Xinyi Zhang, Xuejun Yin, Mei Ling Yap, Qiang Li, Liping Huang, Yishu Liu, Bo Zhou, Zhifang Li, Yi Zhao, Jixin Sun, Yan Yu, Lijing L Yan, Yangfeng Wu, Bruce Neal, Maoyi Tian
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SSaSS was an open-label, cluster randomised controlled trial done in 600 Chinese villages among 20,996 participants. Villages were assigned at random in a 1:1 ratio to receive sodium-reduced potassium-enriched salt substitutes or continue regular salt use. Fatal and hospitalised cancer events were identified through direct face-to-face follow-up and record linkage, with adjudication of fatal, but not non-fatal events.</p><p><strong>Results: </strong>During a mean follow-up of 4.7 years, there were 1040 cancer events (507 fatal, 533 non-fatal) recorded. There were 212 stomach cancers, 725 other cancers, and 103 cancers with an unknown primary site. There was a trend toward but not a significant effect of randomised treatment on total stomach cancer (rate ratio (RR) 0.77, 95% confidence interval (CI) 0.54 to 1.08). The RR for adjudicated fatal stomach cancer was 0.66 (95% CI 0.44 to 1.00) compared to 0.88 (95% CI 0.56 to 1.37) for unadjudicated non-fatal stomach cancer. There was no detectable effect on total cancer at any site (RR 0.94, 95% CI 0.81 to 1.08), adjudicated fatal cancer at any site (RR 0.85, 95% CI 0.69 to 1.05), or unadjudicated non-fatal cancer at any site (RR 1.04, 95% CI 0.88 to 1.23).</p><p><strong>Conclusions: </strong>There was no effect of sodium-reduced potassium-enriched salt substitutes on stomach cancer or other cancer types detected. 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引用次数: 0
摘要
背景：膳食钠摄入量增加与胃癌风险之间存在关联。用钠减少的富钾盐替代品降低饮食中的钠摄入量可能会降低这种风险。评价减钠富钾盐替代品对胃癌和其他类型癌症风险的影响。方法：盐替代品和卒中研究（SSaSS）的初步分析确定了钠还原富钾盐替代品与常规盐相比对卒中风险的影响。这项事后调查探讨了对胃癌和其他癌症的影响。SSaSS是一项开放标签、集群随机对照试验，在600个中国村庄进行，共有20,996名参与者。村庄按1:1的比例随机分配，接受减钠富钾盐替代品或继续常规食盐使用。通过直接面对面的随访和记录联系，确定了致命和住院的癌症事件，但不是非致命事件。结果：在平均4.7年的随访中，记录了1040例癌症事件（507例死亡，533例非致命）。212例胃癌，725例其他癌症，103例原发部位未知。随机化治疗对全胃癌的影响有趋势，但不显著（比率比0.77,95%可信区间0.54 ~ 1.08）。判定致死性胃癌的RR为0.66 (95% CI 0.44 ~ 1.00)，而判定非致死性胃癌的RR为0.88 （95% CI 0.56 ~ 1.37）。对任何部位的总癌症（RR 0.94, 95% CI 0.81至1.08）、任何部位的确诊致死性癌症（RR 0.85, 95% CI 0.69至1.05）或任何部位的未确诊非致死性癌症（RR 1.04, 95% CI 0.88至1.23）均无可检测到的影响。结论：钠还原富钾盐替代品对胃癌及其他癌症类型无明显影响。预防致死性和非致死性胃癌的趋势与观察流行病学一致，值得进一步调查。试验注册：该试验在ClinicalTrials.gov注册为NCT02092090。
Effect of sodium-reduced potassium-enriched salt substitutes on stomach cancer: the Salt Substitute and Stroke Study (SSaSS).
Background: There is an association between increased dietary sodium intake and the risk of stomach cancer. Lowering dietary sodium intake with sodium-reduced potassium-enriched salt substitutes may reduce this risk. To evaluate the effects of sodium-reduced potassium-enriched salt substitutes on the risk of stomach cancer and other types of cancer.
Methods: The primary analyses of the Salt Substitute and Stroke Study (SSaSS) defined the effects of sodium-reduced potassium-enriched salt substitutes compared to regular salt on the risk of stroke. This post-hoc investigation explored effects on stomach and other cancers. SSaSS was an open-label, cluster randomised controlled trial done in 600 Chinese villages among 20,996 participants. Villages were assigned at random in a 1:1 ratio to receive sodium-reduced potassium-enriched salt substitutes or continue regular salt use. Fatal and hospitalised cancer events were identified through direct face-to-face follow-up and record linkage, with adjudication of fatal, but not non-fatal events.
Results: During a mean follow-up of 4.7 years, there were 1040 cancer events (507 fatal, 533 non-fatal) recorded. There were 212 stomach cancers, 725 other cancers, and 103 cancers with an unknown primary site. There was a trend toward but not a significant effect of randomised treatment on total stomach cancer (rate ratio (RR) 0.77, 95% confidence interval (CI) 0.54 to 1.08). The RR for adjudicated fatal stomach cancer was 0.66 (95% CI 0.44 to 1.00) compared to 0.88 (95% CI 0.56 to 1.37) for unadjudicated non-fatal stomach cancer. There was no detectable effect on total cancer at any site (RR 0.94, 95% CI 0.81 to 1.08), adjudicated fatal cancer at any site (RR 0.85, 95% CI 0.69 to 1.05), or unadjudicated non-fatal cancer at any site (RR 1.04, 95% CI 0.88 to 1.23).
Conclusions: There was no effect of sodium-reduced potassium-enriched salt substitutes on stomach cancer or other cancer types detected. Trends toward protection against fatal and non-fatal stomach cancer align with the observational epidemiology and warrant further investigation.
Trial registration: This trial was registered in ClinicalTrials.gov as NCT02092090.
期刊介绍：
BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.
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