The best of ‘best buys’: public health values of potassium-enriched salt substitute

Figures & data

Table 1. Ten Criteria in order of relevance proposed for assessing the best public health interventions and the evaluations on salt substitution against to these criteria.

Criteria	Evaluation of salt substitution	Reference
Relevance: Extent to which the intervention is relevant to the global major health challenges	Effectively lowers blood pressure and risk of CVD and total deaths, has impact on leading causes of global mortality	[4–10]
Effectiveness*: Extent to which the objectives of the intervention were achieved	Consistent large effect size in lowering blood pressure that is equivalent to that from anti-hypertension medications; Significantly lower major cardiovascular adverse events and all-causes mortality.	[1,2,11]
Efficiency*: Extent to which inputs were used to achieve desired outcomes	Proved not only effective but cost-saving, outperforming other proposed ‘best buys.’	[12–14]
Evidence-based*: The strength and validity of evidence supporting the intervention	Rigorous trials support salt substitution’s effectiveness, attaining the highest credibility.	[1,2,11]
Acceptability: Extent to which the intervention is embraced and accepted by the entire target population.	Salt substitute’s taste preservation and high user retention underscore its acceptability	[1,2,15]
Equity*: Extent to which the intervention reduces inequalities in society;	With little dependency on socio-economic status, great potential to enhance health equity.	[1,2,16–18]
Easy-to-do: Extent of difficulty in producing and implementing the intervention	Implementing salt substitution is straightforward, making it one of the most accessible strategies.	[19,20]
Extent of coverage*: Extent to which the intervention reached the target population.	Unlike medications, salt substitutes applicable to whole population, offering broad public health benefits.	[2,19]
Availability: Extent to which the intervention is available to the target population.	Available in major markets but may compete with increasing fertilizer manufacturing for resources.	[21–26]
Suitability: Extent to which a product fits into the global or local situation	Aligns perfectly with the urgent need to reduce sodium intake and increase potassium intake globally.	[9,10,27–30]

*Criteria adopted from OECD five best practice criteria.

Neal B, Wu Y, Feng X, et al. Effect of salt substitution on cardiovascular events and death. N Engl J Med. 2021;385(12):1067–1077. doi: 10.1056/NEJMoa2105675

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Yuan Y, Jin A, Neal B, et al. Salt substitution and salt-supply restriction for lowering blood pressure in elderly care facilities: a cluster-randomized trial. Nat Med. 2023;29(4):973–981. doi: 10.1038/s41591-023-02286-8

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Yin X, Rodgers A, Perkovic A, et al. Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis. Heart. 2022;108(20):1608–1615. doi: 10.1136/heartjnl-2022-321332

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Maleki A, Soltanian AR, Zeraati F, et al. The flavor and acceptability of six different potassium-enriched (sodium reduced) iodized salts: a single-blind, randomized, crossover design. Clin Hypertens. 2016;22(1):18. doi: 10.1186/s40885-016-0054-9

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Greer RC, Marklund M, Anderson CAM, et al. Potassium-enriched salt substitutes as a means to lower blood pressure: benefits and risks. Hypertension. 2020;75(2):266–274. doi: 10.1161/HYPERTENSIONAHA.119.13241

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Google patents: method for producing a low sodium salt composition. [cited 2024 Feb 20]. Available from: https://patents.google.com/patent/EP2668855B1/en

 Google Scholar

WHO. WHO global report on sodium intake reduction. World Health Organization: Geneva; 2023.

 Google Scholar

Reddin C, Ferguson J, Murphy R, et al. Global mean potassium intake: a systematic review and Bayesian meta-analysis. Eur J Nutr. 2023;62(5):2027–2037. doi: 10.1007/s00394-023-03128-6

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