mary University of London Ethics of Research Committee (QMERC22.257) and Chinese Centre for Disease Control and Prevention Institutional Review Board (202210). Written informed consent is required from all participants. Results will be disseminated through presentations, publications and social media.TRIAL REGISTRATION NUMBER:ChiCTR2200058680.

The use of low-sodium salt substitute (LSSS) has the potential to reduce sodium and increase potassium intake. LSSS has been available in the Chinese market for years. However, its real-world use and impact on sodium/potassium intake is unclear. Baseline data of 4000 adult individuals who participated in three similarly designed randomized controlled trials were pooled together for this analysis. Self-reported awareness and use of LSSS were collected using a standardized questionnaire, and the participants’ 24-h urinary sodium and potassium excretion was used to estimate their dietary intake. Mixed-effects models were developed to assess the relationship between LSSS and 24-h urinary sodium and potassium excretion. 32.0% of the participants reported awareness of LSSS and 11.7% reported its current use. After adjusting for location, sex, age, and education, compared with the group of participants unaware of LSSS, participants who were aware of but not using LSSS and those who were using LSSS had a lower 24-h urinary sodium excretion by −356.1 (95% CI: −503.9, −205.9) mg/d and −490.6 (95% CI: −679.2, −293.7) mg/d, respectively (p < 0.001). No significant difference was found for 24-h urinary potassium excretion or sodium-to-potassium ratio among the three groups (p > 0.05). In conclusion, the findings of low usage of LSSS and the reduced urinary sodium excretion associated with the awareness and use of LSSS provide further support for the prometon of LSSS as a key salt reduction strategy in China.

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.

Background: The app-based salt reduction intervention program in school children and their families (AppSalt) is a multicomponent mobile health (mHealth) intervention program, which involves multiple stakeholders, including students, parents, teachers, school heads, and local health and education authorities. The complexity of the AppSalt program highlights the need for process evaluation to investigate how the implementation will be achieved at different sites. Objective: This paper presents a process evaluation protocol of the AppSalt program, which aims to monitor the implementation of the program, explain its causal mechanisms, and provide evidence for scaling up the program nationwide. Methods: A mixed methods approach will be used to collect data relating to five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data, including app use logs, activity logs, and routine monitoring data, will be collected alongside the intervention process to evaluate the quantity and quality of intervention activities. The quantitative data will be summarized as medians, means, and proportions as appropriate. Qualitative data will be collected through semistructured interviews of purposely selected intervention participants and key stakeholders from local health and education authorities. The thematic analysis technique will be used for analyzing the qualitative data with the support of NVivo 12. The qualitative data will be triangulated with the quantitative data during the interpretation phase to explain the 5 process evaluation dimensions. Results: The intervention activities of the AppSalt program were initiated at 27 primary schools in three cities since October 2018. We have completed the 1-year intervention of this program. The quantitative data for this study, including app use log, activity logs, and the routine monitoring data, were collected and organized during the intervention process. After completing the intervention, we conducted semistructured interviews with 32 students, 32 parents, 9 teachers, 9 school heads, and 8 stakeholders from local health and education departments. Data analysis is currently underway. Conclusions: Using mHealth technology for salt reduction among primary school students is an innovation in China. The findings of this study will help researchers understand the implementation of the AppSalt program and similar mHealth interventions in real-world settings. Furthermore, this process evaluation will be informative for other researchers and policy makers interested in replicating the AppSalt program and designing their salt reduction intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/19430

National Herbal Drink (NHD) is a functional food approved by the State Administration for Market Regulation for immune enhancement. In this study, the effects of NHD on Cyclophosphamide (CTX)-induced immune regulation and gut microbiota dysregulation in mice were investigated to elucidate whether the attenuation of immunosuppression was related to the regulation of the gut microbiota by NHD. Our study showed that CTX induced immune organ damage in immunosuppressed mice, with reduced levels of serum immunoglobulins IgG, IgM, and complement C3 and disruption of bone marrow hematopoiesis, accompanied by changes in liver toxicity and shortened colonic length. However, all these changes were reversed to varying degrees by NHD intervention. Delayed-type hypersensitivity (DTH) and serum hemolysins in mice also indicated that NHD could effectively regulate cellular and humoral immunity in the body. In addition, it is noteworthy that NHD can also improve intestinal pathology, elevate the expression of intestinal tight junction proteins Occludin and Claudin-1 to restore intestinal barrier function. Furthermore, α-diversity and β-diversity analysis showed that NHD has a positive regulatory effect on the gut microbiota. At the phylum level, NHD could regulate the abundance of three major phyla, namely, Bacteroidetes, Firmicutes, and Actinobacteriota. At the species level, the abundance of the beneficial genus uncultured_bacterium_g__norank_f__ Muribaculaceae increased and the abundance of the harmful genus unclassified_f__Lachnospiraceae decreased after the NHD intervention. These results provide evidence that NHD modulates the immune response in cyclophosphamide-induced immunocompromised mice by restoring intestinal barrier function and regulating gut microbiota disorders.

