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Willits-Smith A, Taillie LS, Jaacks LM, Frank SM, Grummon AH. Effects of red meat taxes and warning labels on food groups selected in a randomized controlled trial. Int J Behav Nutr Phys Act 2024; 21:39. [PMID: 38622655 PMCID: PMC11020801 DOI: 10.1186/s12966-024-01584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND High consumption of red and processed meat contributes to both health and environmental harms. Warning labels and taxes for red meat reduce selection of red meat overall, but little is known about how these potential policies affect purchases of subcategories of red meat (e.g., processed versus unprocessed) or of non-red-meat foods (e.g., cheese, pulses) relevant to health and environmental outcomes. This study examined consumer responses to warning labels and taxes for red meat in a randomized controlled trial. METHODS In October 2021, we recruited 3,518 US adults to complete a shopping task in a naturalistic online grocery store. Participants were randomly assigned to one of four arms: control (no warning labels or tax), warning labels only (health and environmental warning labels appeared next to products containing red meat), tax only (prices of products containing red meat were increased 30%) or combined warning labels + tax. Participants selected items to hypothetically purchase, which we categorized into food groups based on the presence of animal- and plant-source ingredients (e.g., beef, eggs, pulses), meat processing level (e.g., processed pork versus unprocessed pork), and meat species (e.g., beef versus pork). We assessed the effects of the warning labels and tax on selections from each food group. RESULTS Compared to control, all three interventions led participants to select fewer items with processed meat (driven by reductions in processed pork) and (for the tax and warning labels + tax interventions only) fewer items with unprocessed meat (driven by reductions in unprocessed beef). All three interventions also led participants to select more items containing cheese, while only the combined warning labels + tax intervention led participants to select more items containing processed poultry. Except for an increase in selection of pulses in the tax arm, the interventions did not affect selections of fish or seafood (processed or unprocessed), eggs, or plant-based items (pulses, nuts & seeds, tofu, meat mimics, grains & potatoes, vegetables). CONCLUSIONS Policies to reduce red meat consumption are also likely to affect consumption of other types of foods that are relevant to both health and environmental outcomes. TRIAL REGISTRATION NCT04716010 on www. CLINICALTRIALS gov .
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Affiliation(s)
- Amelia Willits-Smith
- Carolina Population Center, University of North Carolina at Chapel Hill, 27516, Chapel Hill, NC, USA
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, 27516, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 27516, Chapel Hill, NC, USA
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Systems, The University of Edinburgh, Midlothian, UK
| | - Sarah M Frank
- Global Academy of Agriculture and Food Systems, The University of Edinburgh, Midlothian, UK
| | - Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, 3145 Porter Drive, A103, 94034, Palo Alto, CA, USA.
- Department of Health Policy, Stanford University School of Medicine, 94305, Stanford, CA, USA.
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Peñalvo JL. The impact of taxing sugar-sweetened beverages on diabetes: a critical review. Diabetologia 2024; 67:420-429. [PMID: 38177563 DOI: 10.1007/s00125-023-06064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024]
Abstract
The global burden of type 2 diabetes is increasing at an alarming rate, fuelled by the obesity epidemic, with significant associated health and economic consequences and apparent inequalities. Sugar-sweetened beverages (SSBs) are a major source of added sugars in diets worldwide and have been linked to an increased risk of type 2 diabetes through a variety of mechanisms, including excess weight. Taxing SSBs has become a promising public health strategy to reduce consumption and mitigate the burden of type 2 diabetes. A substantial body of evidence suggests that SSB taxes lead to increased prices and subsequent reduced consumption, with a potentially greater effect among lower socioeconomic groups. This highlights the potential for tax policies to have an impact on type 2 diabetes and address health inequalities. Evidence from several ongoing SSB tax schemes, including sales and excise taxes, indicates positive effects on improving consumption patterns, and modelling studies point to health gains by averting type 2 diabetes and other cardiometabolic diseases. In contrast, evidence from empirical evaluation of the impact of SSB tax is scarce. Continued monitoring and the strengthening of evaluation research to develop context-tailored policies are required. In addition, there is a need to implement complementary efforts to amplify the impact of SSB taxation and effectively address the global burden of type 2 diabetes.
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Affiliation(s)
- José L Peñalvo
- Global Health Institute, University of Antwerp, Wilrijk, Belgium.
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Uthman OA, Court R, Anjorin S, Enderby J, Al-Khudairy L, Nduka C, Mistry H, Melendez-Torres GJ, Taylor-Phillips S, Clarke A. The potential impact of policies and structural interventions in reducing cardiovascular disease and mortality: a systematic review of simulation-based studies. Health Technol Assess 2023:1-32. [PMID: 38140927 DOI: 10.3310/nmfg0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
Background The aim of the study was to investigate the potential effect of different structural interventions for preventing cardiovascular disease. Methods Medline and EMBASE were searched for peer-reviewed simulation-based studies of structural interventions for prevention of cardiovascular disease. We performed a systematic narrative synthesis. Results A total of 54 studies met the inclusion criteria. Diet, nutrition, tobacco and alcohol control and other programmes are among the policy simulation models explored. Food tax and subsidies, healthy food and lifestyles policies, palm oil tax, processed meat tax, reduction in ultra-processed foods, supplementary nutrition assistance programmes, stricter food policy and subsidised community-supported agriculture were among the diet and nutrition initiatives. Initiatives to reduce tobacco and alcohol use included a smoking ban, a national tobacco control initiative and a tax on alcohol. Others included the NHS Health Check, WHO 25 × 25 and air quality management policy. Future work and limitations There is significant heterogeneity in simulation models, making comparisons of output data impossible. While policy interventions typically include a variety of strategies, none of the models considered possible interrelationships between multiple policies or potential interactions. Research that investigates dose-response interactions between numerous modifications as well as longer-term clinical outcomes can help us better understand the potential impact of policy-level interventions. Conclusions The reviewed studies underscore the potential of structural interventions in addressing cardiovascular diseases. Notably, interventions in areas such as diet, tobacco, and alcohol control demonstrate a prospective decrease in cardiovascular incidents. However, to realize the full potential of such interventions, there is a pressing need for models that consider the interplay and cumulative impacts of multiple policies. Rigorous research into holistic and interconnected interventions will pave the way for more effective policy strategies in the future. Study registration The study is registered as PROSPERO CRD42019154836. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/148/05.
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Affiliation(s)
- Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Rachel Court
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Seun Anjorin
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Jodie Enderby
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Chidozie Nduka
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Hema Mistry
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
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Consavage Stanley K, Hedrick VE, Serrano E, Holz A, Kraak VI. US Adults' Perceptions, Beliefs, and Behaviors towards Plant-Rich Dietary Patterns and Practices: International Food Information Council Food and Health Survey Insights, 2012-2022. Nutrients 2023; 15:4990. [PMID: 38068852 PMCID: PMC10708400 DOI: 10.3390/nu15234990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Expert groups recommend that populations adopt dietary patterns higher in whole, plant-based foods and lower in red and processed meat as a high-impact climate action. Yet, there is limited understanding of populations' willingness to adopt plant-rich dietary patterns. This study examined United States (US) adults' perceptions, beliefs, and behaviors towards plant-rich dietary patterns and practices over a decade. Fifteen questions from the International Food Information Council's Food and Health Surveys (2012-2022) were analyzed across four sustainability domains (i.e., human health, environmental, social, and economic domains). Most respondents had favorable perceptions of environmentally sustainable food and beverages, but sustainability influenced less than half of consumers' purchase decisions. Plant-rich dietary pattern adherence increased across survey years (12.1% [2019] to 25.8% [2022], p < 0.001). One-quarter (28.1%) of Americans reported reducing their red meat intake over 12 months (2020-2022). Yet, another 15.5% reported greater red meat intake, and 18.8% reported greater plant-based meat alternative (PBMA) intake over 12 months. The percentage of respondents who reported greater red meat and PBMA consumption in the previous 12 months significantly increased across the years surveyed (2020-2022, p < 0.05). IFIC Survey findings highlight growing US consumer awareness of health, environmental, and social sustainability but low adoption of plant-rich dietary patterns and practices. Government leadership and coordinated actions by health professionals, civil society, and businesses are needed to educate and incentivize Americans to adopt plant-rich dietary behaviors, and greater industry transparency is needed to show how food and beverage products support human and planetary health.
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Affiliation(s)
- Katherine Consavage Stanley
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA 24061, USA; (V.E.H.); (E.S.); (V.I.K.)
| | - Valisa E. Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA 24061, USA; (V.E.H.); (E.S.); (V.I.K.)
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA 24061, USA; (V.E.H.); (E.S.); (V.I.K.)
- Virginia Family Nutrition Program, Virginia Tech, Blacksburg, VA 24061, USA
| | - Adrienne Holz
- School of Communication, Virginia Tech, Blacksburg, VA 24061, USA;
| | - Vivica I. Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA 24061, USA; (V.E.H.); (E.S.); (V.I.K.)
