Notes for submission: 'Comments on the World Health Organization Draft Guideline
on Reduced Sodium Salt Substitutes'
Umami Information Center
https://www.umamiinfo.com/Vice Managing Director
Professor
Toshihide Nisimura, Ph.D.

COMMENTARY
Commentary on the appropriateness of the methods for the development of theWorld Health Organization Draft Guideline on Reduced Sodium Salt Substitutes
We appreciate that the WHO has conducted a scoping review to summarize theavailable studies assessing the association between low-sodium salt substitutes(LSSS) intake and health outcomes through the review and evaluation of recent
systematic reviews. However, we are concerned that the scoping review covers
literature up to September 2021, which may exclude valuable scientific papers
published afterwards. Notable papers published after 2021 include:

Papers on health outcomes of LSSS:•Yin X et al.

Effects of salt substitutes on clinical outcomes: a systematicreview and meta-analysis. Heart. 2022 Sep 26;108(20):1608-1615.
•Yuan Y, et al.

Salt substitution and salt-supply restriction for lowering

blood pressure in elderly care facilities: a cluster randomised trial. Nature Medicine.
2023 April 14; NCT03290716.

Papers on new perspectives of LSSS:•Umami: An Alternative Japanese Approach to Reducing Sodium While

Enhancing Taste Desirability
Shuhei Nomura, Aya Ishizuka, Shiori Tanaka, Daisuke Yoneoka, Hisayuki Uneyama,Kenji Shibuya. Health 2021: 13: 629-636 DOI: 10.4236/health.2021.136047•Reducing salt intake with umami: A secondary analysis of data in the UK

National Diet and Nutrition Survey. Haruyo Nakamura, Takayuki Kawashima, Lisa
Yamasaki, Kaung Suu Lwin, Akifumi Eguchi, Hitomi Hayabuchi, Yuta Tanoe, Shiori
Tanaka, Daisuke Yoneoka, Cyrus Ghaznavi, Hisayuki Uneyama, Kenji Shibuya,Shuhei Nomura Food Scie Nutri., 2022 12(2):872-882. doi: 10.1002/fsn3.3121.
•Salt intake reduction using umami substance-incorporated food: asecondary analysis of NHANES 2017-2018 data.
Nomura S, Tanaka S, Eguchi A, Kawashima T, Nakamura H, Lwin KS, Yamasaki L,Yoneoka D, Tanoe Y, Adachi M, Hayabuchi H, Koganemaru S, Nishimura T, Sigel B,Uneyama H, Shibuya K.
Public Health Nutr. 2022: 1:1-8. doi: 10.1017/S136898002200249X. Online aheadof print.
PMID: 36453137•Modelling of salt intake reduction by incorporation of umami substances intoJapanese foods: a cross-sectional study
Shiori Tanaka, Daisuke Yoneoka, Aya Ishizuka, Megumi Adachi, Hitomi Hayabuchi,
Toshihide Nishimura, Yukari Takemi, Hisayuki Uneyama, Haruyo Nakamura, KaungSuu Lwin, Kenji Shibuya, Shuhei Nomura. BMC Public Health1 ;23(1):516. doi:
10.1186/s12889-023-15322-6.
Considering these post-2021 scientific papers, we hope that the WHO will review
and consider these analysis results in addition to the commissioned Cochrane review.
In particular, the development of reduced-sodium products without sacrificing taste
is currently being pursued worldwide, with the core technologies being the validityof using KCl as an LSSS and taste compensation techniques when using KCl for salt
reduction. It is necessary for general consumers to properly understand that there
is no impact on cardiovascular toxicity of KCl at regular intake levels. Without thiscorrect understanding, the global salt reduction efforts, which have not progressed
for more than 30 years, may continue to stagnate. We sincerely hope forappropriate judgment and information provision in this LSSS guideline.