Effect of sodium-reduced potassium-enriched salt substitutes on stomach cancer: the Salt Substitute and Stroke Study (SSaSS)

Sep 23, 2026

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Increased dietary sodium intake is associated with higher stomach cancer risk, and reducing sodium through sodium-reduced potassium-enriched salt substitutes may lower this risk. The study evaluated effects of these salt substitutes on stomach cancer and other cancer types. Post-hoc analyses from the Salt Substitute and Stroke Study (SSaSS) used an open-label, cluster randomised controlled design in 600 Chinese villages with 20,996 participants. Outcomes included fatal and hospitalised cancer events via follow-up and record linkage.

LanguageEnglish

CategoryHealthcare

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Abstract

Background

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Results

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Zhang et al. BMC Medicine (2025) 23:236 [https://doi.org/10.1186/s12916-025-04068-0](https://doi.org/10.1186/s12916-025-04068-0) BMC Medicine RESEARCH Open Access Effect of sodium-reduced potassium-enriched salt substitutes on stomach cancer: the Salt Substitute and Stroke Study (SSaSS) Xinyi Zhang1†, Xuejun Yin2,3*†, Mei Ling Yap4,5,6,7, Qiang Li4, Liping Huang4, Yishu Liu8, Bo Zhou9, Zhifang Li 10, Yi Zhao11, Jixin Sun12, Yan Yu13, Lijing L. Yan 14,15,16,17, Yangfeng Wu18, Bruce Neal4,19,20 and Maoyi Tian1,4,21* Abstract Background There is an association between increased dietary sodium intake and the risk of stomach cancer. Lowering dietary sodium intake with sodium-reduced potassium-enriched salt substitutes may reduce this risk. To evaluate the effects of sodium-reduced potassium-enriched salt substitutes on the risk of stomach cancer and other types of cancer. Methods The primary analyses of the Salt Substitute and Stroke Study (SSaSS) defined the effects of sodiumreduced potassium-enriched salt substitutes compared to regular salt on the risk of stroke. This post-hoc investigation explored effects on stomach and other cancers. SSaSS was an open-label, cluster randomised controlled trial done in 600 Chinese villages among 20,996 participants. Villages were assigned at random in a 1:1 ratio to receive sodium-reduced potassium-enriched salt substitutes or continue regular salt use. Fatal and hospitalised cancer events were identified through direct face-to-face follow-up and record linkage, with adjudication of fatal, but not non-fatal events. Results During a mean follow-up of 4.7 years, there were 1040 cancer events (507 fatal, 533 non-fatal) recorded. There were 212 stomach cancers, 725 other cancers, and 103 cancers with an unknown primary site. There was a trend toward but not a significant effect of randomised treatment on total stomach cancer (rate ratio (RR) 0. 77, 95% confidence interval (CI) 0.54 to 1. 08) . The RR for adjudicated fatal stomach cancer was 0.66 (95% CI 0.44 to 1. 00) compared to 0.88 (95% CI 0.56 to 1. 37) for unadjudicated non-fatal stomach cancer. There was no detectable effect on total cancer at any site (RR 0 . 94, 95% CI 0.81 to 1. 08), adjudicated fatal cancer at any site (RR 0 . 85, 95% CI 0.69 to 1. 05), or unadjudicated non-fatal cancer at any site (RR 1. 04, 95% CI 0.88 to 1. 23) . Conclusions There was no effect of sodium-reduced potassium-enriched salt substitutes on stomach cancer or other cancer types detected. Trends toward protection against fatal and non-fatal stomach cancer align with the observational epidemiology and warrant further investigation. †Xinyi Zhang and Xuejun Yin contributed equally to this work. *Correspondence: Xuejun Yin [xyin@georgeinstitute.org.au](xyin@georgeinstitute.org.au)[ ](xyin@georgeinstitute.org.au)Maoyi Tian [maoyi.tian@hrbmu.edu.cn](maoyi.tian@hrbmu.edu.cn) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativ

FAQs

What was the main objective of the Salt Substitute and Stroke Study post-hoc investigation?

To evaluate effects of sodium-reduced potassium-enriched salt substitutes on the risk of stomach cancer and other types of cancer in addition to the primary stroke-focused analyses.

How was the SSaSS trial designed and what was the intervention?

SSaSS was an open-label, cluster randomized controlled trial in 600 Chinese villages (20,996 participants), where villages were assigned 1:1 to receive sodium-reduced potassium-enriched salt substitutes or continue regular salt use.

What did the study find regarding stomach cancer and other cancers?

No overall detectable effect was observed on total stomach cancer or total cancer at any site; however, trends toward protection against fatal and non-fatal stomach cancer were reported.

Sep 23, 2026

Uploaded by Connor