• Francisco Goiana-da-Silva, David Cruz-E-Silva, Luke Allen, Maria João Gregório, Milton Severo, Paulo Jorge Nogueira, Nunes Alexandre Morais AM Centre for Public Administration and Public Policies,Institute of Social and Political Sciences, University of Lisbon, Lisbon, Portugal., Pedro Graça, Carla Lopes, Marisa Miraldo, João Breda, Kremlin Wickramasinghe, Ara Darzi, Fernando Araújo, and Bente Mikkelsen.
• Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London SW7 2AZ, England.
• Bull. World Health Organ. 2019 Jul 1; 97 (7): 450-459.

ObjectiveTo model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met.MethodsThe 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015-2016 and on population structure and deaths from four major noncommunicable diseases over 1990-2016. We used the Preventable Risk Integrated ModEl tool to estimate the deaths averted if reformulation targets were met in full. We projected future trends in noncommunicable disease deaths using regression modelling and assessed whether Portugal was on track to reduce baseline premature deaths from noncommunicable diseases in the year 2010 by 25% by 2025, and by 30% before 2030.FindingsIf reformulation targets were met, we projected reductions in intake in 2015-2016 for salt from 7.6 g/day to 7.1 g/day; in total energy from 1911 kcal/day to 1897 kcal/day due to reduced sugar intake; and in total fat (% total energy) from 30.4% to 30.3% due to reduced trans-fat intake. This consumption profile would result in 248 fewer premature noncommunicable disease deaths (95% CI: 178 to 318) in 2016. We projected that full implementation of the industry agreement would reduce the risk of premature death from 11.0% in 2016 to 10.7% by 2021.ConclusionThe co-regulation agreement could save lives and reduce the risk of premature death in Portugal. Nevertheless, the projected impact on mortality was insufficient to meet international targets.

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