Tammy M Brady, Kathy Trieu, Laura K Cobb, Mary-Anne Land, Tazeen H Jafar, J Jaime Miranda, Penjani Mkambula, Martijn Noort, Lawrence J Appel
The research priority agenda underscores the substantial opportunity for lower sodium salt substitutes to serve as a transformative, scalable intervention for global cardiovascular disease prevention. Targeted safety/efficacy studies, strategies to ensure consumer receptiveness, cost optimization, and enabling policy frameworks are next steps for widespread implementation.
BACKGROUND: Excess sodium intake is a modifiable cause of elevated blood pressure and cardiovascular disease. Despite the World Health Organization's recommendation to limit sodium intake <2 g/d, average global consumption exceeds twice this amount. Replacing a portion of sodium chloride with potassium chloride in lower sodium salt substitutes lowers blood pressure and cardiovascular disease risk. Further research will support global scale up.
METHODS: We convened 5 international webinars to identify and prioritize research needs to advance global adoption of lower sodium salt substitutes, focusing on 4 domains: safety/efficacy, industry/food technology, implementation, and public policy. Survey data and qualitative feedback were synthesized into a consolidated research agenda.
RESULTS: The top identified research priorities were, safety/efficacy: assessing safety among at-risk individuals, defining clinical significance of modest hyperkalemia, and evaluating long-term effects on cardiovascular disease, kidney function, and age-related blood pressure rise; industry/food technology: testing consumer acceptability, assessing functional performance in processed foods, and determining optimal formulations; implementation: determining how to increase stakeholder engagement, improve labeling and messaging, and identify behavioral-economic approaches to encourage lower sodium salt substitutes adoption without increasing sodium intake; public policy: evaluating the potential cost-effectiveness of subsidies, tariff reductions, procurement mandates, and integration with iodization programs, as well as assessing which implementation contexts are best suited to mandatory versus voluntary approaches.
CONCLUSIONS: The research priority agenda underscores the substantial opportunity for lower sodium salt substitutes to serve as a transformative, scalable intervention for global cardiovascular disease prevention. Targeted safety/efficacy studies, strategies to ensure consumer receptiveness, cost optimization, and enabling policy frameworks are next steps for widespread implementation.