Salt Reduction Strategies in Portuguese School Meals, from Pre-School to Secondary Education—The Eat Mediterranean Program

Abstract

High sodium (salt) consumption is associated with an increased risk of developing non-communicable diseases. However, in most European countries, Portugal included, sodium intake is still high. This study aimed to assess the sodium content of school meals before and after the Eat Mediterranean (EM) intervention—a community-based program to identify and correct nutritional deviations through the implementation of new school menus and through schools’ food handlers training. EM (2015–2017) was developed in 25 schools (pre to secondary education) of two Portuguese Municipalities, reaching students aged 3–21 years old. Samples of the complete meals (soup + main course + bread) from all schools were collected, and nutritional quality and laboratory analysis were performed to determine their nutritional composition, including sodium content. Overall, there was a significant decrease (−23%) in the mean sodium content of the complete school meals, which was mainly achieved by the significant reduction of 34% of sodium content per serving portion of soup. In conclusion, EM had a positive effect on the improvement of the school meals’ sodium content, among the participant schools. Furthermore, school setting might be ideal for nutrition literacy interventions among children, for flavors shaping, and for educating towards less salty food acceptance.

Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study

“…Whilst men consume more salt than women, there are many more older women in Portugal, such that 46 averted deaths were among men (95% CI: 19-74) and 61 were among women (95% CI: 25-99). If we focus exclusively on deaths averted in those aged under 75 years, we find that 16 deaths were averted among males (95% CI: 6-26) vs. 9 among women (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…Data from the latest National Food, Nutrition and Physical Activity Survey ( 5 , 6 ) shows that after salt added to food ( 11 ), bread is the second largest source of salt in the Portuguese diet, constituting 18.2% of daily salt intake in Portugal. The same survey showed that the mean daily consumption of bread was 100.3 g/person/day, which is higher than the consumption of cereals, cereal products and tubers ( 5 , 6 ).…”

“…Another study also highlighted the high salt content of school meals which commonly, in Portugal, include an added piece of bread. The study showed that not only this bread serving portion was double the recommended values (45 g instead of 25 g) but was the major contributor of salt when compared with the main dish and soup, adding a mean value of 0.48 g of salt/serving to the school meal ( 11 ). Controlling salt consumption in bread plays a central part in Portugal's salt reduction strategy.…”

Redução do teor de sódio da sopa para crianças e avaliação do impacto no desperdício alimentar

“…O teor de sódio inicial das sopas (baseline) encontra-se no intervalo de resultados apresentados noutros trabalhos realizados em estabelecimentos de ensino portugueses (18)(19)(20). Tendo em conta os resultados obtidos, e considerando a porção de sopa entre 200 a 250 g, a ingestão de sódio, pode chegar aos 308 a 385 mg (0,78 a 0,97 g de sal), uma quantidade muito superior à recomendada para toda a refeição do almoço (21).…”

Exploring possibilities for the development of healthy eating habits in preschool settings: parent's and teacher's perspectives

“…Therefore, promoting a healthy food environment – including food systems that promote a diversified, balanced, and healthy diet – requires the mutual cooperation of multiple sectors and stakeholders (WHO, 2020a). The most common place for health promotion among children has previously been in the school setting, mostly with children aged 6–12 years‐old (Rito et al., 2020). But there are promising findings in interventions targeting infants and 5‐year‐olds (Brand et al., 2017; Halbeisen & Walther, 2021; Kostecka, 2022; Mikkelsen et al., 2014; Wang et al., 2022).…”