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Background and objectives: The mortality and morbidity burden caused by hypertension are preventable and therefore, efforts need to be taken to address this burden. Excess dietary sodium intake is associated with increased blood pressure and the reduction thereof is considered as one of the best investments for public health. As a first step the South African (SA) government has implemented a mandatory regulation (R.214) pertaining to the reduction of sodium in foodstuffs as part of a wider sodium reduction strategy. Monitoring of different aspects of such a strategy is crucial to establish effectiveness and was the main aim. Objectives included (i) establishing baseline sodium and potassium excretion; (ii) investigating appropriate monitoring methods in terms of sodium intake and (iii) to evaluate sodium content in foodstuffs set out in R.214. Methods: We collected 24-hour urine samples and spot urine samples from three population groups i.e. White, Black and Indians in SA. Sodium and potassium were analysed. Three formulas were used to estimate sodium excretion i.e. Kawasaki, Tanaka and INTERSALT. To evaluate the sodium content of foodstuffs we randomly selected ten food products from each of the categories and measured the sodium through atomic absorption spectrometer. Results: In total, 692 and 681 24-hour and spot urine collections were collected. Median sodium and potassium excretion was 122.9 and 33.5mmol/day, and median salt intake was 7.2g/d. The majority (92.8%) of the population did not meet the recommended potassium intake per day and 65.6% consumed more than 6g/d of salt. The Kawasaki and Tanaka formula showed significantly higher (p≤0.001) estimated sodium values than the measured 24 hour excretion in the whole population (5677.79mg/d and 4235.05mg/d vs. 3279.19mg/d). The majority of the food products tested complied with the 2016 targets (72%) and 42% with the 2019 targets. Conclusions: These findings support the SA government's sodium reduction legislation. Estimated sodium excretion from the three formulas should be used with caution. The sodium content in foodstuffs provides valuable information with regard to monitoring and evaluation. SA is doing well in terms of the strategy but a lot still needs to be done

Limited number of studies on salt intake has been conducted in the South Africa. The present study established the sodium and potassium excretion (24-hour urine collection) of three different South African populations. In total, 692 successful 24-hour urine collections were analyzed for sodium, potassium, and iodine levels. The median sodium and potassium excretion was 122.9 and 33.5 mmol/d, respectively, and the median salt intake was 7.2 g/d. The majority (92.8%) of the population did not meet the recommended potassium intake/d, and 65.6% consumed more than 6 g of salt/d. Potassium excretion showed a linear relationship with salt intake (P-trend ≤ .001). The median sodium-to-potassium ratio was 3.5. These findings support the South African government's sodium reduction legislation, as well as global initiatives. More consideration should be given to promoting the intake of potassium-rich foods, as this may have a greater public health impact than focusing only on dietary sodium reduction

Limited number of studies on salt intake has been conducted in the South Africa. The present study established the sodium and potassium excretion (24-hour urine collection) of three different South African populations. In total, 692 successful 24-hour urine collections were analyzed for sodium, potassium, and iodine levels. The median sodium and potassium excretion was 122.9 and 33.5 mmol/d, respectively, and the median salt intake was 7.2 g/d. The majority (92.8%) of the population did not meet the recommended potassium intake/d, and 65.6% consumed more than 6 g of salt/d. Potassium excretion showed a linear relationship with salt intake (P-trend ≤ .001). The median sodium-to-potassium ratio was 3.5. These findings support the South African government's sodium reduction legislation, as well as global initiatives. More consideration should be given to promoting the intake of potassium-rich foods, as this may have a greater public health impact than focusing only on dietary sodium reduction

As a first step in combating the high hypertension rate in South Africa, the Government has recently implemented a mandatory regulation (R.214) pertaining to the sodium content of foodstuffs with targets for 2016 and 2019. We aimed to measure the sodium content and establish whether industry is complying with the targets set in Regulation R.214. The sodium content of ten food products, randomly selected from each of the 13 food categories as described in the regulation (R.214) were measured by means of atomic absorption spectrometry subsequent to microwave digestion. The majority of the food products tested comply with the targets for 2016 (72%) and almost half of the products with the 2019 targets (42%). The highest variation was observed in the "all fat and butter spread" (20%) category, as well as the "raw-processed meat sausages" (32%). All of the food categories, except for "flavoured potato crisp, excluding salt-and-vinegar" and "flavoured ready-to-eat savoury snack and potato crisp, salt-and-vinegar only", complied with the 2016 target. South Africa is at the forefront of countries implementing mandatory legislation for the reduction of sodium levels in food. These data provide valuable information with regards to baseline measurements and regulation compliance, therefore enabling future endeavours pertaining to sodium regulation in South African foodstuff

Background: In June 2016, the Republic of South Africa introduced legislation for mandatory limits for the upper sodium content permitted in a wide range of processed foods. We assessed the sodium levels of packaged foods in South Africa during the one-year period leading up to the mandatory implementation date of the legislation. Methods: Data on the nutritional composition of packaged foods was obtained from nutrition information panels on food labels through both in-store surveys and crowdsourcing by users of the HealthyFood Switch mobile phone app between June 2015 and August 2016. Summary sodium levels were calculated for 15 food categories, including the 13 categories covered by the sodium legislation. The percentage of foods that met the government's 2016 sodium limits was also calculated. Results: 11,065 processed food items were included in the analyses; 1851 of these were subject to the sodium legislation. Overall, 67% of targeted foods had a sodium level at or below the legislated limit. Categories with the lowest percentage of foods that met legislated limits were bread (27%), potato crisps (41%), salt and vinegar flavoured snacks (42%), and raw processed sausages (45%). About half (49%) of targeted foods not meeting the legislated limits were less than 25% above the maximum sodium level. Conclusion: Sodium levels in two-thirds of foods covered by the South African sodium legislation were at or below the permitted upper levels at the mandatory implementation date of the legislation and many more were close to the limit. The South African food industry has an excellent opportunity to rapidly meet the legislated requirements

Background: In June 2016, the Republic of South Africa introduced legislation for mandatory limits for the upper sodium content permitted in a wide range of processed foods. We assessed the sodium levels of packaged foods in South Africa during the one-year period leading up to the mandatory implementation date of the legislation. Methods: Data on the nutritional composition of packaged foods was obtained from nutrition information panels on food labels through both in-store surveys and crowdsourcing by users of the HealthyFood Switch mobile phone app between June 2015 and August 2016. Summary sodium levels were calculated for 15 food categories, including the 13 categories covered by the sodium legislation. The percentage of foods that met the government's 2016 sodium limits was also calculated. Results: 11,065 processed food items were included in the analyses; 1851 of these were subject to the sodium legislation. Overall, 67% of targeted foods had a sodium level at or below the legislated limit. Categories with the lowest percentage of foods that met legislated limits were bread (27%), potato crisps (41%), salt and vinegar flavoured snacks (42%), and raw processed sausages (45%). About half (49%) of targeted foods not meeting the legislated limits were less than 25% above the maximum sodium level. Conclusion: Sodium levels in two-thirds of foods covered by the South African sodium legislation were at or below the permitted upper levels at the mandatory implementation date of the legislation and many more were close to the limit. The South African food industry has an excellent opportunity to rapidly meet the legislated requirements.