Browsing by Author "Goiana-da-Silva, Francisco"
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- Front-of-pack labelling policies and the need for guidancePublication . Goiana-da-Silva, Francisco; Cruz-e-Silva, David; Miraldo, Marisa; Calhau, Conceição; Bento, Alexandra; Cruz, Diogo; Almeida, Fernando; Darzi, Ara; Araújo, FernandoFood labels are a challenge for most consumers, and the development of easily understandable labelling is essential when it comes to empowering consumers in making healthier food choices. (...)
- Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation studyPublication . Goiana-da-Silva, Francisco; Cruz-e-Silva, David; Rito, Ana; Lopes, Carla; Muc, Magdalena; Darzi, Ara; Araújo, Fernando; Miraldo, Marisa; Morais Nunes, Alexandre; Allen, Luke N.Background: 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 evidence.
- Nutri-Score: a public health tool to improve eating habits in PortugalPublication . Goiana-da-Silva, Francisco; Cruz-e-Silva, David; Gregório, Maria João; Nunes, Alexandre Morais; Calhau, Conceição; Hercberg, Serge; Rito, Ana; Bento, Alexandra; Cruz, Diogo; Almeida, Fernando; Darzi, Ara; Araújo, FernandoThis article intends to help filling the existing gap in guidance for the implementation of FOP labelling systems.4 As such, the following sections present the growing evidence on the impact of the Nutri-Score labelling scheme in promoting healthier eating behaviours and informs health professionals, as well as decision makers, on the way forward.
- Oito anos de consumo de bebidas açucaradas em crianças Portuguesas dos 6 aos 8 anos de idade: COSI Portugal 2008 – 2016Publication . Mendes, Sofia; Bica, Margarida; Baleia, Joana; Goiana-da-Silva, Francisco; Rito, AnaA obesidade é uma das doenças mais prevalentes entre as crianças portuguesas e, neste contexto, o consumo de bebidas açucaradas é apontado como um dos fatores que pode contribuir para o ganho ponderal em crianças. Estudos sugerem que a disponibilidade destas bebidas está a aumentar e, em Portugal, 22% das crianças com idade inferior a 10 anos consome pelo menos uma bebida açucarada por dia. O presente trabalho pretendeu avaliar o consumo de bebidas açucaradas em crianças e a sua disponibilidade nas escolas do 1º Ciclo do Ensino Básico entre 2008 e 2016. Dados da primeira e quarta ronda (2008 e 2016) do estudo COSI Portugal, referentes à frequência de consumo alimentar e à disponibilidade de bebidas açucaradas no ambiente escolar, foram obtidos e comparados através da análise descritiva dos Questionários Família e Escola. Apesar da prevalência de excesso de peso infantil (incluindo obesidade) em Portugal ter diminuído significativamente de 37,9% em 2008 para 30,7% em 2016, os resultados obtidos revelaram um aumento do consumo de bebidas açucaradas em crianças de 66,4% em 2008 para 80,1% em 2016. Também a disponibilidade destas bebidas nos recintos escolares aumentou neste período. Deste modo, este trabalho reflete a necessidade de monitorização contínua, tanto do estado nutricional como do consumo alimentar infantil, de forma a adaptar e/ou criar estratégias que incentivem a adoção de hábitos alimentares saudáveis.
- Portugal’s voluntary food reformulation agreement and the WHO reformulation targetsPublication . Goiana-da-Silva, Francisco; Cruz-e-Silva, David; Allen, Luke; Nunes, Alexandre Morais; Calhau, Conceição; Rito, Ana; Bento, Alexandra; Miraldo, Marisa; Darzi, AraIn response to stalling progress in NCD related premature mortality, the Portuguese government declared the ‘Promotion of Healthy Eating’ a national priority and convened a multisectoral task force with representatives from several ministries in order to tackle unhealthy diets. With the inputs from civil society, non-governmental organisations and health authorities, this task force developed the Integrated Strategy for the Promotion of Healthy Eating (Estratégia Integrada para a Promoção da Alimentação Saudável – “EIPAS”). The strategy – endorsed by the Portuguese Ministers Council in December 2017 – included fiscal measures, co-regulation agreements with the food industry, enhanced cooperation with municipalities, and measures to change the food environments in public settings among many other initiatives. In December 2016, the Portuguese Parliament approved a special consumption tax on sweetened beverages which has been associated with product reformulation and a fall in sales. Inspired by the success of the tax on sweetened beverages, in December 2018, the government proposed a tax on salty processed foods; as salt is the leading dietary risk factor for NCDs in Portugal. Even though the average consumption is 10.7g/d far above of the WHO recommended threshold of <5g/d, the majority of the Portuguese Parliament Members voted against this proposal, recommending instead a co-regulation agreement with the food industry to achieve similar changes in consumption of salt. After one year of negotiations, the Portuguese Ministry of Health (MoH) and the food industry representatives signed a broad ‘Food Industry Co-regulation Agreement’ on the 2nd of May 2019. The agreement covers the main food products high in salt, sugar, and trans fatty acids as well as the main dietary sources of these nutrients for the Portuguese population.(...)
- Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling studyPublication . Goiana-da-Silva, Francisco; Severo, Milton; Cruz e Silva, David; Gregório, Maria João; Allen, Luke N.; Muc, Magdalena; Morais Nunes, Alexandre; Torres, Duarte; Miraldo, Marisa; Ashrafian, Hutan; Rito, Ana; Wickramasinghe, Kremlin; Breda, João; Darzi, Ara; Araújo, Fernando; Lopes, CarlaBackground: Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal. Methods and findings: We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources. Conclusions: The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.
- Salt Reduction Strategies in Portuguese School Meals, from Pre-School to Secondary Education-The Eat Mediterranean ProgramPublication . Rito, Ana Isabel; Mendes, Sofia; Santos, Mariana; Goiana-da-Silva, Francisco; Cappuccio, Francesco Paolo; Whiting, Stephen; Dinis, Ana; Rascôa, Carla; Castanheira, Isabel; Darzi, Ara; Breda, JoãoHigh sodium (salt) consumption is associated with an increased risk of developing non-communicable diseases. However, in most European countries, Portugal included, sodium intake is still high. This study aimed to assess the sodium content of school meals before and after the Eat Mediterranean (EM) intervention-a community-based program to identify and correct nutritional deviations through the implementation of new school menus and through schools' food handlers training. EM (2015-2017) was developed in 25 schools (pre to secondary education) of two Portuguese Municipalities, reaching students aged 3-21 years old. Samples of the complete meals (soup + main course + bread) from all schools were collected, and nutritional quality and laboratory analysis were performed to determine their nutritional composition, including sodium content. Overall, there was a significant decrease (-23%) in the mean sodium content of the complete school meals, which was mainly achieved by the significant reduction of 34% of sodium content per serving portion of soup. In conclusion, EM had a positive effect on the improvement of the school meals' sodium content, among the participant schools. Furthermore, school setting might be ideal for nutrition literacy interventions among children, for flavors shaping, and for educating towards less salty food acceptance.