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Food and health

Impact of a sodium-reduced bread intervention with and without dietary counseling on sodium intake—a cluster randomized controlled trial among Danish families



Excessive intake of sodium is a dietary risk factor for morbidity and mortality. Currently, intake of sodium is much higher than the recommended level in most western countries, and effective strategies to reduce population sodium intake are lacking. The objective of the present study was to investigate the effect of two different sodium reduction strategies on the intake of sodium, potassium, and the sodium to potassium ratio among Danish families


The study was a 4-month, single-blinded, cluster randomized controlled trial with a parallel design. Eighty-nine healthy Danish families, with a minimum of one child and one parent (n = 309), were randomly assigned to receive sodium-reduced bread (Intervention A), sodium-reduced bread and dietary counseling (Intervention B) or regular sodium bread (Control). The primary outcome was change in daily sodium intake, measured by 24-h urinary sodium excretion. Secondary outcomes included changes in dietary potassium and the sodium to potassium ratio.


No significant differences in daily sodium intake were observed in the two intervention groups compared with the control. When analyzing the results separately for children and adults, a reduction in dietary sodium of 0.6 g/day (−1.0, −0.2), p = 0.005 occurred among adults in intervention B compared with control.


This study demonstrates that providing sodium-reduced bread in combination with dietary counseling is an effective strategy to reduce dietary sodium among adults, but the effect is lacking in children. The study was not able to show significant effects when providing sodium-reduced bread alone in neither adults nor children.

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Fig. 1: Flow diagram of families and participants.

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The authors would like to thank the municipalities of Albertslund, Ballerup, Egedal, Glostrup, and Rødovre for supporting recruitment as well as the nurses, data managers, secretary, and other staff members at the research center for helping to prepare and perform the intervention. A great thanks to Jan H Poulsen, Lantmännen Cerealia, Vejle, Denmark, Peter Nielsen and Jens Nielsen, Smørum Konditori for developing and delivering bread for the intervention and the Danish Veterinary and Food Administration for analyzing the sodium content in the bread. Last but not least, a big thanks to all the families who participated in the study.


Danish Heart Foundation, The Research Fund of the Capital Region of Denmark, the Toyota Foundation, Ministry of Environment and Food of Denmark, Axel Muusfeldt’s Foundation, Doctor Sophus Carl Emil Friis and wife Olga Doris Friis’ Foundation, and the Technical University of Denmark

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Authors and Affiliations



UT, KSB, ADL, ET, NLR, and AKSF designed research; AKSF, NLR, KSB, and AB conducted research; NLR and AHA performed statistical analysis; NLR, KSB, UT, ADA, and ET wrote paper. All authors read and approved the final paper.

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Correspondence to Nanna Louise Riis.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Danish Data Protection Agency and the Scientific Ethical Committee, Capital region, Denmark, and conducted in accordance with the Declaration of Helsinki. All participants ≥18 years and caregivers for participants <18 years gave written informed consent.

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Riis, N.L., Bjoernsbo, K.S., Lassen, A.D. et al. Impact of a sodium-reduced bread intervention with and without dietary counseling on sodium intake—a cluster randomized controlled trial among Danish families. Eur J Clin Nutr 74, 1334–1344 (2020).

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