Slashing healthcare costs: Chinese children use apps to convince families to use less salt

10 Feb 2022 --- The Chinese government may be able to prevent 250,000 stroke and heart disease events each year by having children teach families healthy eating with AppSalt for smartphones, a study says.

Lead author Feng He, a professor at Queen Mary University of London, UK, tells NutritionInsight about scale-up study plans for a China-wide rollout with a subdivision of China’s Commission of Health.

“This scale-up study is in collaboration with the George Institute for Global Health China and the Chinese Center for Health Education (CCHE),” she says. The study is set to finish in 2023 and is meant to gain enough information for a successful national launch.

The study has implications for other nations seeking to reduce national salt intake. Apps may be particularly appealing for developing countries in the process of digitizing, where Feng He says the consumer rather than manufacturer adds most dietary salt. 

The reduction of salt intake is the “single most cost-effective” measure to reduce blood pressure. According to the researchers, salt intake in adult family members was reduced by 8% (0.82 g per day), over a 12-month period. This was accompanied by a “significant fall” in systolic blood pressure (1.6 mmHg). 

Kids taught to help parents make healthy choices
The trial was conducted in China’s northern, central and southern regions, where salt intake is high in both adult and child populations. The study population consisted of over 590 children aged eight to nine from 54 schools and over 1,180 adult family members, including parents and grandparents with an average age of 46.

Education on salt reduction and a standard health education curriculum was the basis of the AppSalt system. 

The children’s homework was to regularly remind their parents and grandparents to complete learning tasks with them, using a step-by-step guide in the app. Salt was measured at the start of the 12-month trial, with two 24-hour urine collections. School teachers organized this process by communicating with children and their families via virtual channels or in-person meetings.

He adds that to make the education courses attractive, “the app-based program was designed as a series of interesting mini-lectures, followed by a quiz and fun, practical tasks to put what they have learned into practice.”

“According to the level of salt intake shown on the app, the participants could see whether they have made progress, compared with their previous salt consumption level. The ultimate aim was to achieve and sustain lower salt intake in the long term.”Processed foods like crisps are a rising source of sodium in local diet.  

“Based on the data collected, the app would generate an action plan to help individuals to set salt reduction targets for the top contributors, for example, reducing salt added to cooking by 50%,” says He.

Adults benefitted more than children
Before receiving the education, the baseline salt intake was 5.5 g per day for children, and 10 g per day for adults, double the World Health Organization’s recommended level. 

Salt intake for adults fell significantly. Intake for children, however, was not greatly impacted.

Further measures will be needed to lower intake to acceptable levels. Still, the app contains the potential to foster a generation of children equipped with the information to make healthier choices for themselves and their future families.

Reducing healthcare costs by educating the public
Limiting salt intake is reportedly one of the “most cost-effective public health measures” because it lowers blood pressure, the leading cause of cardiovascular disease. Around 80% of deaths from cardiovascular disease occur in developing nations, say the researchers, with China being the largest developing nation globally.

Salt intake in China is quite high, but approximately 80% of that salt is added by the consumer during cooking. 

In 2019, China saw approximately 2.2 million stroke-related deaths and 1.9 million deaths from heart disease, with this number continuing to rise due to “epidemiological and economic transitions.”

“In recent years, there has also been a rapid increase in the consumption of processed food, restaurant, fast food and takeaways (food delivery is becoming more and more popular), particularly in big cities such as Beijing. Most of those foods are very high in salt,” He explains.

She says some of the major sources of salt in the local diet are “soy sauce, bean paste, pickles, sausages, crisps and salted eggs.” 

So far, “no other country” has run such a successful pilot to lower dietary salt levels in similar settings.Apps can help overwhelmed school systems
He says the program was initially implemented without using apps, but that using apps has facilitated the process. 

“Indeed, this app-based education program actually followed on from a previous study in northern China where we educated primary school children about the dangers of eating too much salt and how to reduce it,” she says.

“The salt reduction education was delivered to children during the schools’ usual health education lessons. Children’s homework was to pass on what they have learned in schools to their families and persuade the people who did the cooking at home to reduce the amount of salt used.”

She says that a 2015 study found the education program led to a 25% reduction in salt intake between children and families in the intervention group after one school term, or three and a half months, while salt intake for the control group rose. 

These results could be further boosted by apps that support learning at home and involve older family members in children’s education.

By Olivia Nelson