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Kim DD, Wang L, Lauren BN, Liu J, Marklund M, Lee Y, Micha R, Mozaffarian D, Wong JB. Development and Validation of the US Diabetes, Obesity, Cardiovascular Disease Microsimulation (DOC-M) Model: Health Disparity and Economic Impact Model. Med Decis Making 2023; 43:930-948. [PMID: 37842820 PMCID: PMC10625721 DOI: 10.1177/0272989x231196916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 07/27/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Few simulation models have incorporated the interplay of diabetes, obesity, and cardiovascular disease (CVD); their upstream lifestyle and biological risk factors; and their downstream effects on health disparities and economic consequences. METHODS We developed and validated a US Diabetes, Obesity, Cardiovascular Disease Microsimulation (DOC-M) model that incorporates demographic, clinical, and lifestyle risk factors to jointly predict overall and racial-ethnic groups-specific obesity, diabetes, CVD, and cause-specific mortality for the US adult population aged 40 to 79 y at baseline. An individualized health care cost prediction model was further developed and integrated. This model incorporates nationally representative data on baseline demographics, lifestyle, health, and cause-specific mortality; dynamic changes in modifiable risk factors over time; and parameter uncertainty using probabilistic distributions. Validation analyses included assessment of 1) population-level risk calibration and 2) individual-level risk discrimination. To illustrate the application of the DOC-M model, we evaluated the long-term cost-effectiveness of a national produce prescription program. RESULTS Comparing the 15-y model-predicted population risk of primary outcomes among the 2001-2002 National Health and Nutrition Examination Survey (NHANES) cohort with the observed prevalence from age-matched cross-sectional 2003-2016 NHANES cohorts, calibration performance was strong based on observed-to-expected ratio and calibration plot analysis. In most cases, Brier scores fell below 0.0004, indicating a low overall prediction error. Using the Multi-Ethnic Study of Atherosclerosis cohorts, the c-statistics for assessing individual-level risk discrimination were 0.85 to 0.88 for diabetes, 0.93 to 0.95 for obesity, 0.74 to 0.76 for CVD history, and 0.78 to 0.81 for all-cause mortality, both overall and in three racial-ethnic groups. Open-source code for the model was posted at https://github.com/food-price/DOC-M-Model-Development-and-Validation. CONCLUSIONS The validated DOC-M model can be used to examine health, equity, and the economic impact of health policies and interventions on behavioral and clinical risk factors for obesity, diabetes, and CVD. HIGHLIGHTS We developed a novel microsimula'tion model for obesity, diabetes, and CVD, which intersect together and - critically for prevention and treatment interventions - share common lifestyle, biologic, and demographic risk factors.Validation analyses, including assessment of (1) population-level risk calibration and (2) individual-level risk discrimination, showed strong performance across the overall population and three major racial-ethnic groups for 6 outcomes (obesity, diabetes, CVD, and all-cause mortality, CVD- and DM-cause mortality)This paper provides a thorough explanation and documentation of the development and validation process of a novel microsimulation model, along with the open-source code (https://github.com/food-price/ DOCM_validation) for public use, to serve as a guide for future simulation model assessments, validation, and implementation.
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Affiliation(s)
- David D. Kim
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lu Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Brianna N. Lauren
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Junxiu Liu
- Department of Population Health Science and Policy, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Yujin Lee
- Department of Food and Nutrition, Myongji University, Yongin, South Korea
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - John B. Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA
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Liu C, Lai W, Zhao M, Zhang Y, Hu Y. Association between the Composite Dietary Antioxidant Index and Atherosclerotic Cardiovascular Disease in Postmenopausal Women: A Cross-Sectional Study of NHANES Data, 2013-2018. Antioxidants (Basel) 2023; 12:1740. [PMID: 37760043 PMCID: PMC10525155 DOI: 10.3390/antiox12091740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
The relationship between composite dietary antioxidant index (CDAI) levels and the risk of atherosclerotic cardiovascular disease (ASCVD) in postmenopausal women is unknown. In total, 3109 women from the National Health and Nutrition Examination Survey 2013-2018 were included in this cross-sectional study. We evaluated the association between CDAI levels and the risk of ASCVD by using three logistic regression models and restricted cubic splines. A stratified analysis and sensitivity analysis were also conducted. The restricted cubic splines exhibited an L-shaped dose-response association between CDAI levels and the ASCVD risk. Logistic regression analysis found that CDAI levels were negatively associated with the occurrence of ASCVD. The ORs associated with a per-SD increase in CDAI were 0.67 (95% CI: 0.51-0.88) for ASCVD risk. Similarly, women in the group with high CDAI levels were less likely to have ASCVD (OR = 0.71, 95% CI: 0.50-0.98) compared to those in the group with low CDAI levels. When the CDAI levels were divided into quartiles, it was found that the ORs for ASCVD with CDAI levels in Q2 (-1.04-1.11), Q3 (1.11-3.72), and Q4 (3.72-43.87) were 0.63 (0.44, 0.90), 0.64 (0.42, 0.94), and 0.51 (0.27, 0.97), respectively, compared to those with CDAI levels in Q1 (-6.83--1.04). In addition, age, high-density lipoprotein cholesterol levels, and smoking behaviors acted as potential modifiers, and ORs were more significant in women aged 40-69 years, in individuals with low high-density lipoprotein cholesterol levels, and in smokers (p for interaction <0.05). These findings may offer valuable insights into the role of CDAI levels in the development of ASCVD among postmenopausal women.
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Affiliation(s)
- Chenning Liu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR 999078, China; (C.L.); (W.L.); (Y.Z.)
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR 999078, China
| | - Wenyu Lai
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR 999078, China; (C.L.); (W.L.); (Y.Z.)
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR 999078, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China;
| | - Yexuan Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR 999078, China; (C.L.); (W.L.); (Y.Z.)
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR 999078, China
| | - Yuanjia Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR 999078, China; (C.L.); (W.L.); (Y.Z.)
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR 999078, China
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Taillie LS, Bercholz M, Prestemon CE, Higgins ICA, Grummon AH, Hall MG, Jaacks LM. Impact of taxes and warning labels on red meat purchases among US consumers: A randomized controlled trial. PLoS Med 2023; 20:e1004284. [PMID: 37721952 PMCID: PMC10545115 DOI: 10.1371/journal.pmed.1004284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/02/2023] [Accepted: 08/22/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Policies to reduce red meat intake are important for mitigating climate change and improving public health. We tested the impact of taxes and warning labels on red meat purchases in the United States. The main study question was, will taxes and warning labels reduce red meat purchases? METHODS AND FINDINGS We recruited 3,518 US adults to participate in a shopping task in a naturalistic online grocery store from October 18, 2021 to October 28, 2021. Participants were randomized to one of 4 conditions: control (no tax or warning labels, n = 887), warning labels (health and environmental warning labels appeared next to products containing red meat, n = 891), tax (products containing red meat were subject to a 30% price increase, n = 874), or combined warning labels + tax (n = 866). We used fractional probit and Poisson regression models to assess the co-primary outcomes, percent, and count of red meat purchases, and linear regression to assess the secondary outcomes of nutrients purchased. Most participants identified as women, consumed red meat 2 or more times per week, and reported doing all of their household's grocery shopping. The warning, tax, and combined conditions led to lower percent of red meat-containing items purchased, with 39% (95% confidence interval (CI) [38%, 40%]) of control participants' purchases containing red meat, compared to 36% (95% CI [35%, 37%], p = 0.001) of warning participants, 34% (95% CI [33%, 35%], p < 0.001) of tax participants, and 31% (95% CI [30%, 32%], p < 0.001) of combined participants. A similar pattern was observed for count of red meat items. Compared to the control, the combined condition reduced calories purchased (-312.0 kcals, 95% CI [-590.3 kcals, -33.6 kcals], p = 0.027), while the tax (-10.4 g, 95% CI [-18.2 g, -2.5 g], p = 0.01) and combined (-12.8 g, 95% CI [-20.7 g, -4.9 g], p = 0.001) conditions reduced saturated fat purchases; no condition affected sodium purchases. Warning labels decreased the perceived healthfulness and environmental sustainability of red meat, while taxes increased perceived cost. The main limitations were that the study differed in sociodemographic characteristics from the US population, and only about 30% to 40% of the US population shops for groceries online. CONCLUSIONS Warning labels and taxes reduced red meat purchases in a naturalistic online grocery store. Trial Registration: http://www.clinicaltrials.gov/ NCT04716010.
