Abstract
Excess sodium consumption and insufficient potassium intake contribute to high blood pressure and thus increase the risk of heart disease and stroke. In low-sodium salt, a portion of the sodium in salt (the amount varies, typically ranging from 10 to 50%) is replaced with minerals such as potassium chloride. Low-sodium salt may be an effective, scalable, and sustainable approach to reduce sodium and therefore reduce blood pressure and cardiovascular disease at the population level. Low-sodium salt programs have not been widely scaled up, although they have the potential to both reduce dietary sodium intake and increase dietary potassium intake. This article proposes a framework for a successful scale-up of low-sodium salt use in the home through four core strategies: availability, awareness and promotion, affordability, and advocacy. This framework identifies challenges and potential solutions within the core strategies to begin to understand the pathway to successful program implementation and evaluation of low-sodium salt use.
Highlights
Cardiovascular disease (CVD) is the leading cause of death globally, accounting for over 17 million deaths per year, of which 82% are in low- and middle-income countries (LMICs) [1]
This impact is likely not due to sodium reduction alone; a recent trial found a reduction in blood pressure despite urinary excretion data showing an increase in potassium intake but no change in sodium intake [19]
Individuals who are most vulnerable to hyperkalemia are those with advanced chronic kidney disease (CKD); other vulnerable individuals are those who are on medications that impair potassium excretion
Summary
Cardiovascular disease (CVD) is the leading cause of death globally, accounting for over 17 million deaths per year, of which 82% are in low- and middle-income countries (LMICs) [1]. Randomized trials [16,17,18,19] have shown that low-sodium salt is effective in reducing both systolic and diastolic blood pressure, and modeling as well as a large-scale trial have documented reductions in cardiovascular disease and mortality [20,21]. This impact is likely not due to sodium reduction alone; a recent trial found a reduction in blood pressure despite urinary excretion data showing an increase in potassium intake but no change in sodium intake [19]. Policies that promote the use of low-sodium salt may be a more effective, scalable, and sustainable approach to reduce sodium from discretionary salt and can be used to reduce sodium in packaged foods or food prepared outside the home such as in restaurants and canteens [30]
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