Publication
Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study
| dc.contributor.author | Goiana-da-Silva, Francisco | |
| dc.contributor.author | Cruz-e-Silva, David | |
| dc.contributor.author | Rito, Ana | |
| dc.contributor.author | Lopes, Carla | |
| dc.contributor.author | Muc, Magdalena | |
| dc.contributor.author | Darzi, Ara | |
| dc.contributor.author | Araújo, Fernando | |
| dc.contributor.author | Miraldo, Marisa | |
| dc.contributor.author | Morais Nunes, Alexandre | |
| dc.contributor.author | Allen, Luke N. | |
| dc.date.accessioned | 2023-03-21T15:49:00Z | |
| dc.date.available | 2023-03-21T15:49:00Z | |
| dc.date.issued | 2022-09-13 | |
| dc.description.abstract | 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. | pt_PT |
| dc.description.sponsorship | This study was funded by Imperial College London. | pt_PT |
| dc.description.version | info:eu-repo/semantics/publishedVersion | pt_PT |
| dc.identifier.citation | Front Public Health. 2022 Sep 13;10:876827. doi: 10.3389/fpubh.2022.876827. eCollection 2022 | pt_PT |
| dc.identifier.doi | 10.3389/fpubh.2022.876827 | pt_PT |
| dc.identifier.issn | 2296-2565 | |
| dc.identifier.uri | http://hdl.handle.net/10400.18/8594 | |
| dc.language.iso | eng | pt_PT |
| dc.peerreviewed | yes | pt_PT |
| dc.publisher | Frontiers Media | pt_PT |
| dc.relation.publisherversion | https://www.frontiersin.org/articles/10.3389/fpubh.2022.876827/full | pt_PT |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | pt_PT |
| dc.subject | Public Health | pt_PT |
| dc.subject | Salt | pt_PT |
| dc.subject | Policy | pt_PT |
| dc.subject | NCD and Risk Factors | pt_PT |
| dc.subject | Nutrition | pt_PT |
| dc.subject | Avaliação do Impacte em Saúde | pt_PT |
| dc.subject | Composição dos Alimentos | pt_PT |
| dc.title | Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study | pt_PT |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.startPage | 876827 | pt_PT |
| oaire.citation.title | Frontiers in Public Health | pt_PT |
| oaire.citation.volume | 10 | pt_PT |
| rcaap.embargofct | Acesso de acordo com política editorial da revista. | pt_PT |
| rcaap.rights | openAccess | pt_PT |
| rcaap.type | article | pt_PT |