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Affiliation(s)
- Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Maxime Bercholz
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Carmen E. Prestemon
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Isabella C. A. Higgins
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Anna H. Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Marissa G. Hall
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Lindsay M. Jaacks
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
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Fang Y, Xia J, Lian Y, Zhang M, Kang Y, Zhao Z, Wang L, Yin P, Wang Z, Ye C, Zhou M, He Y. The burden of cardiovascular disease attributable to dietary risk factors in the provinces of China, 2002-2018: a nationwide population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100784. [PMID: 37693878 PMCID: PMC10485670 DOI: 10.1016/j.lanwpc.2023.100784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 09/12/2023]
Abstract
Background The burden of cardiovascular diseases (CVDs) is on the rise in China, yet a comprehensive and systematic understanding of the temporal trends and distribution of CVD burden attributable to dietary factors across the provinces remains elusive. This study endeavors to provide a comprehensive depiction of the burden of CVDs attributable to dietary risk factors across China's geographical regions from 2002 to 2018. Methods Data from the China National Nutrition Surveys, the China Chronic Disease and Risk Factor Surveillance, the Hypertension Survey, and the Chinese Centre for Disease Control and Prevention cause-of-death reporting system were used to estimate the intake of dietary factor, the number of deaths, and disability-adjusted life years (DALYs), mortality rate, for ischemic heart disease (IHD), ischemic stroke (IS), hemorrhage and other stroke (HOS) attributable to dietary factors at national and provincial levels in China from 2002 to 2018. Using a comparative risk assessment approach, we estimated the proportion of CVDs burden attributable to suboptimal intake of seven dietary factors, both individually and collectively, among Chinese citizens aged 20 years or older. Finding The mean consumption of whole grains, soybeans, nuts, vegetables, fruits, red meat, and sugar-sweetened beverages (SSBs) exhibited an upward trend from 2002 to 2018. However, with the exception of red meat and SSBs, the average intake remained below the levels recommended levels outlined in the Chinese national dietary guidelines. Inadequate fruit, whole grain, and vegetables intake were the leading dietary risk factors for IHD, IS and HOS in China, while nuts, soybean and SSB were only associated with IHD mortality. From 2002 to 2018, the number of deaths and mortality rate for CVDs attributable to suboptimal diet among Chinese males were greater than that of females. With increasing age, the diet-related mortality rate for CVDs increased substantially. In 2018, the nationwide mortality rate attributable to diet was found to be 77.9 (95% UI, 77.5-78.1) per 100,000 population for IHD, 34.1 (95% UI, 33.8-34.2) for IS, and 32.8 (95% UI, 32.4-32.8) for HOS. Suboptimal diet was responsible for 16.0 million (95% UI, 13.8-18.4) DALYs and 1137.1 (95% UI, 980.4-1312.3) DALYs per 100,000 population for stroke, and 13.9 million (95% UI, 11.8-16.3) DALYs and 990.2 (95% UI, 841.2-1158.6) DALYs for IHD. Across the provinces of China, in 2018, the highest age-standardized mortality rates of all diet-related deaths were observed in Shandong (92.8 [95% UI, 89.9-93.3]) for IHD, Heilongjiang (38.1 [95% UI, 36.2-38.8]) for IS, and Tibet (68.3 [95% UI, 65.0-70.1]) for HOS. The highest diet related DALYs were observed in Henan (1.4 million [95% UI, 1.2-1.6] for IS, and 1.3 million [95% UI, 1.1-1.5] for IHD). Interpretation This study provides a comprehensive picture of the geographic variation and temporal trends of the burden of CVDs attributable to dietary risk factors at the national and provincial levels from 2002 to 2018 in China, highlighting the need for geographically targeted intervention strategies to improve the quality of diet and reduce the diet-related burden of CVDs. Funding National Key Research and Development Program of China (2018YFC1315303), National Natural Science Foundation of China (82103966).
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Affiliation(s)
- Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Juan Xia
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yiyao Lian
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Mei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yuting Kang
- Office of National Clinical Research for Geriatrics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zhenping Zhao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zengwu Wang
- Division of Prevention and Community Health, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Chen Ye
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Hirsch JA, Zhao Y, Melly S, Moore KA, Berger N, Quinn J, Rundle A, Lovasi GS. National trends and disparities in retail food environments in the USA between 1990 and 2014. Public Health Nutr 2023; 26:1052-1062. [PMID: 36644895 PMCID: PMC10191888 DOI: 10.1017/s1368980023000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 09/29/2022] [Accepted: 11/25/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe national disparities in retail food environments by neighbourhood composition (race/ethnicity and socio-economic status) across time and space. DESIGN We examined built food environments (retail outlets) between 1990 and 2014 for census tracts in the contiguous USA (n 71 547). We measured retail food environment as counts of all food stores, all unhealthy food sources (including fast food, convenience stores, bakeries and ice cream) and healthy food stores (including supermarkets, fruit and vegetable markets) from National Establishment Time Series business data. Changes in food environment were mapped to display spatial patterns. Multi-level Poisson models, clustered by tract, estimated time trends in counts of food stores with a land area offset and independent variables population density, racial composition (categorised as predominantly one race/ethnicity (>60 %) or mixed), and inflation-adjusted income tertile. SETTING The contiguous USA between 1990 and 2014. PARTICIPANTS All census tracts (n 71 547). RESULTS All food stores and unhealthy food sources increased, while the subcategory healthy food remained relatively stable. In models adjusting for population density, predominantly non-Hispanic Black, Hispanic, Asian and mixed tracts had significantly more destinations of all food categories than predominantly non-Hispanic White tracts. This disparity increased over time, predominantly driven by larger increases in unhealthy food sources for tracts which were not predominantly non-Hispanic White. Income and food store access were inversely related, although disparities narrowed over time. CONCLUSIONS Our findings illustrate a national food landscape with both persistent and shifting spatial patterns in the availability of establishments across neighbourhoods with different racial/ethnic and socio-economic compositions.
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Affiliation(s)
- Jana A Hirsch
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA19104, USA
| | - Yuzhe Zhao
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
| | - Steven Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
| | - Kari A Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
| | - Nicolas Berger
- Department of Epidemiology and Public Health, Sciensano (Belgian Scientific Institute of Public Health), Ixelles, Belgium
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - James Quinn
- Built Environment and Health Research Group, Mailman School of Public Health, Columbia University, New York, USA
| | - Andrew Rundle
- Built Environment and Health Research Group, Mailman School of Public Health, Columbia University, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA19104, USA
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10
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Dötsch-Klerk M, Bruins MJ, Detzel P, Martikainen J, Nergiz-Unal R, Roodenburg AJC, Pekcan AG. Modelling health and economic impact of nutrition interventions: a systematic review. Eur J Clin Nutr 2023; 77:413-426. [PMID: 36195747 PMCID: PMC10115624 DOI: 10.1038/s41430-022-01199-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/17/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022]
Abstract
Diet related non-communicable diseases (NCDs), as well as micronutrient deficiencies, are of widespread and growing importance to public health. Authorities are developing programs to improve nutrient intakes via foods. To estimate the potential health and economic impact of these programs there is a wide variety of models. The aim of this review is to evaluate existing models to estimate the health and/or economic impact of nutrition interventions with a focus on reducing salt and sugar intake and increasing vitamin D, iron, and folate/folic acid intake. The protocol of this systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016050873). The final search was conducted on PubMed and Scopus electronic databases and search strings were developed for salt/sodium, sugar, vitamin D, iron, and folic acid intake. Predefined criteria related to scientific quality, applicability, and funding/interest were used to evaluate the publications. In total 122 publications were included for a critical appraisal: 45 for salt/sodium, 61 for sugar, 4 for vitamin D, 9 for folic acid, and 3 for iron. The complexity of modelling the health and economic impact of nutrition interventions is dependent on the purpose and data availability. Although most of the models have the potential to provide projections of future impact, the methodological challenges are considerable. There is a substantial need for more guidance and standardization for future modelling, to compare results of different studies and draw conclusions about the health and economic impact of nutrition interventions.
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Affiliation(s)
- Mariska Dötsch-Klerk
- Unilever Foods Innovation Centre, Wageningen, The Netherlands.
- Unilever Foods Innovation Centre, Wageningen, Bronland 14, 6708 WH, The Netherlands.
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11
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Trieu K, Coyle DH, Rosewarne E, Shahid M, Yamamoto R, Nishida C, Neal B, He FJ, Marklund M, Wu JHY. Estimated Dietary and Health Impact of the World Health Organization's Global Sodium Benchmarks on Packaged Foods in Australia: a Modeling Study. Hypertension 2023; 80:541-549. [PMID: 36625256 DOI: 10.1161/hypertensionaha.122.20105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In 2021, the World Health Organization (WHO) set sodium benchmarks for packaged foods to guide countries in setting feasible and effective sodium reformulation programs. We modeled the dietary and health impact of full compliance with the WHO's sodium benchmarks in Australia and compared it to the potential impact of Australia's 2020 sodium reformulation targets. METHODS We used nationally representative data on food and sodium intake, sodium levels in packaged foods, and food sales volume to estimate sodium intake pre- and post-implementation of the WHO and Australia's sodium benchmarks for 24 age-sex groups. Using comparative risk assessment models, we then estimated the potential deaths, incidence, and disability-adjusted life years averted from cardiovascular disease, chronic kidney disease, and stomach cancer based on the reductions in sodium intake. RESULTS Compliance with the WHO's sodium benchmarks for packaged foods in Australia could lower mean adult sodium intake by 404 mg/day, corresponding to a 12% reduction. This could prevent about 1770 deaths/year (95% uncertainty interval 1168-2587), corresponding to 3% of all cardiovascular disease, chronic kidney disease, and stomach cancer deaths in Australia, and prevent some 6900 (4603-9513) new cases, and 25 700 (17 655-35 796) disability-adjusted life years/year. Compared with Australian targets, the WHO benchmarks will avert around 3 and a half times more deaths each year (1770 versus 510). CONCLUSIONS Substantially greater health impact could be achieved if the Australian government strengthened its current sodium reformulation program by adopting WHO's more stringent and comprehensive sodium benchmarks.
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Affiliation(s)
- Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Maria Shahid
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Rain Yamamoto
- World Health Organization, Geneva, Switzerland (R.Y., C.N.)
| | | | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.).,Department of Epidemiology and Biostatistics, Imperial College London, United Kingdom (B.N.)
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (F.J.H.)
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.).,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.M.)
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.).,School of Population Health, University of New South Wales, Australia (J.H.Y.W.)
