Modelling Impacts of Food Industry Co-Regulation on Noncommunicable Disease Mortality, Portugal/Modelisation Des Impacts De la Coreglementation De L'industrie Alimentaire Sur la Mortalite Due a Des Maladies Non Transmissibles Au Portugal/Modelizacion De Los Impactos De la Corregulacion En la Industria Alimentaria Sobre la Mortalidad Por Enfermedades No Transmisibles, Portugal

By Goiana-da-Silva, Francisco; Cruz-e-Silva, David et al. | Bulletin of the World Health Organization, July 2019 | Go to article overview

Modelling Impacts of Food Industry Co-Regulation on Noncommunicable Disease Mortality, Portugal/Modelisation Des Impacts De la Coreglementation De L'industrie Alimentaire Sur la Mortalite Due a Des Maladies Non Transmissibles Au Portugal/Modelizacion De Los Impactos De la Corregulacion En la Industria Alimentaria Sobre la Mortalidad Por Enfermedades No Transmisibles, Portugal


Goiana-da-Silva, Francisco, Cruz-e-Silva, David, Allen, Luke, Gregorio, Maria Joao, Severo, Milton, Nogueira, Paulo Jorge, Nunes, Alexandre Morais, Graca, Pedro, Lopes, Carla, Miraldo, Marisa, Breda, Joao, Wickramasinghe, Kremlin, Darzi, Ara, Araujo, Fernando, Mikkelsen, Bente, Bulletin of the World Health Organization


Introduction

In 2017, 88% (96 587) of 109 758 deaths in the Portuguese population of 10 291 027 were attributed to noncommunicable diseases. (1) Portugal has committed to the United Nations sustainable development goal (SDG) target 3.4 to reduce premature mortality from noncommunicable diseases by one third by 2030 and the voluntary target to reduce these deaths by one quarter by 2025 from the baseline year 2010. To date, there have been no efforts to evaluate Portugal's performance against these targets. (2-4)

Dietary risk factors are the leading preventable cause of noncommunicable diseases morbidity and mortality in Portugal. (1,2) In response to the increasing prevalence of noncommunicable diseases the government introduced the National Programme for the Promotion of Healthy Eating in 2012. (5,6) According to national data, the mean daily intake of free sugars in 2015-2016 was 35 g/day and about 24% (2 600 00) of the population exceeded the World Health Organization (WHO) recommended limits for free-sugar consumption. Non-adherence to this recommendation was more prevalent among children (48.4%; 380 000) and adolescents (48.7%; 422 000). For salt intake, 76.4% (8 283 000) of the population exceed the WHO recommended upper limits for daily sodium consumption. Encouragingly, trans-fatty acids (TFAs) intake constituted more than 1% of the total energy intake for only 0.4% (43 000) of the population. (4)

In 2017, Portugal introduced a consumption tax on sugar-sweetened beverages. The tax was set at euro ([euro]) 8.22 per hectolitre of finished product for drinks with < 80 g sugar/L, and 16.46 [euro] for finished products with > 80 g/L sugar. (7) Preliminary results from the first year of the tax implementation in 2017 showed that the mean energy content of sugar-sweetened beverages fell by 11% (from 30.92 kcal per 100 mL to 27.45 kcal per 100 mL). Sales of these drinks have decreased by almost 7% (from 538 million litres in 2016 to 503 million litres in 2017). (7) Inspired by the success of the tax, (8) the government proposed a salt tax to be levied on processed foods. The Portuguese parliament rejected this proposal and recommended instead introducing a co-regulation agreement with the food industry, whereby the government defines food reformulation targets and agrees a follow-up and accountability process with industry. If the targets are not met, stronger measures to promote reformulation, such as taxation, shall be implemented by the government. Such agreements have been adopted by several other countries. (9-15)

The agreement, drafted by the Portuguese health ministry, included reformulation targets and public accountability guidelines on all processed foods high in salt, sugar and TFAs. (16) Guidelines were based on the recommendations of the European Commission's High-Level Group on Nutrition and Physical Activity (17-19) and an analysis of the consumption patterns of the population. (20,21) A consensus was reached among different stakeholders (the Portuguese nutrition association, nutritionist college and consumer protection association) on several food categories that should be reformulated. Defining the targets for the year 2021 would follow a baseline assessment in December 2017 of the nutritional content of processed food products representing at least 80% of the market share. Building on a consultation with the relevant experts, researchers, health professionals and representatives from the food and health sectors, the health ministry established annual milestones as well as a final reformulation target for each food sector (Table 1). The values were derived from the experience of the United Kingdom of Great Britain and Northern Ireland and recommendations from the High Level Group on Nutrition and Physical Activity of the European Commission (11,22) and the World Health Organization (WHO). (23) The reduction targets were 16% for salt, 20% for sugar and a limit of 2 g TFAs per 100 g of fat in margarines and shortening by 2021. …

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Modelling Impacts of Food Industry Co-Regulation on Noncommunicable Disease Mortality, Portugal/Modelisation Des Impacts De la Coreglementation De L'industrie Alimentaire Sur la Mortalite Due a Des Maladies Non Transmissibles Au Portugal/Modelizacion De Los Impactos De la Corregulacion En la Industria Alimentaria Sobre la Mortalidad Por Enfermedades No Transmisibles, Portugal
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