Developing Sodium Reduction Strategy: Context-Specific Frameworks Targeting Main Dietary Sources

Excessive sodium intake remains a leading global dietary risk. Although global targets exist, progress has been slow, highlighting the need to further align existing strategies with the primary sources of dietary sodium for most of the world's population. This review aims to support this effort by examining global sodium sources, identifying opportunities to complement current policy approaches, and proposing a strategic roadmap for effective intervention. We classify the 30 most populous countries by their dominant sodium source, revealing that ∼80% of the global population resides in "discretionary-sodium-dominant" countries, where the majority of intake comes from salt and condiments added during cooking or at the table. Together with "discretionary-formula balanced" countries, 90% of the world's population lives in countries where discretionary sodium plays a major role. Building on existing global guidance that has largely relied on strategies addressing formula sources, we propose a complementary framework for analyzing and reporting sodium sources (natural, formula, and expanded discretionary) to better inform targeted strategies. We outline essential theoretical principles-such as targeting major sources, ensuring structural implementation, and integrating the sodium-potassium balance-and present a concrete, 3-step roadmap for developing national plans. We further propose 9 specific areas for action, emphasizing the need for structured, multisectoral strategies. These include addressing discretionary sodium through mechanisms such as regulated health education for home and restaurant cooks, mandatory training and incentives for food service providers, and scalable digital health programs. We conclude that effective sodium reduction requires context-specific, evidence-based strategies-prioritizing discretionary use where it predominates, and strengthening processed-food-focused approaches where prepackaged foods are the main and growing source.