The Proportion of Dietary Salt Replaced With Potassium-Enriched Salt in the SSaSS: Implications for Scale-Up.

Xuejun Yin, Ellie Paige, Maoyi Tian, Qiang Li, Liping Huang, Jie Yu, Anthony Rodgers, Paul Elliott, Yangfeng Wu, Bruce Neal

Journal: Hypertension (Dallas, Tex. : 1979) 2023;80(5):956-965

PMID: 36628969

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Abstract

BACKGROUND

The SSaSS (Salt Substitute and Stroke Study) recently reported definitive effects of a potassium-enriched salt on cardiovascular outcomes and death. Quantifying the amount of potassium-enriched salt used by trial participants is important for understanding the magnitude of the effect of potassium-enriched salt on risk reduction and how population-wide scale-up might be achieved.

METHODS

Baseline and annual 24-hour urine samples were collected from subgroups of participants in SSaSS throughout the 5-year follow-up. The mean difference in 24-hour potassium excretion between the 2 groups was used to estimate the quantity of potassium-enriched salt consumed in the intervention group. The corresponding projected difference in sodium intake between groups was calculated and compared with the observed difference.

RESULTS

The potassium-enriched salt group, compared to the regular salt group, had a mean increase in 24-hour urinary potassium excretion of 0.80 g/d (95% CI, 0.71-0.90), which equates to consumption of 8.8 g/d (95% CI, 7.8-9.9) of potassium-enriched salt. Based on 8.8 g/d potassium-enriched salt consumption, the projected difference in 24-hour urinary sodium excretion was -0.79 g/d. This compares to an observed difference of -0.35 g/d (95% CI, -0.55 to -0.15) and suggests that 72% of baseline regular salt intake was replaced by potassium-enriched salt.

CONCLUSIONS

The smaller than anticipated between-group difference in sodium excretion likely results from the joint use of regular salt and potassium-enriched salt in the intervention group. Our findings suggest that even an incomplete replacement of regular salt with potassium-enriched salt can deliver significant health gains.

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Address: The George Institute for Global Health, University of New South Wales, Sydney, Australia (X.Y., E.P., M.T., Q.L., L.H., J.Y., A.R., B.N.).; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y.).; The George Institute for Global Health, University of New South Wales, Sydney, Australia (X.Y., E.P., M.T., Q.L., L.H., J.Y., A.R., B.N.).; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia (E.P.).; School of Public Health, Imperial College London, UK (P.E., B.N.).; The George Institute for Global Health, University of New South Wales, Sydney, Australia (X.Y., E.P., M.T., Q.L., L.H., J.Y., A.R., B.N.).; School of Public Health, Harbin Medical University, China (M.T.).; The George Institute for Global Health, University of New South Wales, Sydney, Australia (X.Y., E.P., M.T., Q.L., L.H., J.Y., A.R., B.N.).; The George Institute for Global Health, University of New South Wales, Sydney, Australia (X.Y., E.P., M.T., Q.L., L.H., J.Y., A.R., B.N.).; Department of Cardiology, Peking University Third Hospital, Beijing, China (J.Y.).; School of Public Health, Imperial College London, UK (P.E., B.N.).; Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China (Y.W.).; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China (Y.W.).; The George Institute for Global Health, University of New South Wales, Sydney, Australia (X.Y., E.P., M.T., Q.L., L.H., J.Y., A.R., B.N.).; School of Public Health, Imperial College London, UK (P.E., B.N.).

DOI: 10.1161/HYPERTENSIONAHA.122.20115

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MeSH Terms: Humans, Potassium, Potassium Chloride, Sodium, Sodium Chloride, Sodium Chloride, Dietary, Sodium, Dietary