Salt Substitute Research Articles

Consumers’ Willingness to Pay for Gamy Salt in Jabodetabek

Seaweed, being an abundant resource, has the potential to be processed into raw material for salt. This potential is supported by the high demand for salt consumption and the serious problem of hypertension in Indonesia. Consuming salt made from seaweed can be an alternative with low sodium content, which can help manage hypertension. Currently, the salt made from seaweed that is available to be purchased is Gamy salt. However, Gamy salt is more expensive than other low-sodium salts. This research aims to estimate the amount of consumers’ willingness to pay for Gamy salt and identify factors that influence their willingness to pay. The analytical methods used in this research include descriptive analysis, Contingent Valuation Method, and logistic regression. The research involved 103 respondents aged 30 years and above, residing in Jabodetabek, and having a history or risk of hypertension. The results indicate that the average willingness to pay for Gamy salt is Rp17,873.79 per 100 grams. Factors that significantly influence consumers to pay an extra price for Gamy salt are income, knowledge regarding seaweed salt, and health awareness.

Cost-Effectiveness of Salt Substitution and Antihypertensive Drug Treatment in Chinese Prehypertensive Adults.

Recent guidelines recommend antihypertensive drug treatment for prehypertensive individuals with blood pressure between 130/80 and 139/89 mm Hg. This study evaluates the cost-effectiveness of 3 interventions in Chinese prehypertensive adults: salt substitution, antihypertensive drug treatment, and their combination. We developed a Markov cohort model to estimate cardiovascular disease (CVD) events, costs, and quality-adjusted life years (QALYs) over a lifetime. Data from the China Kadoorie Biobank informed the simulation. Costs and utilities were drawn from published sources. We evaluated the cost-effectiveness of salt substitution alone, antihypertensive drug treatment alone, and a combination of the 2, focusing on the overall prehypertensive population, those at high CVD risk, and different starting ages (40, 50, 60, and 70 years). Incremental cost-effectiveness ratios (ICERs) were calculated per QALY gained. Salt substitution at age 40 years is the only cost-effective strategy for prehypertensive individuals, with an ICER of $6413.62/QALY. For those at high CVD risk, the combination intervention starting at age 40 years is most cost-effective, with an ICER of $2913.30/QALY. Interventions initiated at younger ages yielded greater CVD reductions and lower ICERs. For example, a combined intervention at age 40 years reduces CVD events by 5.3% with an ICER of $2913.30/QALY, compared with 4.9% and $32 635.33/QALY at age 70 years. These results were consistent across sensitivity analyses. In China, replacing usual salt with a salt substitute is more cost-effective than treating prehypertensive individuals over the age of 40 years with antihypertensive drugs. Furthermore, starting intervention at a younger age in prehypertensive adults can result in even greater cost savings.

Health Claims, Product Features and Instructions for Use on the Labels of Potassium-enriched Salt Products: A Content Analysis

BackgroundPotassium-enriched salt is a proven dietary intervention for reducing risk of stroke, cardiovascular disease, and premature mortality when used instead of regular table salt. Potassium-enriched salt products are available globally, but the on-pack health claims, product features, and instructions for use are diverse. ObjectivesThe objective of this study was to summarize the label features of potassium-enriched salt products available worldwide. MethodsA content analysis was conducted on the labels of potassium-enriched salt products available for sale in May 2023. Potassium-enriched salt products were identified through a systematic search of literature, major online shopping websites, and Google using similar keywords such as “salt substitute” or “low sodium salt.” Information on product labels was coded relating to health claims, product features, and instructions for use, and it was quantitatively summarized. ResultsA total of 117 potential potassium-enriched salt products were identified, with 83 included in the final analysis after excluding products containing no sodium (n = 15), no potassium (n = 5), or that were duplicates (n = 14). There were 23 (28%) products with on-pack claims for health benefits and 36 (43%) with health warnings. Twenty-five (30%) of product labels included descriptions of other product features such as taste and potassium content, and 36 (43%) had instructions for use. ConclusionsThere was large variability in the label features of potassium-enriched salt products identified in this study. Most product labels made no health-related statements, but among those that did, warnings occurred more frequently than statements of health benefits. The diversity in labeling may cause confusion among consumers, and standardized, evidence-based labeling should be developed.

