Abstract
BACKGROUND/OBJECTIVES: Potassium-enriched lower-sodium salt substitutes (LSSS) offer consumers a practical way to increase potassium intake and decrease sodium intake, thereby reducing their risk of high blood pressure and cardiovascular disease. This risk reduction, however, depends on whether consumers can access affordable, evidence-based LSSS products. This study investigated the availability, formulation and price of LSSS in China. METHODS: A cross-sectional salt survey was conducted across 195 supermarkets in 15 cities from 2023 to 2025 in China. RESULTS: LSSS availability varied substantially by supermarket size: 90.9% of large (33), 88.9% of middle-sized (45), and only 53.0% of small supermarkets (117) stocked LSSS. Of 1861 total salt products surveyed, 310 were LSSS and 1551 were regular salt. A critical evidence-practice gap exists in product formulation: the mean potassium chloride (KCl) content among unique LSSS products was only 16.6%, with 53.4% of LSSS containing <15% KCl. LSSS products are also consistently more expensive than regular salt. The median LSSS price (11.7 yuan/kg) was significantly higher than regular salt (9.8 yuan/kg, p < 0.001). Price disparities were most pronounced at lower price points. Within-brand and within-supermarket comparisons revealed that the lowest-priced LSSS cost 2.0-fold and 2.2-fold more than the lowest-priced regular salt, respectively. Multiple regression analysis identified that LSSS price was significantly associated with KCl content, salt source, supermarket size and geographic region. CONCLUSIONS: Consumer access to affordable, effective LSSS products can be increased by expanding LSSS availability in small supermarkets, incentivizing higher-KCl formulations, and reducing price barriers to consumer adoption, which could substantially contribute to salt reduction at the population level.