Are restaurants complying with reduced salt requests from consumers ordering via meal delivery apps? | BMC Public Health

examine design

The present examine was a part of our total mission through which we examined the effectiveness of modifications in selection construction in rising customers’ uptake of low-salt dishes on ELEME, one of many largest MDA platforms in China ( 20 ). The excellent analysis included three remedies that included a standard instructional well being message of “not more than 5 grams of salt per day” on the high of the order web page, a salt submenu for customers’ particular person dishes to point a selection between “lowered salt” and “common salt,” and modifications to the default setting Both “lowered salt” or “common salt.” Taking part eating places have been assigned to completely different combos of the three remedies to create 5 intervention teams: (1) with a well being message; (2) Salt submenu with default setting of “Common Salt”; (3) Salt submenu with default setting of “Decreased Salt”; (4) a salt submenu with the default setting of “common salt” plus a well being message; and (5) a salt submenu that defaults to “lowered salt” plus a well being message.

Information sources

We collected knowledge from three sources to help the present evaluation. These knowledge sources have been as follows: (1) shopper feedback offered on the MDA for eating places taking part within the MDA for six months previous to the examine intervention; (2) a web based survey with restaurant managers to evaluate their angle and willingness to help salt discount interventions; and (3) laboratory testing of sodium content material in samples of “common salt” and “lowered salt” variations of dishes randomly collected from taking part eating places.

Restaurant recruitment

We used two strategies to recruit eating places on a voluntary foundation. Eating places can be part of the examine by responding to an open invitation despatched by MDA to eating places in seven cities, or by responding to a focused invitation submitted by means of the analysis groups’ present networks. In complete, the two,430 eating places that signed up have been from cities throughout completely different geographic areas in China, together with Beijing, Changsha, Guangzhou, Hangzhou, Xi’an, Shenyang, Taizhou, Chengdu and Taiyuan, in addition to chain eating places with branches throughout China. Tier 1 and Tier 2 cities in China. After signing up, eating places have been inspired and guided on how you can arrange their interface on the MDA based on their assigned intervention group. Topics assigned to the salt submenu intervention teams chosen the person dishes to be included throughout preparation. A complete of 285 eating places, or 11.7% of eating places, accurately accomplished the intervention setting.

To watch and preserve restaurant compliance, we carried out a weekly interface setup test of eating places for every assigned intervention group. We additionally created on-line teams for restaurant house owners and managers to affix by means of focused invites for routine follow-ups. As well as, we developed a sequence of free supplies to help salt discount in eating places, together with Q&As, handouts and self-guided coaching movies, which have been distributed by means of MDA to all taking part eating places.

Client feedback

Of the two,430 eating places that originally signed up, 718 (largely from the cities of Beijing, Taizhou, Shenyang and Chengdu, together with chain eating places) offered operational knowledge to the examine group. From these eating places, we collected shopper feedback made when ordering meals on the MDA between July and December 2020, earlier than the intervention started in 2021. Two researchers independently extracted after which reviewed the feedback, figuring out key phrases or phrases (“much less salt”). . “, “much less sauce”, “not too salty”, and “lighter style”) associated to lowering the quantity of salt in meals orders to research shopper demand for salt discount.

On-line survey with restaurant managers

We distributed a survey questionnaire developed by the analysis group by means of the MDA to restaurant managers after they signed up for the examine. Throughout follow-up, we collected 201 questionnaires from eating places responding to the open invitation, and 220 questionnaires from eating places responding to the focused invitation. Within the questionnaire we included questions masking basic data of the restaurant; Data, attitudes and practices associated to salt discount; and the potential influence of salt discount practices on their enterprise. By way of the survey outcomes, we assessed the willingness of eating places to serve low-salt dishes.

Measurement of sodium content material

The sodium content material in dishes ordered randomly on the MDA was measured by a professional testing firm utilizing the tactic documented within the Nationwide Normal for Meals Security – Willpower of Potassium and Sodium in Meals (GB5009.91-2017) (22). Samples have been injected into the atomic absorption spectrometer after digestion. After flame ablation, the 589.0 nm resonance line was absorbed by sodium. Inside a sure vary of focus, the absorbance worth was proportional to the sodium content material. To carry out the measurement, we developed a sampling plan to gather dishes from 285 eating places with an interface arrange on the MDA (proven in Desk 1). We assumed a typical deviation of 1 g/100 g for the sodium content material of the dishes and anticipated to realize 80% energy (with two-sided alpha = 0.05) and detect a change of 0.5 g/100 g within the common and reduced-salt model of the dish (16). Assuming 5 g of sodium per 100 g of standard salt dish (5 g/100 g) (23), and a correlation coefficient of 0.1 for sodium content material in common and low-salt dishes, the minimal pattern dimension for every stratum (per intervention group) is 60 – This implies a complete pattern dimension of 300 dishes within the common and low-salt variations.

A enough variety of eating places (greater than 60) have been included within the intervention teams for “salt submenu with default setting of ‘common salt’ and ‘with well being message.’ From these two teams, 60 eating places have been randomly chosen to pattern dishes; One dish from every chosen restaurant was randomly sampled to measure sodium content material. As a result of small dimension of the group, all eating places within the different three intervention teams had samples of dishes to measure sodium content material. Every restaurant had one to 4 randomly chosen dishes till the To a sampling ceiling of 60 dishes per group.In all circumstances, completely different variations of the identical dish (common and lowered) have been ordered individually however from the identical restaurant so as to receive related dishes.

Desk 1: Sampling plan for measuring sodium content material

statistical evaluation

The SAS statistical software program package deal model 9.4 was used to research the information. N (%) was used to current categorical variables, and s The worth indicated two-sided possibilities, and s<0.05 was thought of important. The Shapiro-Wilk take a look at was used to check the normality of information distribution, and skewed sodium content material knowledge have been introduced as median (P25, P75). The Wilcoxon signed rank take a look at was used to match knowledge in a matched pairs design. Sodium content material was in contrast between the 2 teams utilizing the Wilcoxon rank sum take a look at, whereas the Kruskal-Wallis take a look at was used to match multigroup knowledge, with the Dwass-Metal-Critchlow-Fligner methodology utilized for additional comparisons.


Eating places have been additionally rated primarily based on the kind of predominant dishes they serve, together with Chinese language delicacies, snacks and extra. The dishes served are categorized into meat dishes, vegetarian dishes and snacks/staples.

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