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. Trial registration Chinese Clinical Trial Registry ChiCTR1800017553.

Objective To understand salt-related knowledge, attitudes and behaviors（KABs） among residents in China. Methods A multi-stage random sampling method was used to recruit 5453 adults.After informed consent, the participants answered salt-related questionnaires.A series of chi-square tests were carried out to compare population groups across salt-related KABs. Results A total of 5408 valid questionnaires were collected, of which 2637（48.8%） were from males and 2771（51.2%） were from females.The awareness rates of maximum recommended salt intake for adults, the nutrition label of salt, and low sodium salt were 22.3%,43.1%,and 30.6%,respectively.Among the participants, 76.2% of them agreed that high salt intake would cause hypertension, 28.3% believed that low salt intake wouldn′t make people weakened, and 81.9% were willing to choose low salt diet.Among the participants, 10.4%,39.8%,8.2%,79.4%,and 17.2% reported using low-sodium salt at home, eating pickled foods more than once a week, eating salty snacks more than once a week, eating out or ordering delivery, and asking for less-salted meals when eating out.The differences in knowledge awareness and attitude agreement rates by age, education, and urban and rural areas were statistically significant（all P＜0.001）. Multivariate logistic regression analysis showed that the use of low-sodium salt of women were higher than men, with an OR value of 1.345（95%CI:1.115-1.623）. Compared with urban residents, rural residents had a lower use of low-sodium salt, with an OR of 0.651（95%CI:0.532-0.796）. Referring primary school or less educated group, the OR of junior school education was 4.332（95%CI:3.082-6.089） and 13.349（95%CI:9.505-18.747） in senior high school or above education. Conclusion We found that the awareness rate of knowledge and the holding rate of behavior were low, while the recognition rate of attitude was high in China.There is a long way to reduce salt intake 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 < 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 < 0.0001) per 1 mg/d in potassium and to 0.36 (95% CI: 0.26 to 0.45, p < 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.

Dendrobium officinale (DOF) is a traditional Chinese edible and officinal plant. Ultrafine DOF powder (DOFP) can regulate lipids and histopathology in the liver, but the underlying mechanisms of hepatic fatty acid (FA) metabolism, which is generally correlated with the development of nonalcoholic fatty liver disease (NAFLD), remain unclear. The purpose of the present study was to investigate whether DOFP treatment alters hepatic FA metabolism in NAFLD mice by using multidimensional mass spectrometry-based shotgun lipidomics (MDMS-SL) and analyse the underlying mechanisms. A 3-week DOFP treatment prevented lipid deposition and improved hepatic histopathology in NAFLD mice after withdrawal from the high-sucrose, high-fat (HSHF) diet, and it decreased triglyceride and FA content in the liver. Furthermore, the C16 : 0/C14 : 0 and C18 : 1/18 : 0 ratios in FAs were significantly decreased in the DOFP treatment group, and the C20 : 4/C20 : 3 and C22 : 4/C22 : 3 ratios were increased, and saturated FA was inhibited. Additionally, DOFP treatment significantly increased the content of two FA β-oxidation-related proteins (carnitine palmitoyltransferase 1-α and acyl-coenzyme A oxidase 1). It also decreased the content of a FA synthesis-related protein (fatty acid synthase), a FA desaturation-related protein (stearoyl-coenzyme A desaturase-1), and a FA uptake-related protein (fatty acid transport protein 2). Moreover, DOFP treatment improved dysregulated levels of major phospholipids in the livers of model mice. The results of this study confirm that DOFP treatment in NAFLD mice has liver recovery effects by regulating FA metabolism.