Effect of salt substitution on fracture—a secondary analysis of the Salt Substitute and Stroke Study (SSaSS)

BackgroundAssociations of dietary sodium and potassium intake with fracture risk are inconsistent and the effects of salt substitute on fracture incidence are unknown. We assessed the effect of salt substitute compared to regular salt intake on fracture incidence using data from the Salt Substitute and Stroke Study (SSaSS).MethodsSSaSS was a cluster-randomized controlled trial conducted in 600 villages in northern China. Villages were randomly allocated into intervention and control groups in a 1:1 ratio. Salt substitute was provided to intervention villages and control villages continued regular salt use for 5 years. The primary outcome for this secondary analysis was the incidence of all fractures. Secondary outcomes included incidence of vertebral fracture, non-vertebral fracture, and fracture of unknown or non-specific location.Results20,995 participants were included in this study, and 821 fractures occurred during follow-up. Intention-to-treat analyses showed no differences between the salt substitute and regular salt groups in the incidence of all fractures (rate ratio (RR) 0.96; 95% CI 0.81 to 1.14), vertebral fracture (RR 0.82; 95% CI 0.53 to 1.26), non-vertebral fracture (RR 1.05; 95% CI 0.86 to 1.29), or fracture of unknown or non-specific location (RR 0.80; 95% CI 0.54 to 1.18).ConclusionsUse of salt substitute compared to regular salt had no detectable effect on the incidence of fracture in a population at high risk of cardiovascular disease and fracture.Trial registrationClinicalTrials.gov, NCT02092090. Registered on March 12, 2014.

Abstract P366: Co-Created Intervention Promotes Uptake of Low Sodium Iodized Salt Substitute to Control Hypertension: Results from a Large Community-based Quasi-Experimental Study from India

Introduction: India has a high burden of uncontrolled hypertension (28%) with low control rates (<10%). Mean dietary sodium intake (4000mg/d) is also high, which warrants implementation of population-level sodium reduction interventions, such as using low-sodium iodized salt (LSIS). Given the low awareness about LSIS, we co-created and evaluated an intervention to promote its usage. Objective: To estimate change from baseline to end line in proportion of households reporting LSIS use post implementation of a co-created (involving multiple stakeholders) intervention to provide education (education only arm) on LSIS and education along with subsidy to purchase LSIS (education+subsidy arm). Methods: The study was implemented (8 months intervention) in rural and urban sites of north and south India. In the education only arm, trained health workers provided education on LSIS to community members using pamphlets, a short video and encouraged retailers to sell LSIS to consumers by displaying point of sale posters. In the education+subsidy arm, apart from aforementioned activities, subsidy of $ 0.24/kg (~50% of the price) to purchase LSIS was provided to the distributors, who passed this on to retailers and consumers. Results: A total of 1,602 households and 3,108 participants were interviewed. The mean(SD) age of the participants was 46.9(14.2) years. Fifty two percent were females. At baseline, proportion of households reporting ever use of LSIS was 1.3% (95%CI: 0.9–2.1) and 2.3% (1.8–2.7) respectively, in the education and education+subsidy arms. At end line, this proportion increased to 22.6% (21.1–24.1) and 49.3% (47.5-51.2%) respectively. The odds of LSIS ever use was 2.6 (1.2-5.7) times higher in the education+subsidy arm compared to education only arm. The odds of reporting LSIS use was higher if the household had ≥ one patient with hypertension (1.7[1.3-2.3]), with graduate education (1.6[1.3-2.0]) or belonged to richest quintile (1.6[1.3-2.0]). There was no significant change in mean systolic and diastolic blood pressure, urinary sodium, and potassium between the two arms from baseline to end line. Conclusion: We demonstrated the possibility of increasing LSIS usage through a co-created intervention providing either education only or education+subsidy to buy LSIS with a substantially higher response for the latter. This underscores the need to make LSIS accessible, available, and affordable for regular use to reduce dietary sodium intake and control hypertension.