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12
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Chatelan A, Rouche M, Kelly C, Fismen AS, Pedroni C, Desbouys L, Castetbon K. Tax on sugary drinks and trends in daily soda consumption by family affluence: an international repeated cross-sectional survey among European adolescents. Am J Clin Nutr 2023; 117:576-585. [PMID: 36775689 DOI: 10.1016/j.ajcnut.2023.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The WHO recommends soda taxes to reduce sugar consumption, but the effect across socioeconomic groups is unclear. OBJECTIVES We assessed 16-y trends in daily soda consumption among adolescents in 4 European countries with a soda tax and 5 comparison countries, by family affluence. METHODS Five rounds of the international "Health Behaviour in School-Aged Children" school-based survey were used (school years 2001/2002 to 2017/2018, repeated cross-sectional design). Finland, France, Belgium, and Portugal introduced or updated a soda tax during this period. For comparison, we selected 5 neighboring countries without such a tax. Nationally representative samples of adolescents aged 13 and 15 y (n = 165,521; 51.2% girls) completed a standardized questionnaire, including a question on soda consumption frequency. Using the family affluence scale (FAS), we categorized adolescents into lower-, middle- or higher-affluent groups. Changes in daily soda consumption were assessed in each country independently. RESULTS Before taxation, daily soda consumption was more likely among lower-affluent adolescents in France and Belgium (P < 0.001, socioeconomic inequalities) and was similar across FAS groups in Finland and Portugal (no inequalities). After the tax, daily soda consumption was reduced across all FAS groups in Finland, Belgium, and Portugal (Pinteractions ≥ 0.33). In France, a posttax decrease was observed only among lower-affluent adolescents (ORlower, 0.76; 95% CI: 0.60, 0.96; reduced inequalities). During the same periods, socioeconomic patterns remained stable in 3 comparison countries (Pinteractions ≥ 0.38), and larger reductions in daily soda consumption were observed among middle- or higher-affluent adolescents compared with lower-affluent adolescents in the remaining 2 comparison countries (Pinteractions ≤ 0.08, increased inequalities). CONCLUSIONS Socioeconomic patterns did not change after the tax implementation in 3 out of 4 countries, and socioeconomic inequalities were reduced in France. Taxing sodas might be an effective measure to attenuate, or at least not exacerbate, socioeconomic inequalities in adolescent daily soda consumption. Am J Clin Nutr 20XX;xx:xx-xx.
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Affiliation(s)
- Angeline Chatelan
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium; Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.
| | - Manon Rouche
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - Anne-Siri Fismen
- Department of Health Promotion and Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Bergen, Norway
| | - Camille Pedroni
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Lucille Desbouys
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Katia Castetbon
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
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13
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Smith NR, Grummon AH, Ng SW, Wright ST, Frerichs L. Simulation models of sugary drink policies: A scoping review. PLoS One 2022; 17:e0275270. [PMID: 36191026 PMCID: PMC9529101 DOI: 10.1371/journal.pone.0275270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Simulation modeling methods are an increasingly common tool for projecting the potential health effects of policies to decrease sugar-sweetened beverage (SSB) intake. However, it remains unknown which SSB policies are understudied and how simulation modeling methods could be improved. To inform next steps, we conducted a scoping review to characterize the (1) policies considered and (2) major characteristics of SSB simulation models. METHODS We systematically searched 7 electronic databases in 2020, updated in 2021. Two investigators independently screened articles to identify peer-reviewed research using simulation modeling to project the impact of SSB policies on health outcomes. One investigator extracted information about policies considered and key characteristics of models from the full text of included articles. Data were analyzed in 2021-22. RESULTS Sixty-one articles were included. Of these, 50 simulated at least one tax policy, most often an ad valorem tax (e.g., 20% tax, n = 25) or volumetric tax (e.g., 1 cent-per-fluid-ounce tax, n = 23). Non-tax policies examined included bans on SSB purchases (n = 5), mandatory reformulation (n = 3), warning labels (n = 2), and portion size policies (n = 2). Policies were typically modeled in populations accounting for age and gender or sex attributes. Most studies focused on weight-related outcomes (n = 54), used cohort, lifetable, or microsimulation modeling methods (n = 34), conducted sensitivity or uncertainty analyses (n = 56), and included supplementary materials (n = 54). Few studies included stakeholders at any point in their process (n = 9) or provided replication code/data (n = 8). DISCUSSION Most simulation modeling of SSB policies has focused on tax policies and has been limited in its exploration of heterogenous impacts across population groups. Future research would benefit from refined policy and implementation scenario specifications, thorough assessments of the equity impacts of policies using established methods, and standardized reporting to improve transparency and consistency.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah Towner Wright
- Health Sciences Library, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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14
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on the available data regarding the associations of Ultra-processed food (UPF) consumption with food intake and possible underlying mechanisms relating UPF consumption to weight gain and co-morbidities. RECENT FINDINGS In primarily observational studies, UPF consumption is consistently associated with an increased risk for weight gain among adults and children and increased risk for adiposity-related co-morbidities in adults. In a single mechanistic study, consumption of UPFs led to increased energy intake and weight gain relative to whole foods. UPFs tend to be more energy-dense than nutrient-dense, and UPF consumption is associated with increased adiposity and co-morbidity risk. These data suggest that recommendations to limit UPF consumption may be beneficial to health - though further mechanistic studies are needed.
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Affiliation(s)
- Anthony Crimarco
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Matthew J Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christopher D Gardner
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA.
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15
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Love DC, Thorne-Lyman AL, Conrad Z, Gephart JA, Asche F, Godo-Solo D, McDowell A, Nussbaumer EM, Bloem MW. Affordability influences nutritional quality of seafood consumption among income and race/ethnicity groups in the United States. Am J Clin Nutr 2022; 116:415-425. [PMID: 35691612 PMCID: PMC9348982 DOI: 10.1093/ajcn/nqac099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/08/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The 2020 US Dietary Guidelines for Americans recommend that the US population consume more seafood. Most analyses of seafood consumption ignore heterogeneity in consumption patterns by species, nutritional content, production methods, and price, which have implications for applying recommendations. OBJECTIVES We assessed seafood intake among adults by socioeconomic and demographic groups, as well as the cost of seafood at retail to identify affordable and nutritious options. METHODS NHANES 2011-2018 dietary data (n = 17,559 total, n = 3285 eating seafood) were used to assess adult (≥20 y) intake of seafood in relation to income and race/ethnicity. Multivariable linear regression assessed the association between seafood consumption and income, adjusted for age, sex, and race/ethnicity, and the association between nutrients and seafood price, using Nielsen 2017-2019 retail sales data, adjusted for sales volume. RESULTS Low-income groups consume slightly less seafood than high-income groups [low income: mean 120.2 (95% CI: 103.5, 137.2) g/wk; high income: 141.8 (119.1, 164.1) g/wk] but substantially less seafood that is high in long-chain n-3 (ω-3) PUFAs [lower income: 21.3 (17.3, 25.5) g/wk; higher income: 46.8 (35.4, 57.8) g/wk]. Intake rates, species, and production method choices varied by race/ethnicity groups and within race/ethnicity groups by income. Retail seafood as a whole costs more than other protein foods (e.g., meat, poultry, eggs, beans), and fresh seafood high in n-3 PUFAs costs more (P < 0.002) than fresh seafood low in n-3 PUFAs. Retail seafood is available in a wide range of price points and product forms, and some lower-cost fish and shellfish were high in n-3 PUFAs, calcium, iron, selenium, and vitamins B-12 and D. CONCLUSIONS New insights into the relation between seafood affordability and consumption patterns among income and ethnicity groups suggest that specific policies and interventions may be needed to enhance the consumption of seafood by different groups.
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Affiliation(s)
| | - Andrew L Thorne-Lyman
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, USA,Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zach Conrad
- Department of Kinesiology, William & Mary, Williamsburg, VA, USA,Global Research Institute, William & Mary, Williamsburg, VA, USA
| | - Jessica A Gephart
- Department of Environmental Science, American University, Washington, DC, USA
| | - Frank Asche
- School of Forest, Fisheries and Geomatics Sciences and Food Systems Institute, University of Florida, Gainesville, FL, USA,Department of Safety, Economics and Planning, University of Stavanger, Stavanger, Norway
| | - Dakoury Godo-Solo
- Department of Environmental Science, American University, Washington, DC, USA
| | - Acree McDowell
- Department of Kinesiology, William & Mary, Williamsburg, VA, USA,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Elizabeth M Nussbaumer
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, USA,Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Martin W Bloem
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, USA,Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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16
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Mello AVD, Sarti FM, Fisberg RM. Associations among diet costs, food prices and income: Elasticities of risk and protection food groups for cardiometabolic diseases in Sao Paulo, Brazil (2003-2015). Nutr Health 2022:2601060221104579. [PMID: 35673763 DOI: 10.1177/02601060221104579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Economic dimension comprises important determinants of food choices, particularly income and prices. Aim: Identification of the influence of food prices and diet costs on the consumption of food groups considered protection and risk factors for cardiometabolic diseases. Methods: Food groups classification follows the proposal of "What we eat in America?" from the National Health and Nutrition Examination Survey (NHANES), adapted to Latin America. Data on food consumption from the Health Survey of Sao Paulo (2003, 2008, and 2015), representative at population level, was used. Log-linear regressions were estimated for food groups, controlling for endogeneity through augmented regression-test Results: Results showed increase in prices per calorie of whole grains and red meat from 2003-2015 and a decrease in prices per calorie of fruits, vegetables, beans, legumes, oilseeds and fish/seafood. Food groups had price elasticities between -0.01 and -1.6, i.e., decrease in consumption associated with increase in prices. Results showed statistically significant effects of substitution and complementarity, particularly substitution between sweetened beverages and fruits (2003, β = 0.606; 2008: β = 0.683; 2015, β = 0.848), complementarity between nuts and seeds and whole grains (2003, β = -0.646; 2008, β = -0.647; 2015,β = -0.901), and vegetables and processed meat (2003, β = -1.379; 2015, β = -1.685). Conclusion: Findings of the study represent relevant evidence for design strategies towards the adoption of healthier diets, particularly through subsidies to protection food groups, promoting lower prices and higher diet quality. The evidence may be useful for policymakers and researchers in fields of nutrition and health in diverse countries worldwide, especially due to absence of robust evidence in literature.
