Awareness, Use and Perceptions of Potassium-Enriched Low-Sodium Salt Substitutes in Canada: A Cross-Sectional Study

BACKGROUND: Excess dietary sodium is a major contributor to cardiovascular disease and stroke, and most Canadians exceed recommended intake levels. Efforts to reduce population sodium intake have had minimal impact in Canada to date. Recently, the World Health Organization conditionally recommended potassium-enriched low-sodium salt substitutes (LSSS) as a strategy to reduce population sodium intake; however, public awareness, perceptions, and use of LSSS are unknown. OBJECTIVE: The objective of this study was to assess Canadians' awareness, perceptions, and use of LSSS, and to examine how these vary by age, gender, and hypertension status in order to generate evidence to inform sodium reduction policy in Canada. DESIGN: This cross-sectional study used data from the Canadian Nutrition and Health Survey (CNHS), administered between November 2024 and February 2025 using a stratified random sample of Canadian adults considering age, gender, province and educational level. PARTICIPANTS/SETTINGS: Participants were eligible if they were aged ≥18 years, were literate in English or French, used a computing device with internet access, and lived in Canada. MAIN OUTCOME MEASURES: The main outcome measures were awareness, use, attitudes toward government LSSS policy, and perceptions of LSSS. STATISTICAL ANALYSES PERFORMED: Quantitative data were stratified by age, gender, and hypertension status. Chi-square tests were used to compare categorical variables, and logistic regression models were used to describe subgroup differences. Open survey responses were thematically analyzed. RESULTS: Participants (n=3,283; mean age 49.9 ± 17.7 [SD] years, 50.8% women) reported low awareness (39.6%) and current use (11.1%) of LSSS, although many had tried LSSS in the past (69.3%). Awareness and current use were significantly higher among those with hypertension compared to those without hypertension (awareness: 48.1% vs. 36.2%, p<0.001; current use: 13.7% vs. 9.8%, p=0.001). Awareness was lowest among adults aged 35-44 years (29.6%), while current use was lowest among adults aged 18-24 years (8.8%). The distribution of overall use of LSSS differed by gender (p<0.001), with a higher proportion of women reporting that they had tried LSSS but did not currently use them (72.4% vs. 66.0%). Overall, 55.4% supported government LSSS policy (24.4% were neutral), with greater support among individuals with hypertension than those without hypertension (59.2% vs. 54.2%, p=0.042). Common barriers to adoption included taste concerns, cost, perceived health risks, and accessibility. CONCLUSIONS: Canadians have low awareness and use of LSSS with differences by age, gender, and hypertension status. Key barriers such as taste and cost limit broader LSSS adoption despite reasonable support for government LSSS policy.