New research reveals substantial health and economic impact of low-sodium substitutes in Indonesia

18 Jun 2024 --- Switching current table salt to a low-sodium potassium-rich salt substitute (LSSS) in Indonesia would prevent a substantial disease burden in the country, according to a new study. This would result in an additional 24.6 million health-adjusted life years over the population’s lifetime. Excess salt intake and a lack of potassium contribute to high blood pressure in the country.

They estimate that LSSS substitution could prevent up to 1.5 million events of non-fatal cardiovascular diseases (CVD) and 643,000 incident chronic kidney disease (CKD) cases in the first ten years of implementation. It would also avert over 200,000 CVD and CKD deaths and reduce CVD-related health inequalities. 

“LSSS look similar to table salt, and research shows they have a similar taste with some consumers unable to differentiate between the two options,” says co-author Dr. Leopold Aminde from the School of Medicine and Dentistry at Griffith University, Australia.

“The research shows that making LSSS available would positively impact the Indonesian health system by reducing blood pressure and preventing heart attacks, strokes and kidney disease.”

Cost-effectiveness analysis 
The study, published in The Lancet Regional Health Southeast Asia, uses a proportional multistate lifetable Markov model to assess a government-led strategy to replace LSSS instead of regular salt consumption in Indonesia. 

The authors derived blood pressure data from the Indonesian Basic Health Research Survey and the Global Burden of Disease 2019 study. They also estimated implementation costs and the impact of blood pressure changes on disease events, healthcare costs and cost-effectiveness ratios. 

According to the model, an implementation cost of US$1.2 billion would outweigh the net health expenditure savings. “Ultimately, it would reduce health expenditure by up to US$2 billion over ten years, providing a much-needed cost-saving measure,” adds Aminde. 

LSSS substitution could prevent up to 1.5 million events of non-fatal cardiovascular diseases by lowering blood pressure.“The greatest health benefits will likely be seen in the low-income bracket of the population.”

He notes that the World Health Organization (WHO) has recommended reducing sodium consumption population-wide to tackle the country’s high blood pressure and non-communicable diseases. 

The research findings will inform upcoming WHO guidelines on evidence gaps related to implementation costs, cost-effectiveness and the possible impact on health inequalities. 

Reformulation efforts  
As the model finds LSSS cost-saving over a lifetime and even cost-effective at a high price, the research team hopes the findings will prompt the Indonesian government and other countries to reconsider the formulation of regular salt to LSSS alternatives or facilitate supply chains to expand their availability and affordability. 

International guidelines increasingly call for salt reductions. For example, Action on Salt has revealed that 37% of children’s main meals sold in the out-of-home sector in the UK exceed the country’s maximum salt target. Meanwhile, food manufacturers are developing innovations for reduced sodium that do not compromise on taste or texture. 

Dr. Wahyu Nugraheni, co-author and head of the Research Centre for Public Health and Nutrition at the National Research and Innovation Agency in Jakarta, adds: “Indonesians consume more sodium than is physiologically required.”

“LSSS is an excellent option to help people effortlessly reduce the sodium in their diet,” she concludes.  

By Jolanda van Hal