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Affiliation(s)
- Aline Veroneze de Mello
- Nutrition Department, School of Public Health, 28133University of São Paulo, São Paulo, Brazil
| | - Flávia Mori Sarti
- Nutrition Department, School of Public Health, 28133University of São Paulo, São Paulo, Brazil
| | - Regina Mara Fisberg
- Nutrition Department, School of Public Health, 28133University of São Paulo, São Paulo, Brazil
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17
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Vellakkal S, Khan Z, Alavani H, Fledderjohann J, Stuckler D. Effects of public policies in the prevention of cardiovascular diseases: a systematic review of global literature. Public Health 2022; 207:73-81. [PMID: 35567826 DOI: 10.1016/j.puhe.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Given the growing interest worldwide in applying public policies to improve human health, we undertook a systematic review of studies investigating whether public policies targeting unhealthy products could reduce cardiovascular diseases. STUDY DESIGN This study was a systematic review of the literature. METHODS We searched research studies published in 2000-2020 from major databases, including MEDLINE and Embase. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and narratively synthesized the studies based on vote counting and direction of the intervention effect. RESULTS Ninety-eight studies, mostly from high-income countries, met the inclusion criteria. Most studies were on public policies targeting sugar-sweetened beverages and tobacco, followed by alcohol, sugar, salt, and junk foods. Overall, many reported that several fiscal, regulatory, and educational policies generated beneficial effects of reducing the diseases. Those studies that reported no or limited effects highlighted several sociodemographic and health risk characteristics and design and implementation aspects of the policy interventions as factors limiting the policy effects; most of these are modifiable with appropriate policy interventions. For instance, low magnitude of tax, substitution with other unhealthy products, firms' competitive response strategies, pre-existence of smoking bans, incremental enactment of smoking regulations, degree of enforcement, and various sociocultural factors minimized the effects of the policies. CONCLUSION The literature supports a growing consensus on the beneficial effects of public policy for improving human health. The design and implementation of public policies must address various impeding factors and incorporate appropriate remedial measures. Further research is needed from low- and middle-income countries and on whether and how multiple policy instruments work in tandem.
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Affiliation(s)
- S Vellakkal
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kalyanpur, Uttar Pradesh, India.
| | - Z Khan
- IIPH Bhubaneshwar, Bhubaneshwar, Odisha, India
| | - H Alavani
- Department of Economics and Finance, BITS Pilani, KK Birla Goa Campus, Zuarinagar, Goa, India
| | - J Fledderjohann
- Department of Sociology, Lancaster University, Lancaster, UK
| | - D Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
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18
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Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022; 23:e13366. [PMID: 34632692 PMCID: PMC8639733 DOI: 10.1111/obr.13366] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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19
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Krieger J, Bleich SN, Scarmo S, Ng SW. Sugar-Sweetened Beverage Reduction Policies: Progress and Promise. Annu Rev Public Health 2021; 42:439-461. [PMID: 33256536 DOI: 10.1146/annurev-publhealth-090419-103005] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, political, and public health needs; and emerging science is critical.
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Affiliation(s)
- James Krieger
- Healthy Food America, Seattle, Washington 98122, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98195, USA;
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Stephanie Scarmo
- American Heart Association, National Center, Dallas, Texas 75231, USA;
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA;
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20
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Ramesh G, Belardo D, Gulati M, Ostfeld RJ, Michos ED. Agricultural policy and societal factors influence patients' ability to follow a healthy diet. Am J Prev Cardiol 2021; 8:100285. [PMID: 34816143 PMCID: PMC8593558 DOI: 10.1016/j.ajpc.2021.100285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022] Open
Abstract
Cardiovascular and cardiometabolic diseases are largely preventable, and are propagated by a poor diet. Poor diet may be due to a lack of supply and access to healthy foods, agricultural subsidies, and marketing. Improving national dietary intake starts with enhancing dietary guidelines, enacting legislative changes to optimize agricultural subsidies and food advertising, and incentivizing a plant-forward diet.
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Affiliation(s)
- Gautam Ramesh
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, AZ, USA
| | - Robert J Ostfeld
- Division of Cardiology, Montefiore Health System, Bronx, NY, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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21
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Trieu K, Coyle DH, Afshin A, Neal B, Marklund M, Wu JHY. The estimated health impact of sodium reduction through food reformulation in Australia: A modeling study. PLoS Med 2021; 18:e1003806. [PMID: 34699528 PMCID: PMC8547659 DOI: 10.1371/journal.pmed.1003806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Australian Government recently established sodium targets for packaged foods to encourage voluntary reformulation to reduce population sodium consumption and related diseases. We modeled the health impact of Australia's sodium reformulation targets and additional likely health gains if more ambitious, yet feasible sodium targets had been adopted instead. METHODS AND FINDINGS Using comparative risk assessment models, we estimated the averted deaths, incidence, and disability-adjusted life years (DALYs) from cardiovascular disease (CVD), chronic kidney disease (CKD) and stomach cancer after implementation of (a) Australia's sodium targets (overall and by individual companies); (b) United Kingdom's targets (that covers more product categories); and (c) an optimistic scenario (sales-weighted 25th percentile sodium content for each food category included in the UK program). We used nationally representative data to estimate pre- and post-intervention sodium intake, and other key data sources from the Global Burden of Disease study. Full compliance with the Australian government's sodium targets could prevent approximately 510 deaths/year (95% UI, 335 to 757), corresponding to about 1% of CVD, CKD, and stomach cancer deaths, and prevent some 1,920 (1,274 to 2,600) new cases and 7,240 (5,138 to 10,008) DALYs/year attributable to these diseases. Over half (59%) of deaths prevented is attributed to reformulation by 5 market-dominant companies. Compliance with the UK and optimistic scenario could avert approximately an additional 660 (207 to 1,227) and 1,070 (511 to 1,856) deaths/year, respectively, compared to Australia's targets. The main limitation of this study (like other modeling studies) is that it does not prove that sodium reformulation programs will prevent deaths and disease events; rather, it provides the best quantitative estimates and the corresponding uncertainty of the potential effect of the different programs to guide the design of policies. CONCLUSIONS There is significant potential to strengthen Australia's sodium reformulation targets to improve its health impact. Promoting compliance by market-dominant food companies will be critical to achieving the potential health gains.
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Affiliation(s)
- Kathy Trieu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Daisy H. Coyle
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ashkan Afshin
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Epidemiology and Biostatistics, Imperial College London, United Kingdom
| | - Matti Marklund
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jason H. Y. Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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22
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Siegel KR, Albright AL. Population-Level Approaches to Preventing Type 2 Diabetes Globally. Endocrinol Metab Clin North Am 2021; 50:401-414. [PMID: 34399953 DOI: 10.1016/j.ecl.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes (T2DM) is increasingly considered an epidemic rooted in modern society as much as in individual behavior. Addressing the T2DM burden thus involves a dual approach, simultaneously addressing high-risk individuals and whole populations. Within this context, this article summarizes the evidence base, in terms of effectiveness and cost-effectiveness, for population-level approaches to prevent T2DM: (1) modifications to the food environment; (2) modifications to the built environment and physical activity; and (3) programs and policies to address social and economic factors. Existing knowledge gaps are also discussed.
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Affiliation(s)
- Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Atlanta, GA 30341, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Ann L Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Atlanta, GA 30341, USA
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23
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Alcaraz A, Pichon-Riviere A, Palacios A, Bardach A, Balan DJ, Perelli L, Augustovski F, Ciapponi A. Sugar sweetened beverages attributable disease burden and the potential impact of policy interventions: a systematic review of epidemiological and decision models. BMC Public Health 2021; 21:1460. [PMID: 34315428 PMCID: PMC8317409 DOI: 10.1186/s12889-021-11046-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Around 184,000 deaths per year could be attributable to sugar-sweetened beverages (SSBs) consumption worldwide. Epidemiological and decision models are important tools to estimate disease burden. The purpose of this study was to identify models to assess the burden of diseases attributable to SSBs consumption or the potential impact of health interventions. METHODS We carried out a systematic review and literature search up to August 2018. Pairs of reviewers independently selected, extracted, and assessed the quality of the included studies through an exhaustive description of each model's features. Discrepancies were solved by consensus. The inclusion criteria were epidemiological or decision models evaluating SSBs health interventions or policies, and descriptive SSBs studies of decision models. Studies published before 2003, cost of illness studies and economic evaluations based on individual patient data were excluded. RESULTS We identified a total of 2766 references. Out of the 40 included studies, 45% were models specifically developed to address SSBs, 82.5% were conducted in high-income countries and 57.5% considered a health system perspective. The most common model's outcomes were obesity/overweight (82.5%), diabetes (72.5%), cardiovascular disease (60%), mortality (52.5%), direct medical costs (57.35%), and healthy years -DALYs/QALYs- (40%) attributable to SSBs. 67.5% of the studies modelled the effect of SSBs on the outcomes either entirely through BMI or through BMI plus diabetes independently. Models were usually populated with inputs from national surveys -such us obesity prevalence, SSBs consumption-; and vital statistics (67.5%). Only 55% reported results by gender and 40% included children; 30% presented results by income level, and 25% by selected vulnerable groups. Most of the models evaluated at least one policy intervention to reduce SSBs consumption (92.5%), taxes being the most frequent strategy (75%). CONCLUSIONS There is a wide range of modelling approaches of different complexity and information requirements to evaluate the burden of disease attributable to SSBs. Most of them take into account the impact on obesity, diabetes and cardiovascular disease, mortality, and economic impact. Incorporating these tools to different countries could result in useful information for decision makers and the general population to promote a deeper implementation of policies to reduce SSBs consumption. PROSPERO PROTOCOL NUMBER CRD42020121025 .