Formulation of novel low-sodium salts using potassium salts and dietary polysaccharide

Potassium citrate (KC) and potassium lactate (KL) are considered as salt replacers due to their saltiness, processing advantages, and health benefits. However, the obvious bitter taste associated with these compounds has limited their use in salt substitutes. Despite this challenge, little attention has been paid to improving their sensory properties. This study provided evidence that dietary polysaccharide carrageenan can effectively mask the bitterness of KC and KL by specifically binding K+ and forming double helix chains. A highly accurate prediction model was then established for the saltiness and bitterness of low-sodium salts using mixture design principles. Three low-sodium salt formulas containing different potassium salts (KC, KL, KCl), NaCl, and carrageenan were created based on the prediction model. These formulas exhibited favorable saltiness potencies (>0.85) without any noticeable odor, preserving the sensory characteristics of high-sodium food products like seasoning powder while significantly reducing their sodium content. This research provides a promising approach for the food industry to formulate alternative low-sodium products with substantially reduced sodium content, potentially contributing to decreased salt intake.

Effect of salt substitute and antihypertensive medications among high cardiovascular risk patients: A sub-study of Salt Substitute and Stroke Study (SSaSS).

The relationship between the differential protective effect of salt substitute between hypertensive and normotensive individuals and the use of cardiovascular medications remains unclear. This study involved 4211 individuals with a history of stroke or hypertension who participated in the Salt Substitute and Stroke Study (SSaSS) from 120 villages in Shanxi Province. The aim of this study was to investigate the differences in major adverse cardiovascular events and blood pressure changes between the salt substitute and the regular salt group in the subgroups of participants taking different antihypertensive medications. Mixed models were employed and adjusted for the cluster effect (village) and potential confounding variables. During the average follow-up period of 4.66 years, a significantly protective effect of salt substitute on reducing the risk of cardiovascular events was observed in the participants who taking antihypertensive medications (rate ratio: 0.81, 95% CI: 0.68 to 0.95. p=0.011), whereas no significant effect in participants not taking antihypertensive medications (rate ratio: 0.91, 95% CI: 0.62 to 1.32, p=0.612). Significant effects to lower systolic blood pressure of the salt substitutes were observed in the participants who took different antihypertensive medications. This study emphasized that the use of salt substitutes might enhance the efficacy of anti-hypertensive medications in lowering blood pressure and reducing the risk of adverse cardiovascular events.

Exploring the taste presentation and receptor perception mechanism of salty peptides from Stropharia rugosoannulata based on molecular dynamics and thermodynamics simulation

The taste presentation and receptor perception mechanism of the salty peptide of Stropharia rugosoannulata were predicted and verified using peptide omics and molecular interaction techniques. The combination of aspartic acid (D) and glutamic acid (E), or peptide fragments composed of arginine (R), constitute the characteristic taste structural basis of salty peptides of S. rugosoannulata. The taste intensity of the salty peptide positively correlates with its concentration within a specific concentration range (0.25–1.0 mg/mL). The receptor more easily recognizes the first amino acid residue at the N-terminal of salty peptides and the aspartic acid residue in the peptides. GLU513, ASP707, and VAL508 are the critical amino acid residues for the receptor to recognize salty peptides. TRPV1 is specifically the receptor for recognizing salty peptides. Hydrogen bonds and electrostatic interactions are the main driving forces for the interactions between salty peptides and TRPV1 receptors. KSWDDFFTR has the most potent binding capacity with the receptor and has tremendous potential for application in sodium salt substitution. This study confirmed the taste receptor that specifically recognizes salty peptides, analyzed the receptor-peptide binding interaction, and provided a new idea for understanding the taste receptor perception of salty peptides.

The Guidelines for use and promotion of low sodium salt in China.

Both excessive intake of sodium and inadequate intake of potassium are associated with blood pressure elevation and subsequent increase in the risk of cardiovascular disease, which accounts for the largest number of deaths in China and worldwide. Low sodium salt, a mixture of mainly sodium chloride and potassium chloride, has shown its great potential as a promising population strategy for sodium intake reduction through multiple large-scale, multicenter, randomized controlled trials among populations including patients with cardiovascular disease, individuals with and without hypertension, older and younger adults, and men and women in China and other countries. This Guidelines aims to provide expert recommendations for promotion and use of low sodium salt in China, based on the current available scientific evidence regarding the effectiveness, safety, cost-effectiveness, and acceptability of low sodium salts in various population groups and different application scenarios. The suggestions to key stakeholders are also made. A working group, an expert review committee and an advisory committee were established to be responsible for formulating the guidelines' scope and key questions to be addressed, for searching, synthesizing, and evaluating research evidence, proposing and reviewing the recommendations. The consensus on the final recommendations was reached using the GRADE grid method. The working group summarized current available evidence of salt substitution regarding its effectiveness, safety, cost-effectiveness, acceptability, availability, suitability, etc. The Guidelines provided six recommendations advising different populations how to use low sodium salt, four recommendations on the application of low sodium salts in different scenarios, and five suggestions for key stakeholders to promote salt substitution. The first evidence-based guidelines on promotion and use of low sodium salts covers all key questions in relevance and would play a critical role in prevention and control of hypertension and cardiovascular disease in China and worldwide.

