@Article{info:doi/10.2196/27423,
author="Yin, Xuejun
and Liu, Hueiming
and Webster, Jacqui
and Trieu, Kathy
and Huffman, Mark D
and Miranda, J Jaime
and Marklund, Matti
and Wu, Jason H Y
and Cobb, Laura K
and Li, Ka Chun
and Pearson, Sallie-Anne
and Neal, Bruce
and Tian, Maoyi",
title="Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan",
journal="JMIR Public Health Surveill",
year="2021",
month="Jul",
day="14",
volume="7",
number="7",
pages="e27423",
keywords="low-sodium salt; salt substitute; availability; formulation; labeling; price; sodium; salt; blood pressure; cardiology",
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 ",
issn="2369-2960",
doi="10.2196/27423",
url="https://publichealth.jmir.org/2021/7/e27423",
url="https://doi.org/10.2196/27423",
url="http://www.ncbi.nlm.nih.gov/pubmed/33985938"
}