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Affiliation(s)
- Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
| | - Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Dario Javier Balan
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Popkin BM, Barquera S, Corvalan C, Hofman KJ, Monteiro C, Ng SW, Swart EC, Taillie LS. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol 2021; 9:462-470. [PMID: 33865500 PMCID: PMC8217149 DOI: 10.1016/s2213-8587(21)00078-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
The global surges in obesity and nutrition-related non-communicable diseases (NCDs) have created a need for decisive new food policy initiatives. A major concern has been the impact of ultra-processed foods (UPFs) and ultra-processed drinks on weight gain and on the risk of several NCDs. These foods, generally high in calories, added sugar, sodium, and unhealthy fats, and poor in fibre, protein, and micronutrients, have extensive negative effects on human health and on the environment (due to their associated carbon emission and water use). There is a growing tendency worldwide, and especially in South America, for food companies to add micronutrients to UPFs to make health claims regarding these products, to which food-regulating authorities refer to fake foods. Although more than 45 countries and smaller subregional or urban entities have created taxes on ultra-processed drinks, such as sugar-sweetened beverages, only a few have adopted taxes on snacks and other UPFs, and none have added major subsidies for truly healthy, fresh or minimally processed food for people from lower socioeconomic backgrounds. Another major focus has been on developing effective package labelling. A smaller number of countries have selected the most impactful warning labels and linked them with other measures to create a mutually reinforcing set of policies; a few other countries have developed effective school food policies. We herein present in-depth results from key countries involved in all these actions and in comprehensive marketing controls, and conclude with our recommendations for the future. This field is quite new; progress to date is substantial, but much more is left to learn.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Simon Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Karen J Hofman
- South African Medical Research Council Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Carlos Monteiro
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth C Swart
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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25
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Tönnies T, Heidemann C, Paprott R, Seidel-Jacobs E, Scheidt-Nave C, Brinks R, Hoyer A. Estimating the impact of tax policy interventions on the projected number and prevalence of adults with type 2 diabetes in Germany between 2020 and 2040. BMJ Open Diabetes Res Care 2021; 9:9/1/e001813. [PMID: 33455907 PMCID: PMC7813323 DOI: 10.1136/bmjdrc-2020-001813] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION As a population-wide intervention, it has been proposed to raise taxes on unhealthy products to prevent diseases such as type 2 diabetes. In this study, we aimed to estimate the effect of tax policy interventions in 2020 on the projected prevalence and number of people with type 2 diabetes in the German adult population in 2040. RESEARCH DESIGN AND METHODS We applied an illness-death model and the German Diabetes Risk Score (GDRS) to project the prevalence and number of adults with type 2 diabetes in Germany under a base case scenario and under a tax policy intervention scenario. For the base case scenario, we assumed constant age-specific incidence rates between 2020 and 2040. For the intervention scenario, we assumed a 50% price increase for sugar-sweetened beverages, tobacco and red meat products in the year 2020. Based on price elasticities, we estimated the impact on these risk factors alone and in combination, and calculated subsequent reductions in the age-specific and sex-specific GDRS. These reductions were used to determine reductions in the incidence rate and prevalence using a partial differential equation. RESULTS Compared with the base case scenario, combined tax interventions in 2020 resulted in a 0.95 percentage point decrease in the prevalence of type 2 diabetes (16.2% vs 17.1%), which corresponds to 640 000 fewer prevalent cases of type 2 diabetes and a relative reduction by 6%. CONCLUSIONS Taxation of sugar-sweetened beverages, tobacco products and red meat by 50% modestly lowered the projected number and prevalence of adults with type 2 diabetes in Germany in 2040. Raising taxes on unhealthy products as a stand-alone measure may not be enough to attenuate the future rise of type 2 diabetes.
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Affiliation(s)
- Thaddäus Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Esther Seidel-Jacobs
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Chair for Medical Biometry and Epidemiology, Witten/Herdecke University, Faculty of Health/School of Medicine, Witten, Germany
- Department of Statistics, Ludwig Maximilians University Munich, Munich, Germany
| | - Annika Hoyer
- Department of Statistics, Ludwig Maximilians University Munich, Munich, Germany
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Du M, Griecci CF, Kim DD, Cudhea F, Ruan M, Eom H, Wong JB, Wilde PE, Michaud DS, Lee Y, Micha R, Mozaffarian D, Zhang FF. Cost-Effectiveness of a National Sugar-Sweetened Beverage Tax to Reduce Cancer Burdens and Disparities in the United States. JNCI Cancer Spectr 2020; 4:pkaa073. [PMID: 33409452 PMCID: PMC7771430 DOI: 10.1093/jncics/pkaa073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/24/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) consumption contributes to obesity, a risk factor for 13 cancers. Although SSB taxes can reduce intake, the health and economic impact on reducing cancer burdens in the United States are unknown, especially among low-income Americans with higher SSB intake and obesity-related cancer burdens. METHODS We used the Diet and Cancer Outcome Model, a probabilistic cohort state-transition model, to project health gains and economic benefits of a penny-per-ounce national SSB tax on reducing obesity-associated cancers among US adults aged 20 years and older by income. RESULTS A national SSB tax was estimated to prevent 22 075 (95% uncertainty interval [UI] = 16 040-28 577) new cancer cases and 13 524 (95% UI = 9841-17 681) cancer deaths among US adults over a lifetime. The policy was estimated to cost $1.70 (95% UI = $1.50-$1.95) billion for government implementation and $1.70 (95% UI = $1.48-$1.96) billion for industry compliance, while saving $2.28 (95% UI = $1.67-$2.98) billion cancer-related healthcare costs. The SSB tax was highly cost-effective from both a government affordability perspective (incremental cost-effectiveness ratio [ICER] = $1486, 95% UI = -$3516-$9265 per quality-adjusted life year [QALY]) and a societal perspective (ICER = $13 220, 95% UI = $3453-$28 120 per QALY). Approximately 4800 more cancer cases and 3100 more cancer deaths would be prevented, and $0.34 billion more healthcare cost savings would be generated among low-income (federal poverty-to-income ratio [FPIR] ≤ 1.85) than higher-income individuals (FPIR > 1.85). CONCLUSIONS A penny-per-ounce national SSB tax is cost-effective for cancer prevention in the United States, with the largest health gains and economic benefits among low-income Americans.
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Affiliation(s)
- Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Christina F Griecci
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Mengyuan Ruan
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Heesun Eom
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA
| | - Parke E Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Yujin Lee
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Consumption of Foods Derived from Subsidized Crops Remains Associated with Cardiometabolic Risk: An Update on the Evidence Using the National Health and Nutrition Examination Survey 2009-2014. Nutrients 2020; 12:nu12113244. [PMID: 33113961 PMCID: PMC7690710 DOI: 10.3390/nu12113244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 01/17/2023] Open
Abstract
In this study, we examined the associations between the consumption of foods derived from crops subsidized under the 2008 United States (US) Farm Bill and cardiometabolic risk factors and whether the magnitude of these associations has changed since the 2002 US Farm Bill. Four federal databases were used to estimate daily consumption of the top seven subsidized commodities (corn, soybeans, wheat, rice, sorghum, dairy, and livestock) and to calculate a subsidy score (0-1 scale) for Americans' daily dietary intake during 2009-2014, with a higher score indicative of a higher proportion of the diet derived from subsidized commodities. The cardiometabolic risk factors included obesity, abdominal adiposity, hypertension, dyslipidemia, and dysglycemia. Linear and logistic regression models were adjusted for age, sex, race/ethnicity, the poverty-income ratio, the smoking status, educational attainment, physical activity, and daily calorie intake. During 2009-2014, adults with the highest subsidy score had higher probabilities of obesity, abdominal adiposity, and dysglycemia compared to the lowest subsidy score. After the 2002 Farm Bill (measured using data from 2001-2006), the subsidy score decreased from 56% to 50% and associations between consuming a highly-subsidized diet and dysglycemia did not change (p = 0.54), whereas associations with obesity (p = 0.004) and abdominal adiposity (p = 0.002) significantly attenuated by more than half. The proportion of calories derived from subsidized food commodities continues to be associated with adverse cardiometabolic risk factors, though the relationship with obesity and abdominal adiposity has weakened in recent years.