The Relationship between Low-Sodium Salt Intake and Both Blood Pressure Level and Hypertension in Chinese Residents.

Compared to common salt, low-sodium salt can reduce blood pressure to varying degrees. However, the exact dosage relationship remains unclear. We aimed to investigate the dose-response relationships between low-sodium salt intake and systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as the risk of hypertension, and to determine the optimal range for low-sodium salt intake. We investigated the basic characteristics and dietary profile of 350 individuals who consumed low-sodium salt. The samples were divided into three groups according to the 33.3rd and 66.6th percentiles of low-sodium salt intake in condiments (Q1: <4.72 g/d, Q2: ≥4.72 g/d, and <6.88 g/d, and Q3: ≥6.88 g/d). The restricted cubic spline results indicated that low-sodium salt intake decreased linearly with SBP and DBP, while low-sodium intake demonstrated a non-linear, L-shaped relationship with the risk of hypertension, with a safe range of 5.81 g to 7.66 g. The multiple linear regression analysis revealed that compared with group Q1, the DBP in group Q2 decreased by 2.843 mmHg (95%CI: -5.552, -0.133), and the SBP in group Q3 decreased by 4.997 mmHg (95%CI: -9.136, -0.858). Exploratory subgroup analyses indicated that low-sodium salt intake had a significant impact on reducing SBP in males, DBP in females, SBP in rural populations, and DBP in urban populations. The intake of low-sodium salt adheres to the principle of moderation, with 5.81-7.66 g potentially serving as a pivotal threshold.

Cost-effectiveness analysis of low-sodium potassium-rich salt substitutes in Indonesia: an equity modelling study

Evidence suggests low-sodium potassium-rich salt substitutes (LSSS) are effective in reducing blood pressure (BP). However, the health and economic impacts of LSSS in Indonesia are currently unknown. We developed a proportional multistate lifetable Markov model to assess a government-led strategy implementing the use of LSSS compared to current regular salt consumption. BP data were derived from the Indonesian Basic Health Research Survey (RISKESDAS 2018), while epidemiological data were from the Global Burden of Disease 2019 study. We estimated implementation costs and the impact of changes in BP on disease events and healthcare costs, and incremental cost-effectiveness ratios. Outcomes were simulated over different time horizons for the 2019 Indonesian population overall, and by income quintiles. Probabilistic sensitivity analysis was done to capture uncertainty. Over the first 10 years, LSSS could prevent 1.5 million non-fatal cardiovascular disease (CVD) events (8.3%-19.4% reduction) and 643,000 incident chronic kidney disease (CKD) cases (8.2% reduction), while averting over 200,000 CVD and CKD deaths (0.2%-5.2% reduction). This translated to over 24.6 million health-adjusted life years (HALYs) gained over the lifetime of the population, and reduced CVD-related health inequalities (concentration index,-0.075, 95% CI:-0.088 to-0.062). Implementation cost (US$ 1.2 billion [IDR 17.2 trillion] total; US$ 4.5 [IDR 63,665] per capita, as of July 2019) was outweighed by the net health expenditure savings (∼US$ 2 billion [IDR 27.7 trillion] total; US$ 7.3 [IDR 103,300] per capita) in the first 10 years. LSSS were cost-saving over the lifetime, and very cost-effective even with a high LSSS price. Scaling the use of LSSS nationally could be a cost-saving strategy to prevent substantial cardiovascular and kidney disease burden in Indonesia. Griffith University Postdoctoral Fellowship.

Quality and Flavor Difference in Dry-Cured Meat Treated with Low-Sodium Salts: An Emphasis on Magnesium.

