Research Priorities to Accelerate Global Uptake of Lower Sodium Salt Substitutes

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.

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.

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.

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.