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Moran AJ, Gu Y, Clynes S, Goheer A, Roberto CA, Palmer A. Associations between Governmental Policies to Improve the Nutritional Quality of Supermarket Purchases and Individual, Retailer, and Community Health Outcomes: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7493. [PMID: 33076280 PMCID: PMC7602424 DOI: 10.3390/ijerph17207493] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 01/19/2023]
Abstract
Supermarkets are natural and important settings for implementing environmental interventions to improve healthy eating, and governmental policies could help improve the nutritional quality of purchases in this setting. This review aimed to: (1) identify governmental policies in the United States (U.S.), including regulatory and legislative actions of federal, tribal, state, and local governments, designed to promote healthy choices in supermarkets; and (2) synthesize evidence of these policies' effects on retailers, consumers, and community health. We searched five policy databases and developed a list of seven policy actions that meet our inclusion criteria: calorie labeling of prepared foods in supermarkets; increasing U.S. Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) benefits; financial incentives for the purchase of fruit and vegetables; sweetened beverage taxes; revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package; financial assistance for supermarkets to open in underserved areas; and allowing online purchases with SNAP. We searched PubMed, Econlit, PsycINFO, Web of Science, and Business Source Ultimate to identify peer-reviewed, academic, English-language literature published at any time until January 2020; 147 studies were included in the review. Sweetened beverage taxes, revisions to the WIC food package, and financial incentives for fruits and vegetables were associated with improvements in dietary behaviors (food purchases and/or consumption). Providing financial incentives to supermarkets to open in underserved areas and increases in SNAP benefits were not associated with changes in food purchasing or diet quality but may improve food security. More research is needed to understand the effects of calorie labeling in supermarkets and online SNAP purchasing.
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Affiliation(s)
- Alyssa J. Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Yuxuan Gu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (Y.G.); (S.C.)
| | - Sasha Clynes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (Y.G.); (S.C.)
| | - Attia Goheer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Anne Palmer
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21202, USA
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29
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Bleich SN, Long MW. Simple Is Better for Local Beverage Tax Policy Diffusion. Circulation 2020; 142:535-537. [PMID: 32776845 PMCID: PMC7418759 DOI: 10.1161/circulationaha.120.048336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (S.N.B.)
| | - Michael W. Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC (M.W.L.)
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30
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Maani N, McKee M, Petticrew M, Galea S. Corporate practices and the health of populations: a research and translational agenda. LANCET PUBLIC HEALTH 2020; 5:e80-e81. [PMID: 32032560 DOI: 10.1016/s2468-2667(19)30270-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Nason Maani
- School of Public Health, Boston University, Boston, MA 02118, USA; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA 02118, USA.
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31
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Pomeranz JL, Huang Y, Mozaffarian D, Micha R. Legal Feasibility and Implementation of Federal Strategies for a National Retail-Based Fruit and Vegetable Subsidy Program in the United States. Milbank Q 2020; 98:775-801. [PMID: 32691937 DOI: 10.1111/1468-0009.12461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Policy Points Suboptimal intake of fruit and vegetables is associated with increased risk of diet-related diseases. A national retail-based fruit and vegetable subsidy program could broadly benefit the health of the entire population. Existing fruit and vegetable subsidy programs can inform potential implementation mechanisms; Congress's powers to tax, spend, and regulate interstate commerce can be leveraged to create a federal program. Legal and administrative feasibility considerations support a conditional funding program or a federal-state cooperative program combining regulation, licensing, and state or local options for flexible implementation strategies. Strategies to engage key stakeholders would enable the program to utilize lessons learned from existing programs. CONTEXT Suboptimal intake of fruit and vegetables (F&Vs) is associated with increased risk of diet-related diseases. Yet, there are no US government programs to support increased F&V consumption nationally for the whole population, most of whom purchase food at retail establishments. To inform policy discussion and implementation, we identified mechanisms to effectuate a national retail-based F&V subsidy program. METHODS We conducted legal and policy research using LexisNexis, the UConn Rudd Center Legislation Database, the Centers for Disease Control and Prevention Chronic Disease State Policy Tracking System, the US Department of Agriculture's website, Congress.gov, gray literature, and government reports. First, we identified existing federal, state, local, and nongovernmental organization (NGO) policies and programs that subsidize F&Vs. Second, we evaluated Congress's power to implement a national retail-based F&V subsidy program. FINDINGS We found five federal programs, three federal bills, four state laws, and 17 state (including the District of Columbia [DC]) bills to appropriate money to supplement federal food assistance programs with F&Vs; 74 programs (six multistate, 22 state [including DC], and 46 local) administered by state and local governments and NGOs that incentivize the purchase of F&Vs for various subpopulations; and two state laws and 11 state bills to provide tax exemptions for F&Vs. To create a national F&V subsidy program, Congress could use its Commerce Clause powers or its powers to tax or spend, through direct regulation, licensing, taxation, tax incentives, and conditional funding. Legal and administrative feasibility considerations support a voluntary conditional funding program or, as a second option, a mandatory federal-state cooperative program combining regulation and licensing. CONCLUSIONS Multiple existing programs provide an important foundation to inform potential implementation mechanisms for a national F&V subsidy program. Results also highlight the value of state and local participation to leverage existing networks and stakeholder knowledge.
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Affiliation(s)
| | - Yue Huang
- Friedman School of Nutrition Science and Policy, Tufts University
| | | | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University
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To what extent could cardiovascular diseases be reduced if Germany applied fiscal policies to increase fruit and vegetable consumption? A quantitative health impact assessment. Public Health Nutr 2020; 24:2570-2576. [PMID: 32662362 PMCID: PMC8145472 DOI: 10.1017/s1368980020000634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: This study aimed to dynamically model and quantify expected health effects of four scenarios: (i) a reference scenario with an unchanged fruit and vegetable intake, (ii) the removal of value-added tax (VAT) on fruits and vegetables, (iii) the implementation of a 20 % subsidy on fruits and vegetables and (iv) a guideline scenario with a population-wide fruit and vegetable intake of five portions per day. Design: Baseline fruit and vegetable intake data was derived from the GEDA 2012 study. We used price elasticities for Germany to calculate the change in fruit and vegetable consumption under the zero VAT and the 20 % subsidy scenario. All scenarios were modelled over a 10-year projection period using DYNAMO-HIA. Setting: Germany. Participants: A projected real-life population. Results: Cumulated over the 10-year projection period, an estimated 4450 incident ischaemic heart disease (IHD) cases, 7010 stroke cases and 13 960 deaths would be prevented under the zero VAT scenario. Under the 20 % subsidy scenario, 17 990 incident IHD cases, 27 390 stroke cases and 54 880 deaths would be averted. Although this corresponds to only a fraction of the incidents that would occur under the reference scenario, the averted cases translate to 2 % (for the zero VAT scenario) and 9 % (for the 20 % subsidy scenario) of IHD, stroke and death cases that would be prevented if the whole population consumed the recommended five portions of fruits and vegetables per day. Conclusions: Fiscal policies on fruits and vegetables provide a non-negligible step towards the removal of the health burden induced by low fruit and vegetable intake.
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Lobstein T, Neveux M, Landon J. Costs, equity and acceptability of three policies to prevent obesity: A narrative review to support policy development. Obes Sci Pract 2020; 6:562-583. [PMID: 33082998 PMCID: PMC7556431 DOI: 10.1002/osp4.423] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022] Open
Abstract
Obesity prevention policies are a priority for many governments and intergovernmental agencies. Policy makers not only use systematic reviews of effectiveness but also consider contextual issues including cost and cost‐effectiveness, equity, rights, acceptability and feasibility. To support their work, the present narrative review examines three contextual issues (costs, equity and acceptability) in relation to three policies for obesity prevention: sweetened beverage taxes, front‐of‐pack nutrition labelling and restrictions on advertising to children. Literature searches led to over 1100 documents, of which 125 informed the present review. Beverage taxes were found likely to be highly cost‐effective, moderately favourable for health equity, supported by the public (depending on the use of revenues) and by health professionals and civil society groups and opposed by commercial interests. Depending on the design, front‐of‐pack nutritional labelling is likely to be highly cost‐effective, moderately favourable for health equity, supported by the public, health professionals and civil society groups, and opposed by commercial interests. Restrictions on child‐directed advertising are likely to be highly cost‐effective in the longer term, moderately favourable for health equity, supported by the public, health professionals and civil society groups and opposed by commercial interests (unless voluntary). The evidence base needs strengthening, but the authors find that all three policies merit consideration by governmental authorities, and should be implemented to reduce obesity risk.
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Affiliation(s)
- Tim Lobstein
- Policy Department World Obesity Federation London UK.,The Boden Institute, Charles Perkins Centre The University of Sydney Sydney New South Wales Australia
| | - Margot Neveux
- Policy Department World Obesity Federation London UK
| | - Jane Landon
- Policy Department UKPH Consultancy London UK
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Deal BJ, Huffman MD, Binns H, Stone NJ. Perspective: Childhood Obesity Requires New Strategies for Prevention. Adv Nutr 2020; 11:1071-1078. [PMID: 32361757 PMCID: PMC7490151 DOI: 10.1093/advances/nmaa040] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity among youth in the USA is currently >18% with projections that more than half of today's children will be obese as adults. The growth trajectory of children more likely to become obese is determined by weight in earliest childhood, and childhood body mass index (BMI) tracks through adolescence and adulthood. Childhood consequences of obesity include increased risk of asthma, type 2 diabetes mellitus, orthopedic disorders, and reduced academic performance. Health implications of obesity in adulthood include premature coronary artery disease, hypertension, type 2 diabetes, stroke, and certain cancers, contributing to the leading causes of adult mortality. Early childhood obesity is influenced by prenatal exposure to maternal obesity and environmental obesogens, and is associated with poverty, food insecurity, and poor nutritional quality. New strategies for primordial prevention of early childhood obesity require focusing attention on growth parameters during the first 2 y of life, with support for increasing the duration of breastfeeding, and improvements in dietary quality and availability, particularly the reduced consumption of added sugars. Reducing the prevalence of obesity among adolescent females and reducing exposure to environmental obesogens may reduce the prevalence of transgenerational obesity. The reduction of early childhood obesity could improve population health, quality of life, and longevity throughout the life course.