The present study aimed to develop low-sodium curing agents for dry-cured meat products. Four low-sodium formulations (SPMA, SPM, SP, and SM) were used for dry-curing meat. The physicochemical properties and flavor of the dry-cured meat were investigated. The presence of Mg2+ ions hindered the penetration of Na+ into the meat. The weight loss, moisture content, and pH of all low-sodium salt groups were lower than those of S. Mg2+ addition increased the water activity (Aw) of SPMA, SPM, and SM. Dry-curing meat with low-sodium salts promoted the production of volatile flavor compounds, with Mg2+ playing a more prominent role. Furthermore, low-sodium salts also promoted protein degradation and increased the content of free amino acids in dry-cured meat, especially in SM. Principal component analysis (PCA) showed that the low-sodium salts containing Mg2+ were conducive to improving the quality of dry-cured meat products. Therefore, low-sodium salts enriched with Mg2+ become a desirable low-sodium curing agent for achieving salt reduction in dry-cured meat products.

Effect of Salt Substitution on Ambulatory Blood Pressure, Kidney Function and Inflammation in Middle-Aged and Elderly Hypertensive Patients.

Low-sodium (LS) salt substitution is recognized for its potential to reduce blood pressure (BP), but most research relies on office BP measurement (OBPM). There is a lack of data on salt substitution's effect on target organs, such as the kidney as measured by the urine albumin-to-creatinine ratio (UACR), and its impact on inflammatory cytokines, particularly high-sensitivity C-reactive protein (hs-CRP). To evaluate the effect of LS salt substitution on ambulatory BP measurement (ABPM), kidney function, and inflammation in middle-aged and elderly hypertensive patients. In this 12-month prospective, multi-center, randomized, double-blind study, 352 hypertensive patients were randomly assigned to the normal salt (NS) group (n = 176) or the LS group (n = 176) at a 1:1 ratio. ABPM, fasting blood, and morning first spot urine samples were obtained at baseline and the endpoint. Of the 352 patients, 322 completed all follow-up surveys, and 301 underwent ABPM. In the LS roup, significant reductions were observed in 24-hr systolic BP (-2.3 mmHg), 24-hr diastolic BP (-1.5 mmHg), daytime systolic BP (-2.6 mmHg), daytime diastolic BP (-1 mmHg), and nighttime systolic BP (-0.1 mmHg) compared to the NS group (all p 0.05). However, the change in nighttime diastolic BP was not statistically significant (-0.3 vs. 1.1 mmHg, p = 0.063). Additionally, the LS group showed a more substantial decrease in UACR (-2.05 vs. -7.40 µg/mg, p = 0.004) and hs-CRP (-0.06 vs. -0.24 mg/L, p = 0.048) compared to NS. LS salt substitution significantly decreased ABPM, suggesting a notable impact on hypertension. Furthermore, it demonstrated a protective impact on kidney function, as evidenced by changes in UACR. Additionally, LS salt substitution appeared to reduce inflammation, indicated by the decrease in hs-CRP levels. The study was registered in the Chinese clinical trial registry (registration number: ChiCTR1800019727).

Summary of a Cochrane review: Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women

Summary of a Cochrane review: Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women

Long-Term Effect of Salt Substitution for Cardiovascular Outcomes : A Systematic Review and Meta-analysis.

