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

Abstract

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

Cost-Effectiveness of a Household Salt Substitution Intervention: Findings From 20 995 Participants of the Salt Substitute and Stroke Study

“…A range of 1-way sensitivity analyses were performed to test the robustness of base-case results. The variations included (1) using lowest, median, and highest market price for salt substitute in China 31 ; (2) using alternative discount rates of 0% and 8% as recommended by the Chinese Pharmacoeconomic Guidelines 16 ; (3) using lowest and highest unit prices for outpatient medication costs; (4) including only inpatient costs for health care costs; (5) assuming 0, 10%, and 30% of fatal events occurred at home with 0 inpatient health care costs; and (6) assigning inpatient costs for all hospitalizations, not just hospitalizations for cardiovascular causes. For the analyses of QALYs, we also assessed the effects of (7) using the lower and upper bounds of the 95% CI for the baseline HSU and (8) varying the HSU decrements applied by ±20%.…”

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

“…A recent research study showed that a range of modelled reduced-sodium salt strategies had the potential to be cost-effective in lowering blood pressure at a population level in Vietnam [ 18 ]. Despite reduced-sodium salts being effective and cost-effective, as demonstrated in trials and modelling studies, reduced-sodium salts are not widely available on the market and are more expensive than regular salts [ 19 ].…”

Core Strategies to Increase the Uptake and Use of Potassium-Enriched Low-Sodium Salt

“…Low-sodium salt is not widely available on the global market, particularly in LMICs [ 35 ]. A recent study found that low-sodium salt is available in just under a quarter of all countries [ 35 ].…”

“…Low-sodium salt is not widely available on the global market, particularly in LMICs [ 35 ]. A recent study found that low-sodium salt is available in just under a quarter of all countries [ 35 ]. Production and regulatory challenges (e.g., development of national standards on low-sodium salt, consistent definitions of acceptable levels of sodium and potassium, etc.)…”

“…Cost is also a barrier to low-sodium salt use, which is particularly concerning for individuals with a lower income level [ 36 ]. It costs 1.6 to 6.0 times more than regular salt, a reflection of the higher cost of potassium compared to sodium [ 35 ]. Regular salt, an essential commodity, is sold at subsidized rates in some countries, which further increases the cost difference between the two products [ 38 ].…”