{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:48:59Z","timestamp":1790045339360,"version":"4.0.1"},"reference-count":66,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"National Council for Scientific and Technological Development","doi-asserted-by":"crossref","award":["405161\/2021-2"],"award-info":[{"award-number":["405161\/2021-2"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Sugar-sweetened beverage (SSB) consumption has been linked to obesity, metabolic diseases, and rising healthcare costs. This study aimed to assess the impact of a 20% excise tax on SSBs in Brazil on obesity\/overweight prevalence, seven musculoskeletal and cardiovascular diseases, and related healthcare costs, with their associated impacts on health inequalities. Methods: Using 2017\/2018 Brazilian Household Budget Survey data for baseline consumption and own- and cross-price elasticities for taxed beverages, we estimated changes in caloric consumption for the entire population and for lower- and upper-income quartiles. The PRIMEtime dynamic individual-level simulation model projected body weight changes, lifetime Quality-Adjusted Life-Years (QALYs), healthcare costs (discounted at 5%), and disease cases (20-year horizon). Results: A 20% excise SSB tax was projected to reduce obesity prevalence by 1.7 percentage points in men and 1.5 percentage points in women, from baseline rates of 19.8% and 23.6%, respectively. Lifetime gains were estimated at 17,878 QALYs per million men and 12,181 per million women, alongside healthcare cost savings of Int$520 million. Impacts varied by income, with smaller health gains in the lowest quartile and higher among the wealthiest. Over 20 years, the tax could avert 1784 cases of type 2 diabetes mellitus\/100,000 adults (52% in men) and 1070 cases of ischemic heart disease\/100,000 adults (80% in men). Conclusions: A 20% excise SSB tax in Brazil could yield large health and cost benefits. With the recent approval of the Selective Tax under Complementary Law 214\/2025, Brazil has a timely opportunity to translate these projected benefits into effective public health policy.<\/jats:p>","DOI":"10.3390\/nu18030435","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T17:40:22Z","timestamp":1769622022000},"page":"435","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Fiscal Policy for Sugar-Sweetened Beverages on Reducing the Burden of Disease and Healthcare Costs in Brazil: A Simulation Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5140-3622","authenticated-orcid":false,"given":"Luciana Bertoldi","family":"Nucci","sequence":"first","affiliation":[{"name":"Postgraduate Program in Health Sciences, School of Life Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Campinas 13060-904, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7079-1288","authenticated-orcid":false,"given":"Ben","family":"Amies-Cull","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2834-2005","authenticated-orcid":false,"given":"Flavia Mori","family":"Sarti","sequence":"additional","affiliation":[{"name":"School of Arts, Sciences and Humanities (EACH-USP), University of S\u00e3o Paulo, S\u00e3o Paulo 03828-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0493-134X","authenticated-orcid":false,"given":"Wolney Lisboa","family":"Conde","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health, University of S\u00e3o Paulo, S\u00e3o Paulo 01246-904, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4634-4402","authenticated-orcid":false,"given":"Carla Cristina","family":"Enes","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Health Sciences, School of Life Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Campinas 13060-904, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.ajcnut.2023.12.013","article-title":"National taxation on sugar-sweetened beverages and its association with overweight, obesity, and diabetes","volume":"119","author":"Sassano","year":"2024","journal-title":"Am. 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