Salt substitution is a simple yet increasingly promising strategy to improve cardiovascular outcomes. To evaluate the long-term effects of salt substitution on cardiovascular outcomes. PubMed, EMBASE, Cochrane CENTRAL, and CINAHL searched from inception to 23 August 2023. Trial registries, citation analysis, and hand-search were also done. Randomized controlled trials (RCTs) comparing provision of or advice to use a salt substitute with no intervention or use of regular salt among adults for 6 months or longer in total study duration. Two authors independently screened articles, extracted data, and assessed risk of bias. Primary outcomes include mortality, major cardiovascular events (MACE), and adverse events at 6 months or greater. Secondary and post hoc outcomes include blood pressure, cause-specific mortality, and urinary excretion at 6 months or greater. Random-effects meta-analyses were done and certainty of effect estimates were assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Of the 16 included RCTs, 8 reported on primary outcomes. Most (n = 7 of 8) were done in China or Taiwan, 3 were done in residential facilities, and 7 included populations of older age (average 62 years) and/or with higher-than-average cardiovascular risk. In this population, salt substitute may reduce risk for all-cause mortality (6 RCTs; 27 710 participants; rate ratio [RR], 0.88 [95% CI, 0.82 to 0.93]; low certainty) and cardiovascular mortality (4 RCTs; 25 050 participants; RR, 0.83 [CI, 0.73 to 0.95]; low certainty). Salt substitute may result in a slight reduction in MACE (3 RCTs; 23 215 participants; RR, 0.85 [CI, 0.71 to 1.00]; very low certainty), with very low-certainty evidence of serious adverse events (6 RCTs; 27 995 participants; risk ratio, 1.04 [CI, 0.87 to 1.25]). The evidence base is dominated by a single, large RCT. Most RCTs were from China or Taiwan and involved participants with higher-than-average cardiovascular risk; therefore, generalizability to other populations is very limited. Salt substitution may reduce all-cause or cardiovascular mortality, but the evidence for reducing cardiovascular events and for not increasing serious adverse events is uncertain, particularly for a Western population. The certainty of evidence is higher among populations at higher cardiovascular risk and/or following a Chinese diet. National Health and Medical Research Council. (PROSPERO: CRD42022327566).

Web Exclusive. Annals Video Summary - Long-Term Effect of Salt Substitution for Cardiovascular Outcomes: A Systematic Review and Meta-analysis.

Web Exclusive. Annals Video Summary - Long-Term Effect of Salt Substitution for Cardiovascular Outcomes: A Systematic Review and Meta-analysis.

Application effects of NaCl substitute on the fermentation profile of Pixian douban (broad bean paste).

The effects of a reduced-salt substitute (composed of NaCl, sodium gluconate, KCl, L-histidine, and L-lysine) applied in the fermentation of traditional Pixian douban (PXDB) were explored in this study according to sensory quality, physicochemical characteristics, color, colony count, and the contents of free amino acids (FAAs), organic acids, and volatile flavor compounds. The results showed that the PXDB with a 15% salt substitution had the most attractive reddish-brown color, a mellow fragrance, and the lowest total colony count of the three pastes. The fermentation quality of the 15% salt substitute PXDB was superior to that of the control groups, its sensory quality was more readily accepted, and the contents of its amino acid nitrogen, FAAs and organic acids had increased by 0.1050, 0.3290, and 3.9068mg/g, respectively. Moreover, the concentrations of the main aroma compounds in the PXDB containing the salt substitute were higher than those of the control. These included phenylethanol, 3-methylthiopropanol, isoamyl alcohol, furfural, benzaldehyde, phenylacetaldehyde, nonanal, isoamyl aldehyde, 4-ethylphenol, and, particularly, 2,6-dimethylpyrazine, which had increased as much as 100 times. Correlation analysis showed that Glu, Phe, Tyr, Gly, Leu, Val, Asp, Ile, citric acids, and succinic acids were all positively correlated with the main aroma and contributed to the generation of PXDB's characteristic flavor, and main aroma substances in turn positively influence PXDB flavor sensory attributes. Overall, these results showed the application of the 15% salt substitute during PXDB fermentation improved the quality of the paste and, thus, would benefit the development of reduced-salt PXDB.

Secondary Analysis of the Salt Substitute and Stroke Study (SSaSS): Effects of Potassium-Enriched Salt on Cardiac Outcomes.

