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Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study

2022-09-13Journal article Open access
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dc.contributor.authorGoiana-da-Silva, Francisco
dc.contributor.authorCruz-e-Silva, David
dc.contributor.authorRito, Ana
dc.contributor.authorC, Lopes
dc.contributor.authorMuc, Magdalena
dc.contributor.authorDarzi, Ara
dc.contributor.authorAraujo, Fernando
dc.contributor.authorMiraldo, Marisa
dc.contributor.authorNunes, A.
dc.contributor.authorAllen, Luke N
dc.date.accessioned2023-08-21T15:23:14Z
dc.date.available2023-08-21T15:23:14Z
dc.date.issued2022-09-13
dc.description.abstractBackground: Excessive salt consumption—associated with a range of adverse health outcomes—is very high in Portugal, and bread is the second largest source. Current Portuguese legislation sets a maximum limit of 1.4 g salt per 100 g bread, but imported and traditional breads are exempted. In 2017 the Ministry of Health proposed reducing the salt threshold to 1.0/100 g by 2022, however the legislation was vetoed by the European Commission on free-trade grounds. Aims: To estimate the health impact of subjecting imported and traditional breads to the current 1.4 g threshold, and to model the potential health impact of implementing the proposed 1.0 g threshold. Methods: We gathered bread sales, salt consumption, and epidemiological data from robust publicly available data sources. We used the open source WHO PRIME modeling tool to estimate the number of salt-related deaths that would have been averted in 2016 (the latest year for which all data were available) from; (1) Extending the 1.4 g threshold to all types of bread, and (2) Applying the 1.0 g threshold to all bread sold in Portugal. We used Monte Carlo simulations to generate confidence intervals. Results: Applying the current 1.4 g threshold to imported and traditional bread would have averted 107 deaths in 2016 (95% CI: 43–172). Lowering the current threshold from 1.4 to 1.0 g and applying it to all bread products would reduce daily salt consumption by 3.6 tons per day, saving an estimated 286 lives a year (95% CI: 123–454). Conclusions: Salt is an important risk factor in Portugal and bread is a major source. Lowering maximum permissible levels and removing exemptions would save lives. The European Commission should revisit its decision on the basis of this new evidencept_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationGoiana-da-Silva F, Cruz-e-Silva D, Rito A, Lopes C, Muc M, Darzi A, Araújo F, Miraldo M, Morais Nunes A and Allen LN (2022) Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study. Front. Public Health 10:876827. doi: 10.3389/fpubh.2022.876827pt_PT
dc.identifier.doi10.3389/fpubh.2022.876827pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.5/28133
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.relationImperial College Londonpt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectpublic health, salt, policy, NCD and risk factors, nutritionpt_PT
dc.titleModeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.titleFrontiers in Public Healthpt_PT
oaire.citation.volume10pt_PT
person.familyNameGoiana-da-Silva
person.familyNameCruz e Silva
person.familyNameRito
person.familyNameLopes
person.familyNameMuc
person.familyNameDarzi
person.familyNameAraujo
person.familyNameMiraldo
person.familyNameMartins Morais Nunes
person.familyNameAllen
person.givenNameFrancisco
person.givenNameDavid
person.givenNameAna
person.givenNameCarla
person.givenNameMagdalena
person.givenNameAra
person.givenNameFernando
person.givenNameMarisa
person.givenNameAlexandre Manuel
person.givenNameLuke
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person.identifier.orcid0000-0002-5772-7740
person.identifier.orcid0000-0002-6808-7769
person.identifier.orcid0000-0003-2750-3575
person.identifier.ridP-1140-2018
person.identifier.ridU-9327-2017
person.identifier.scopus-author-id57204861907
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person.identifier.scopus-author-id7103222291
person.identifier.scopus-author-id7101718403
person.identifier.scopus-author-id55959535800
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
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