Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.
PLoS Med. 2020 Mar 12;17(3):e1003036. doi: 10.1371/journal.pmed.1003036. eCollection 2020 Mar.
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.
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.
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.
过量摄入糖与肥胖有着明确的关联。初步结果表明，葡萄牙政府于 2017 年对含糖饮料（SSB）征收的税款导致了这些产品的销售额下降和配方改革。本研究通过对葡萄牙各种年龄段人群的肥胖发病率进行建模，分析了对 SSB 征税所引发的市场变化的影响。
我们使用葡萄牙非酒精饮料协会（GlobalData 和尼尔森消费者小组）提供的 2014-2018 年市场数据、全国调查（IAN-AF 2015-2016 年）的饮食数据以及多项队列研究的肥胖发病率数据，进行了全国市场分析和全人群建模研究。通过将 SSB 中的能量含量（千卡/克）除以总食物摄入量（克），计算出 SSB 的饮食能量密度。我们使用潜在影响分数（PIF）方程，通过销售量减少和配方改革，对税收引发的糖消费变化对肥胖发病率的预期影响进行建模。结果显示，每年 SSB 的销售量减少了 660 万升。产品配方改革使 SSB 的平均能量密度降低了 3.1 千卡/100 毫升。这估计在 2016 年至 2018 年期间每年预防了 40-78 例肥胖病例，在 10 至<18 岁的青少年中观察到的预期影响最大。该模型表明，与仅通过配方改革相比，实施该税收可以使针对肥胖的预期影响大 4 至 8 倍。本研究的主要限制是，我们使用的模型包括来自各种来源的数据，这可能导致与这些来源之间的方法学差异相关的偏差，尽管我们已尽力减轻这些偏差。
税收既引起了需求的减少，又引起了产品配方的改革。这些因素结合起来可以降低 SSB 频繁消费者的肥胖水平。这种税收是一种有效的全人群干预措施。如果没有销售量的下降，仅配方改革对葡萄牙人口的肥胖发病率的影响将小得多。
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