Modelling the health impact of legislation to limit the salt content of bread in Portugal: a macro simulation study
File(s)fpubh-10-876827.pdf (584.43 KB)
Published version
Author(s)
Goiana-Da-Silva, F
Miraldo, M
Type
Journal Article
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 1.4g salt per 100g bread, but imported and traditional breads are exempted. In 2017 the Ministry of Health proposed reducing the salt threshold to 1.0g/100g 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 1.4g threshold, and to model the potential health impact of implementing the proposed 1.0g threshold. Methods: We gathered bread sales, salt consumption, and epidemiological data from robust publicly available data sources. We used the open source WHO PRIME modelling 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 1.4g threshold to all types of bread, and 2) Applying the 1.0g threshold to all bread sold in Portugal. We used Monte Carlo simulations to generate confidence intervals. Results: Applying the current 1.4g threshold to imported and traditional bread would have averted 107 deaths in 2016 (95%CI: 43 to 172). Lowering the current threshold from 1.4 to 1.0g and applying it to all bread products would reduce daily salt consumption by 3.6 tonnes 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.
Date Issued
2022-09-13
Date Acceptance
2022-07-20
ISSN
2296-2565
Publisher
Frontiers Media
Start Page
1
End Page
9
Journal / Book Title
Frontiers in Public Health
Volume
10
Copyright Statement
© 2022 Goiana-da-Silva, Cruz-e-Silva, Rito, Lopes, Muc, Darzi, Araújo, Miraldo, Morais Nunes and Allen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Identifier
https://www.frontiersin.org/articles/10.3389/fpubh.2022.876827/full
Publication Status
Published
Article Number
876827
Date Publish Online
2022-09-13