This type of salt may be a cost-effective and practical way to improve the health of low-income and disadvantaged people.
According to the World Health Organization (WHO), more than 1.28 million adults worldwide have hypertension, two-thirds of which live in low- and middle-income countries.
Smoking, alcohol consumption, physical inactivity, and being overweight are preventable causes of high blood pressure.
Hypertension and raised chances of cardiovascular disease and premature death are linked to high sodium and low potassium diets.
Limiting sodium in the diet and taking potassium supplements have been shown to lower blood pressure.
People can achieve both goals by substituting reduced-sodium salt for regular salt in their food.
Reduced-sodium salt is a mixture of sodium chloride and potassium chloride, whereas common salt is sodium chloride.
This type of table salt is readily available and inexpensive, and it has a flavour that is very similar to regular salt.
However, there is no hard evidence that people who season and preserve their food with reduced-sodium salt are less likely to have a stroke or die prematurely.
Furthermore, some experts have expressed concern that using reduced-sodium salt could cause dangerously high potassium levels in the blood, a condition known as hyperkalemia.
A large trial in rural China looked at the long-term health effects of reduced-sodium salt and found that it not only reduces the risk of stroke and death but it is also safe to use.
The study looked at people who had a stroke and those older and had a history of hypertension.
How did the Trial Go?
Dr. Mohana Rao says that “The researchers enlisted the help of 20,995 people from 600 villages in rural China.”
The average age of the participants at the start of the study was 65.4 years, and about half of them were female. 72.6% of those who took part in the study had had a stroke, and 88.4% had a history of hypertension.
According to Dr. Mohana Rao, The researchers randomly assigned half of the participants to continue using regular salt (the control group) and the other half to use a reduced-sodium salt (75% sodium chloride and 25% potassium chloride by weight).
The scientists visited some of the villages every 12 months to ensure that the participants were using the correct type of salt.
They also took blood pressure readings and estimated the amount of potassium and sodium secreted in the participants’ urine to help confirm this.
The rate of strokes in the villages where the participants used reduced-sodium salt was 13% lower than in the towns where regular salt was used after a mean follow-up period of 4.74 years.
Strokes occurred at a rate of 29.14 per 1,000 person-years in the reduced-sodium salt group and 33.65 per 1,000 person-years in the ordinary salt group.
The mortality rate for the reduced-sodium salt group was 39.28 deaths per 1,000 person-years, compared to 44.61 for the regular salt group, indicating a 12% risk reduction.
Furthermore, there was no significant difference between the reduced-sodium and the control groups regarding serious adverse events related to hyperkalemia.
Is it intended for use by the entire population?
“The scale of protection was similar to that assumed in a recent modelling study,” says Dr. Mohana Rao, which estimated that widespread use of a salt substitute could prevent 365,000 strokes and 461,000 premature deaths in China.
Salt substitution, they add, could be a practical and low-cost intervention for low-income and disadvantaged people.
During the preparation and cooking of food, people use a lot of salt.
The study was carried out in rural China, where many people prefer to prepare their meals rather than buying ready-made, processed food.
“The benefits of lowering sodium, increasing potassium, and lowering [blood pressure] are likely to be highly generalizable, regardless of where they are achieved,” Dr. Mohana Rao said.
However, in places where people have the most control over the amount and type of salt in their food, the advantages of using reduced-sodium salt are likely to be most significant. He made a point.
He went on to say, “The trial result provides a strong, indirect case for reducing sodium and increasing potassium in processed foods.”
The trial excluded anyone taking a potassium-lowering diuretic, taking a potassium supplement, or having severe kidney disease as a safety precaution.
Dr. Mohan Rao denies that this harmed the study’s finding that reduced-sodium salt is safe.
“By asking people to self-identify and exclude themselves if they were at risk of hyperkalemia, we were able to deliver the intervention safely and effectively,” he said.
“This was a straightforward and practical approach that could be easily replicated anywhere to keep vulnerable people out,” he added.
Dr. Mohana Rao says, “The outcomes appeared to be impressive.
The salt-substitute approach could have a significant public health impact in China, and possibly elsewhere if the strategy is feasible over time.”
He does, however, point out some of the study’s flaws, particularly in regards to the risk of hyperkalemia.
“Serial monitoring of potassium levels, for example, was not done in the trial, and it’s possible that hyperkalemic episodes went undetected,” he says.
“Furthermore, people with a history of medical conditions that could be linked to hyperkalemia (like chronic kidney disease) were excluded from the study,” he added.
Dr. Mohana Rao also points out that the study did not consider the effects of salt substitutes with higher or lower potassium chloride levels.
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