Discussion

This study aimed to assess the sodium content of packaged foods and beverages sold in Nigeria and compared these levels with the WHO Global Sodium Benchmarks, as well as with data from South Africa and Kenya. Findings from this study revealed that the sodium content of packaged foods and beverages in the Nigerian retail market varied across food categories, with more than half of the food categories exceeding WHO Global Sodium Benchmarks. Approximately 40.0% of food categories available in Nigeria were captured in the WHO global sodium benchmark for specific food subcategories, with about 64.0% of subcategories exhibiting higher sodium content than the recommended benchmarks. Additionally, three-quarters of the food products showed higher sodium content in Nigeria compared to WHO benchmarks. This highlight the urgent need for targeted sodium reduction initiatives to align Nigeria’s packaged foods with international health standards and improve public health outcomes. Analysis of sodium levels in Nigerian food subcategories also frequently exceeded those found in both South Africa and Kenya, indicating a widespread issue of elevated sodium content across various Nigerian food categories.

South Africa is the only country in Africa that has successfully implemented national sodium reduction targets and guidelines as part of its efforts to address non-communicable diseases, including hypertension and CVDs. Between 2015 and 2016, South Africa established national sodium benchmarks for packaged foods and beverages as part of its efforts to address the health impacts of excessive sodium consumption. Significant strides have been made in sodium reduction through mandatory measures, with the government implementing maximum limits for sodium content across 13 food categories in 2016, followed by phased enforcement starting in 2016 and further reductions in targets enforced from 2019. This initiative has resulted in a notable decrease of 1.15g/day in salt intake between 2015 and 2019.^{(Reference Peters, Dunford, Ware, Harris, Walker and Wicks29)} For Nigeria, the adoption of similar national sodium benchmarks for packaged foods and beverages holds paramount importance in safeguarding public health. These benchmarks would provide vital guidelines and regulations, guiding acceptable levels of sodium content and facilitating collaborative efforts among manufacturers, policymakers, and consumers to reduce excessive sodium dietary intake and mitigate associated health risks.

These results underscore the need for more effective regulations to promote healthier food choices and mitigate potential health risks associated with excessive sodium consumption, similar to other countries with successful sodium reduction initiatives. Several countries have taken significant steps to address salt reduction.^{(Reference Mugavero, Gunn, Dunet and Bowman37)} Among others, the United Kingdom has implemented a ‘Salt Reduction Programme’ since 2006 which encompassed key elements such as the establishment of voluntary targets to reduce salt content in diverse food categories, advocacy for product reformulation, and the dissemination of information to educate consumers on the potential health consequences linked to excessive salt intake.^{(Reference England38)} The United States implemented voluntary sodium reduction targets set by the Food and Drug Administration (FDA); this strategy encompasses collaborative endeavours with public health organisations, industry stakeholders, and scientific experts to enhance awareness, advance education, and endorse initiatives aimed at diminishing dietary sodium intake and enhancing overall public health.⁽³⁹⁾ However, voluntary targets have not generally been considered effective in the US, as they often lack the enforcement necessary to achieve substantial and consistent reductions in sodium consumption.^{(Reference Staudigel and Anders40)}

In contrast, there is a growing readiness in Nigeria and other African countries to implement benchmark-based approaches, which may offer more promise than voluntary schemes such as those used in the UK and USA. Unlike voluntary approaches that rely heavily on industry self-regulation and have shown mixed results, benchmark-based approaches use clear reference values, such as the WHO Global Sodium Benchmarks, that can be translated into enforceable standards. This allows governments to establish mandatory limits for sodium content across food categories, ensuring more consistent reformulation and potentially faster reductions in sodium intake.^{(Reference Sanuade, Alfa, Yin, Liu, Ojo and Shedul25,Reference Tekle, Santos, Trieu, Thout, Ndanuko and Charlton41)} Australia has set sodium reduction targets through the ‘Food and Health Dialogue’ initiative; this strategy includes public awareness campaigns to educate consumers about the health risks associated with high sodium consumption and promote healthier food choices.^{(Reference Coyle, Shahid, Dunford, Mhurchu, Mckee and Santos42)} Finland stands out as a pioneer in salt reduction efforts, implementing comprehensive strategies to reduce salt consumption. Finland’s National Nutrition Council took the pioneering step of launching a salt reduction campaign in the late 1970s, marking one of the earliest efforts by a country to systematically reduce dietary sodium intake among its population. This initiative demonstrates Finland’s proactive stance in tackling the health consequences associated with high sodium consumption and promoting healthier dietary habits.^{(Reference Henney, Taylor and Boon9,Reference Hyseni, Elliot-green, Lloyd-williams, Kypridemos, Flaherty and Mcgill43)} Additionally, Colombia has made strides in salt reduction, exemplified by Resolution 2013 which set mandatory maximum sodium targets for 59 categories including snacks, processed meat, dairy, etc.^{(Reference Report, Assessments, Commodity, Issues, By and Staff44)} In Chile, a significant sodium reduction initiative is the Law of Food Labelling and Advertising (Law No. 20,606) enacted in 2012. This law regulates sodium content in packaged foods, setting maximum levels for various food categories to combat obesity and promote healthier eating habits. Chile also conducts public health campaigns and educational programmes to raise awareness about the risks of excessive sodium consumption, demonstrating its commitment to improving public health by encouraging healthier dietary habits.^{(Reference Scarpelli, Fernandes, Osiac and Quevedo45)} These initiatives reflect a global recognition of the importance of salt reduction in promoting public health and preventing related diseases,^{(Reference Tekle, Santos, Trieu, Thout, Ndanuko and Charlton41)} providing valuable lessons for Nigeria to consider in its own efforts to address sodium consumption. Relating these experiences to our findings, the consistently high sodium levels observed in Nigerian packaged foods highlight the need for a regulatory model closer to South Africa’s mandatory limits, which achieved measurable reductions in salt intake, rather than voluntary schemes such as those in the UK and USA that yielded mixed results. The Nigerian data therefore suggest that adopting enforceable benchmarks, contextualised to the local food supply, could achieve more substantial sodium reduction and provide evidence for future updates of the WHO Global Sodium Benchmarks that currently lack West African representation.

