Estimated Benefits and Risks of Using a Reduced-Sodium, Potassium-Enriched Salt Substitute in India: A Modeling Study

Marklund, Matti and Tullu, Fikru and Raj Thout, Sudhir and et al, . (2022) Estimated Benefits and Risks of Using a Reduced-Sodium, Potassium-Enriched Salt Substitute in India: A Modeling Study. Hypertension, 79 (10). pp. 2188-2198. ISSN 0194-911X

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Abstract

Background: Salt substitution (ie, replacement of table and cooking salt with potassium-enriched salt substitutes) is a promising strategy to reduce blood pressure and prevent cardiovascular disease, particularly in countries like India where there is high sodium intake, mainly from discretionary salt, and low potassium intake. Life-threatening hyperkalemia from increased potassium intake is a postulated concern for individuals with chronic kidney disease. methods: We used comparative risk assessment models to estimate the number of (1) cardiovascular deaths averted due to blood pressure reductions; (2) potential hyperkalemia-related deaths from increased potassium intake in individuals with advanced chronic kidney disease; and (3) net averted deaths from nationwide salt substitution in India. We evaluated a conservative scenario, based on a large, long-term pragmatic trial in rural China; and an optimistic scenario informed by our recent trial in India. Sensitivity analyses were conducted to assess the robustness of the findings. Results: In the conservative scenario, a nationwide salt substitution intervention was estimated to result in approximate to 214 000 (95% uncertainty interval, 92 764-353 054) averted deaths from blood pressure reduction in the total population and approximate to 52 000 (22 961-80 211) in 28 million individuals with advanced chronic kidney disease, while approximate to 22 000 (15 221-31 840) hyperkalemia-deaths might be caused by the intervention. The corresponding estimates for the optimistic scenario were approximate to 351 000 (130 470-546 255), approximate to 66 000 (24 925-105 851), and approximate to 9000 (4251-14 599). Net benefits were consistent across sensitivity analyses. Conclusions: Modeling nationwide salt substitution in India consistently estimated substantial net benefits, preventing around 8% to 14% of annual cardiovascular deaths. Even allowing for potential hyperkalemia risks there were net benefits estimated for individuals with chronic kidney disease.

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IITH Creators:

IITH Creators	ORCiD

Item Type:

Article

Additional Information:

Funding for this work was provided by The World Health Organization. M. Marklund, B. Neal, and J.H.Y. Wu are researchers within a National Health and Medical Research Council Centre for Research Excellence in reducing salt intake using food policy interventions (APP1117300). M. Marklund, T. Brady, and L.J. Appel report research funding from Resolve to Save Lives, a global non-profit public health organization. Resolve to Save Lives is funded by grants from Bloomberg Philanthropies, the Bill and Melinda Gates Foundation and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation. J.H.Y. Wu was supported by a University of New South Wales Scientia Fellowship.

Uncontrolled Keywords:

AWARENESS,MORTALITY,SAFETY

Subjects:

Arts > Liberal arts

Divisions:

Department of Liberal Arts

Depositing User:

. LibTrainee 2021

Date Deposited:

23 Sep 2022 06:57

Last Modified:

23 Sep 2022 06:57