The SSaSS (Salt Substitute and Stroke Study) has shown that use of a potassium-enriched salt lowers the risk of stroke, total cardiovascular events, and premature death. The effects on cause-specific cardiac outcomes are reported here. SSaSS was an unblinded, cluster-randomised trial assessing the effects of potassium-enriched salt compared with regular salt among 20 995 Chinese adults with established stroke and older age and uncontrolled hypertension. Post hoc efficacy analyses were performed using an intention-to-treat method and a hierarchical Poisson regression model adjusting for clustering to obtain rate ratios and 95% CIs. We assessed acute coronary syndrome, heart failure, arrhythmia, and sudden death. Over a mean 4.74 years follow-up, there were 695 acute coronary syndrome events, 454 heart failure events, 230 arrhythmia events, and 1133 sudden deaths recorded. The rates of events were lower in potassium-enriched salt group for all outcomes but CIs were wide for most: acute coronary syndrome (6.32 versus 7.65 events per 1000 person-years; rate ratio, 0.80 [95% CI, 0.65-0.99]); heart failure (9.14 versus 11.32 events per 1000 person-years; rate ratio, 0.88 [95% CI, 0.60-1.28]); arrhythmia (4.43 versus 6.20 events per 1000 person-years; rate ratio, 0.59 [95% CI, 0.35-0.98]); and sudden death (11.01 versus 11.76 events per 1000 person-years; rate ratio, 0.94 [95% CI, 0.82-1.07]; all P>0.05 with adjustment for multiple comparisons). These results suggest that use of potassium-enriched salt is more likely to prevent than cause cardiac disease but the post hoc nature of these analyses precludes definitive conclusions. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02092090.

Characterization of the Effects of Low-Sodium Salt Substitution on Sensory Quality, Protein Oxidation, and Hydrolysis of Air-Dried Chicken Meat and Its Molecular Mechanisms Based on Tandem Mass Tagging-Labeled Quantitative Proteomics.

The effects of low-sodium salt mixture substitution on the sensory quality, protein oxidation, and hydrolysis of air-dried chicken and its molecular mechanisms were investigated based on tandem mass tagging (TMT) quantitative proteomics. The composite salt formulated with 1.6% KCl, 0.8% MgCl2, and 5.6% NaCl was found to improve the freshness and texture quality scores. Low-sodium salt mixture substitution significantly decreased the carbonyl content (1.52 nmol/mg), surface hydrophobicity (102.58 μg), and dimeric tyrosine content (2.69 A.U.), and significantly increased the sulfhydryl content (74.46 nmol/mg) and tryptophan fluorescence intensity, suggesting that protein oxidation was inhibited. Furthermore, low-sodium salt mixture substitution significantly increased the protein hydrolysis index (0.067), and cathepsin B and L activities (102.13 U/g and 349.25 U/g), suggesting that protein hydrolysis was facilitated. The correlation results showed that changes in the degree of protein hydrolysis and protein oxidation were closely related to sensory quality. TMT quantitative proteomics indicated that the degradation of myosin and titin as well as changes in the activities of the enzymes, CNDP2, DPP7, ABHD12B, FADH2A, and AASS, were responsible for the changes in the taste quality. In addition, CNDP2, ALDH1A1, and NMNAT1 are key enzymes that reduce protein oxidation. Overall, KCl and MgCl2 composite salt substitution is an effective method for producing low-sodium air-dried chicken.

The effect of salt substitution on frequency and severity of headache: results from the SSaSS cluster-randomised controlled trial of 20,995 participants

BackgroundHeadache is one of the most common neurological symptoms. Headache disorders are associated with a high global burden of disease. Prior studies indicate that short-to-medium term sodium reduction reduces headache symptom. This study evaluated the effects of long-term reduced-sodium, added-potassium salt on headache frequency and severity in rural China.MethodsThe Salt substitute and stroke study (SSaSS) was an open-label cluster-randomised trial in rural China designed to evaluate the effect of salt substitution on mortality and cardiovascular events. Participants included adults with a history of prior stroke and those aged ≥60 years with uncontrolled high blood pressure (BP). Villages were randomly assigned in a 1:1 ratio either to intervention with salt substitute (75% sodium chloride and 25% potassium chloride by mass) or to control with continued use of regular salt (100% sodium chloride). In this pre-specified analysis, between-group differences in headache frequency and severity were evaluated. The study was registered with ClinicalTrials.gov (identifier number: NCT02092090).ResultsA total of 20,995 participants were included in the trial (mean age 64.3 years, 51% female, mean follow-up 4.7 years). At final follow-up at the end of the study, headache outcome data including frequency and severity of headaches was available for 16,486 (98%) of 16,823 living participants. Overall, 4454/16,486 (27%) individuals reported having headache: 27.4% in the intervention group (2301/8386) vs 26.6% in the control group (2153/8100) (RR 1.04, 95% CI: 0.93, 1.16, p = 0.48). There was no difference in headache severity between intervention and control groups (p = 0.90).ConclusionLong term salt substitution did not reduce the frequency or severity of headaches in this population.