Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan.

Xuejun Yin,Matti Marklund,Laura K Cobb,J Jaime Miranda,Maoyi Tian,Ka Chun Li,Mark D Huffman,Jason H Y Wu,Bruce Neal,Jacqui Webster,Hueiming Liu,Kathy Trieu,Sallie-Anne Pearson

doi:10.2196/27423

Abstract

BackgroundRegular salt is about 100% sodium chloride. Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride. Low-sodium salts have a potential role in reducing the population's sodium intake levels and blood pressure, but their availability in the global market is unknown.ObjectiveThe aim of this study is to assess the availability, formulation, labeling, and price of low-sodium salts currently available to consumers worldwide.MethodsLow-sodium salts were identified through a systematic literature review, Google search, online shopping site searches, and inquiry of key informants. The keywords “salt substitute,” “low-sodium salt,” “potassium salt,” “mineral salt,” and “sodium reduced salt” in six official languages of the United Nations were used for the search. Information about the brand, formula, labeling, and price was extracted and analyzed.ResultsA total of 87 low-sodium salts were available in 47 out of 195 (24%) countries worldwide, including 28 high-income countries, 13 upper-middle-income countries, and 6 lower-middle-income countries. The proportion of sodium chloride varied from 0% (sodium-free) to 88% (as percent of weight; regular salt is 100% sodium chloride). Potassium chloride was the most frequent component with levels ranging from 0% to 100% (potassium chloride salt). A total of 43 (49%) low-sodium salts had labels with the potential health risks, and 33 (38%) had labels with the potential health benefits. The median price of low-sodium salts in high-income, upper-middle-income, and lower-middle-income countries was US $15.00/kg (IQR 6.4-22.5), US $2.70/kg (IQR 1.7-5.5), and US $2.90/kg (IQR 0.50-22.2), respectively. The price of low-sodium salts was between 1.1 and 14.6 times that of regular salts.ConclusionsLow-sodium salts are not widely available and are commonly more expensive than regular salts. Policies that promote the availability, affordability, and labeling of low-sodium salts should increase uptake, helping populations reduce blood pressure and prevent cardiovascular diseases.International Registered Report Identifier (IRRID)RR2-10.1111/jch.14054

Highlights

Cardiovascular diseases (CVDs) are the leading causes of death worldwide, and high blood pressure is a leading risk factor for CVDs [1,2]
From the published research studies, 4440 abstracts were screened, 67 of them were related to low-sodium salts, and 9 brands of low-sodium salts were identified from full-text papers
The findings of this study indicated that low-sodium salts were only available in 24% of the countries worldwide

Summary

Introduction

Cardiovascular diseases (CVDs) are the leading causes of death worldwide, and high blood pressure is a leading risk factor for CVDs [1,2]. Dietary sodium intake is a strong causal determinant of blood pressure levels [3,4]. The World Health Organization (WHO) recommends reducing sodium intake as one of the best-buy strategies for lowering the population-level risk of CVDs and set a goal of 30% reduction in the population [5]. Different strategies are proposed to reduce dietary sodium intake. Innovative strategies are needed to reduce sodium intake from processed foods, food eaten outside the home, and home cooked foods. Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride. Low-sodium salts have a potential role in reducing the population's sodium intake levels and blood pressure, but their availability in the global market is unknown

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Discussion

Conclusion