Browsing by Author "Miraldo, Marisa"
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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.
- 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.