The effectiveness, feasibility, and acceptability of low‐sodium salts worldwide: An environmental scan protocol

Yin, Xuejun; Liu, Hueiming; Trieu, Kathy; Webster, Jacqui; Farrand, Clare; Li, Ka-Chun; Pearson, Sallie Anne; Tian, Maoyi

doi:10.1111/jch.14054

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…This study was a systematic search of low-sodium salts conducted from October 2019 to September 2020. The study protocol has been published previously [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

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

Yin¹,

Liu²,

Webster³

et al. 2021

JMIR Public Health Surveill

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Background Regular 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. Objective The aim of this study is to assess the availability, formulation, labeling, and price of low-sodium salts currently available to consumers worldwide. Methods Low-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. Results A 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. Conclusions Low-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

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“…This study was a systematic search of low-sodium salts conducted from October 2019 to September 2020. The study protocol has been published previously [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

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

Yin¹,

Liu²,

Webster³

et al. 2021

JMIR Public Health Surveill

Self Cite

View full text Add to dashboard Cite

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“…This study is part of a broader environmental scan, consisting of a systematic online search, systematic review, and key informant interviews. The protocol of the environmental scan has been published [ 20 ]. The study received ethics approval from the University of New South Wales Human Research Ethics Advisory Panel (HC190921).…”

Section: Methodsmentioning

confidence: 99%

Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study

et al. 2021

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Widespread use of reduced-sodium salts can potentially lower excessive population-level dietary sodium intake. This study aimed to identify key barriers and facilitators to implementing reduced-sodium salt as a population level intervention. Semi-structured interviews were conducted with key informants from academia, the salt manufacturing industry, and government. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to inform our interview guides and data analysis. Eighteen key informants from nine countries across five World Health Organization regions participated in the study from January 2020 to July 2020. Participants were concerned about the lack of robust evidence on safety for specific populations such as those with renal impairment. Taste and price compared to regular salt and an understanding of the potential health benefits of reduced-sodium salt were identified as critical factors influencing the adoption of reduced-sodium salts. Higher production costs, low profit return, and reduced market demand for reduced-sodium salts were key barriers for industry in implementation. Participants provided recommendations as potential strategies to enhance the uptake. There are presently substantial barriers to the widespread use of reduced-sodium salt but there are also clear opportunities to take actions that would increase uptake.

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Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan (Preprint)

Yin¹,

Liu²,

Webster³

et al. 2021

Preprint

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BACKGROUND Regular salt is about 100% sodium chloride (NaCl). Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride (KCl). Low-sodium salts have a potential role in reducing population sodium intake level and blood pressure, but its availability in global market was unknown. OBJECTIVE The aim of this study was to assess the availability, formulation, labelling, and price of low-sodium salts currently available to consumers around the world. METHODS Low-sodium salts were identified through a systematic literature review, Google search, online shopping sites search, and inquiry of key informants. The keywords of “salt substitute”, “low-sodium salt”, “potassium salt”, “mineral salt”, and “sodium reduced salt” in six official languages of the United Nations were used for search. Information about the brand, formula, labelling, and price was extracted and analysed. RESULTS Eighty-seven low-sodium salts were available in 47 out of 195 countries around the world (24%), including 28 high-income countries, 13 upper-middle-income countries, and six lower-middle-income countries. The proportion of sodium chloride varied from 0% (sodium-free) to 88% (as percent of weight, regular salt is 100% NaCl). Potassium chloride was the most frequent another component with levels ranging from 0% to 100% (potassium chloride salt). Forty-three (49%) had labels advising potential health risk, 33 (38%) labelling the advice of potential health benefits. The median price of low-sodium salts in high-income, upper-middle-income, lower-middle-income countries was USD 15.0/kg (IQR: 6.4 to 22.5), USD 2.7/kg (IQR: 1.7 to 5.5) and USD 2.9/kg (IQR: 0.50 to 22.2) respectively. The price of low-sodium salts was between 1.1 and 14.6 times that of regular salts. CONCLUSIONS Low-sodium salts are not widely available and are commonly more expensive than regular salts. Policies that promote the availability, affordability and labelling of low-sodium salts should enhance appropriate uptake for blood pressure lowering and cardiovascular prevention. CLINICALTRIAL N/A INTERNATIONAL REGISTERED REPORT RR2-10.1111/jch.14054

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The effectiveness, feasibility, and acceptability of low‐sodium salts worldwide: An environmental scan protocol

Cited by 3 publications

References 17 publications

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

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

Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study

Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan (Preprint)

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