The establishment of national sodium benchmarks for packaged foods and beverages is of paramount importance in safeguarding public health in Nigeria. These benchmarks would serve as essential guidelines and regulations that dictate the acceptable levels of sodium content in such products. By providing reference points for manufacturers, policymakers, and consumers, these benchmarks would enable concerted efforts to reduce excessive dietary sodium intake and mitigate the health risks associated with it. More importantly, the thirty-third percentile is recommended to be used for sodium content targets in various food subcategories in Nigeria where there is no existing WHO sodium benchmarks; This approach aligns with the recommendations provided in the WHO South-East Asia Region Sodium Benchmarks for Packaged Foods. This percentile provides a more achievable target for sodium reduction efforts compared to higher percentiles and can serve as a mandatory target for food manufacturers. The values in the 33rd percentile column indicate the sodium content that 33% of products in each subcategory do not exceed, offering a practical benchmark for sodium reduction in the Nigerian food supply. This approach is based on international best practises,⁽³⁶⁾ which emphasise setting realistic and attainable targets to encourage compliance and gradual improvement. By adopting the 33rd percentile as a benchmark, Nigeria can effectively promote public health while considering the current state of the food industry. Additionally, using this percentile aligns with strategies employed by other countries to gradually lower sodium content in food products.

Currently, the WHO Global Sodium Benchmarks do not incorporate sodium data from West Africa, leaving a critical evidence gap for the subregion. By providing empirical data from Nigeria, and comparing with Kenya and South Africa, this study helps to fill part of that gap and highlights the importance of regional representation in global benchmark-setting. Incorporating West African data into future updates of the WHO Global Sodium Benchmarks would ensure that targets are more context-specific, feasible for local food environments, and reflective of the unique dietary patterns in the region. This would also support other West African countries that are beginning to consider sodium reduction strategies but lack robust local data to guide their policies.

While this study recommends the adoption of WHO Global Sodium Benchmarks for Nigeria, it is important to note that the WHO report advises that benchmarks should be contextualised to country-specific circumstances. In Nigeria, this could be pursued by setting phased and realistic targets for priority food categories that contribute most to sodium intake, using local market data to adapt thresholds where necessary, and aligning targets with existing regulatory frameworks such as NAFDAC food labelling policies. Engagement with the food industry will also be essential to encourage gradual product reformulation, while consumer education campaigns can help build demand for lower-sodium options. This dual approach using WHO benchmarks as a reference while tailoring implementation to the Nigerian food supply would ensure both feasibility and effectiveness in reducing sodium intake in alignment with the established product-category sodium benchmarks.

The study’s strengths include its comprehensive analysis of sodium content in a broad range of packaged foods and beverages across major Nigerian cities, providing valuable insights into dietary sodium levels. The use of WHO benchmarks as a reference point for comparison is a robust approach, ensuring that the findings are aligned with global standards.

However, the study also has limitations. We reported the percentage of food categories not covered by the benchmarks, but this gap may underestimate sodium exposure from excluded categories. While the study offers comparisons with Kenya and South Africa, it does not account for regional variations within these countries. The secondary data for Kenya and South Africa may also introduce inconsistencies due to differences in data collection methods and periods. Another limitation of this study is the discrepancy in data collection periods across the three countries. While Nigerian data were collected in 2020–2021, the South African dataset dates back to 2015–2016 and the Kenyan dataset to 2019. These differences may affect comparability, as product formulations, labelling practises, and regulatory changes could have occurred during this time. Additionally, sodium estimates were derived from declared nutrition information on food labels rather than direct laboratory analyses, which may introduce reporting errors. Some products lacked complete sodium information, potentially leading to bias. Although data cleaning and quality assurance procedures were undertaken to minimise errors, reliance on secondary label data may still affect accuracy.