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Affiliation(s)
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA,The George Institute for Global Health, Sydney, Australia
| | - Helen Binns
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Neil J Stone
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Zorbas C, Grigsby-Duffy L, Backholer K. Getting the Price Right: How Nutrition and Obesity Prevention Strategies Address Food and Beverage Pricing Within High-Income Countries. Curr Nutr Rep 2020; 9:42-53. [PMID: 31953676 DOI: 10.1007/s13668-020-00300-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Food and beverage prices are major influences on dietary intakes. International health bodies recommend leveraging food prices to create healthier food environments. A policy review was conducted to understand the extent to which national nutrition and obesity prevention policy strategies within high-income countries (i) consider food price as a determinant of health and (ii) propose and implement policies to rebalance food pricing towards healthier options. RECENT FINDINGS Policy strategies were inconsistent and fragmented in their inclusion of food prices as determinants of diet-related health. The equity benefits of pricing policies were often indicated. Fiscal measures and food subsidies in schools were the most commonly proposed and implemented pricing policies, predominantly used in Europe. Price is a pertinent but underutilized policy lever in nutrition policy. Comprehensive food and beverage pricing strategies need to be identified, adopted and implemented to improve population diets for everyone.
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Affiliation(s)
- Christina Zorbas
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Lily Grigsby-Duffy
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
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Abstract
Objective: To measure change in price of food groups over time (1995–2030) in Brazil, considering the Brazilian Dietary Guidelines’ recommendations. Design: Data from the Household Budget Survey (2008–2009 HBS) and the National System of Consumer Price Indexes (NSCPI) were used to create a data set containing monthly prices for the foods and beverages most consumed in the country (n 102), from January 1995 to December 2017. Data on price of foods and beverages from 2008–2009 HBS (referring to January 2009) were used to calculate real price over time using the monthly variation in prices from NSCPI. All prices were deflated to December 2017. Foods and beverages were classified following the Brazilian Dietary Guidelines’ recommendations. The monthly price for each food group and subgroup was used to analyse changes in prices from 1995 to 2017 and to forecast prices up to 2030 using fractional polynomial models. Setting: Brazil. Participants: National estimates of foods and beverages purchased for Brazil. Results: In 1995, ultra-processed foods were the most expensive group (R$ 6·51/kg), followed by processed foods (R$ 6·44/kg), then unprocessed or minimally processed foods and culinary ingredients (R$ 3·45/kg). Since the early 2000s, the price of ultra-processed foods underwent successive reductions, becoming cheaper than processed foods and reducing the distance between it and the price of the other group. Forecasts indicate that unhealthy foods will become cheaper than healthy foods in 2026. Conclusions: Food prices in Brazil have changed unfavourably considering the Brazilian Dietary Guidelines’ recommendations. This may imply a decrease in the quality of the population’s diet.
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Mendoza-Herrera K, Pedroza-Tobías A, Hernández-Alcaraz C, Ávila-Burgos L, Aguilar-Salinas CA, Barquera S. Attributable Burden and Expenditure of Cardiovascular Diseases and Associated Risk Factors in Mexico and other Selected Mega-Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4041. [PMID: 31652519 PMCID: PMC6843962 DOI: 10.3390/ijerph16204041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/13/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND This paper describes the health and economic burden of cardiovascular diseases (CVD) in Mexico and other mega-countries through a review of literature and datasets. METHODS Mega-countries with a low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S.A./Japan) human development index were included. The review was focused on prevalence of dyslipidemias and CVD economic impact and conducted according to the PRISMA statement. Public datasets of CVD indicators were explored. RESULTS Heterogeneity in economic data and limited information on dyslipidemias were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared with other countries. Higher contribution of dietary risk factors for cardiovascular mortality and greater probability of dying prematurely from CVD were observed in developing countries. From 1990-2016, a greater decrease in cardiovascular mortality in developed countries was registered. In 2015, a CVD expense equivalent to 4% of total health expenditure was reported in Mexico. CVD ranked first in health expenditures in almost all these nations and the economic burden will remain significant for decades to come. CONCLUSIONS Resources should be assured to optimize CVD risk monitoring. Educational and medical models must be improved to enhance CVD diagnosis and the prescription and adherence to treatments. Long-term benefits could be attained by modifying the food system.
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Affiliation(s)
- Kenny Mendoza-Herrera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
| | - Andrea Pedroza-Tobías
- Institute for Global Health Sciences, University of California, San Francisco, CA 94158, USA.
| | - César Hernández-Alcaraz
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
| | - Leticia Ávila-Burgos
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabolicas, Mexico City 14080, Mexico.
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City 14080, Mexico.
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64710, N.L., Mexico.
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
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Conrad Z, Johnson LK, Jahns L, Roemmich JN. Food Price Elasticity by Status of Participation in Federal Food Assistance Programs: A Laboratory-Based Grocery Store Study. Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Background
Federal food assistance programs target low-income and nutritionally vulnerable Americans, with the dual goals of reducing food insecurity and improving diet quality. Individuals on limited food budgets may face constraints on their ability to purchase healthy foods when their prices increase, which could mitigate the intended impact of federal feeding programs. To better understand the effect of food price changes on healthy food purchases, we focus on eggs, which are rich in many important nutrients and can be a healthy part of a wide range of cultural food menus.
Objective
We use a laboratory-based grocery store experiment (n = 80) to examine the difference in price elasticity of eggs between individuals participating in food assistance programs and those not participating in these programs. This trial was registered at clinicaltrials.gov as NCT03296878.
Methods
Subjects completed several food purchasing trials, as well as questionnaires that assessed demographic, psychosocial, and other factors. Mixed linear regression models were used to assess the relationship between food price changes and food purchases (price elasticity).
Results
No difference in price elasticity was observed between groups, but subjects in both groups decreased their egg purchases by 6.9–8.6% for every 10% increase in egg price. For every 10% increase in the price of all nonegg foods, egg purchases increased by 3.3% among federal food assistance program participants but not nonparticipants, and purchases for foods such as lean meats, low-fat dairy, fruits, vegetables, and whole grains decreased by up to 14% among both groups.
Conclusions
Efforts to emphasize healthy eating strategies for individuals on limited budgets will be especially important during times of food price increases. Additional research is needed to estimate the price elasticities of other food groups among individuals participating in federal food assistance programs.
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Affiliation(s)
- Zach Conrad
- Grand Forks Human Nutrition Research Center. US Department of Agriculture, Agricultural Research Service, Grand Forks, ND
- Department of Health Sciences, William and Mary, Williamsburg, VA
| | - LuAnn K Johnson
- Grand Forks Human Nutrition Research Center. US Department of Agriculture, Agricultural Research Service, Grand Forks, ND
| | - Lisa Jahns
- Grand Forks Human Nutrition Research Center. US Department of Agriculture, Agricultural Research Service, Grand Forks, ND
| | - James N Roemmich
- Grand Forks Human Nutrition Research Center. US Department of Agriculture, Agricultural Research Service, Grand Forks, ND
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Intake of 12 food groups and disability-adjusted life years from coronary heart disease, stroke, type 2 diabetes, and colorectal cancer in 16 European countries. Eur J Epidemiol 2019; 34:765-775. [PMID: 31030306 PMCID: PMC6602984 DOI: 10.1007/s10654-019-00523-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/20/2019] [Indexed: 12/28/2022]
Abstract
Our aim was to estimate and rank 12 food groups according to disability-adjusted life years (DALYs) from coronary heart disease (CHD), stroke, type 2 diabetes (T2D), and colorectal cancer (CRC) in 16 European countries. De novo published non-linear dose-response meta-analyses of prospective studies (based on 297 primary reports), and food consumption data from the European Food Safety Authority Comprehensive European Food Consumption Database in Exposure Assessment, and DALY estimates from the Institute for Health Metrics and Evaluation were used. By implementing disease-specific counterfactual scenarios of theoretical minimum risk exposure level (TMRELs), the proportion of DALYs attributed to 12 food groups was estimated. In addition, a novel modelling approach was developed to obtain a single (optimized) TMREL across diseases. Four scenarios were analysed (A: disease-specific TMRELs/all food-disease associations; B: disease-specific TMRELs/only significant food-disease associations; C: single TMREL/all food-disease associations; D: single TMREL/only significant food-disease associations). Suboptimal food intake was associated with the following proportions of DALYs; Scenario A (highest-estimate) and D (lowest-estimate): CHD (A: 67%, D: 52%), stroke (A: 49%, D: 30%), T2D (A: 57%, D: 51%), and CRC (A: 54%, D: 40%). Whole grains (10%) had the highest impact on DALYs, followed by nuts (7.1%), processed meat (6.4%), fruit (4.4%) and fish and legumes (4.2%) when combining all scenarios. The contribution to total DALYs of all food groups combined in the different scenarios ranged from 41-52% in Austria to 51-69% in the Czech-Republic. These findings could have important implications for planning future food-based dietary guidelines as a public health nutrition strategy.
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MAANI HESSARI NASON, RUSKIN GARY, McKEE MARTIN, STUCKLER DAVID. Public Meets Private: Conversations Between Coca-Cola and the CDC. Milbank Q 2019; 97:74-90. [PMID: 30693564 PMCID: PMC6422605 DOI: 10.1111/1468-0009.12368] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Policy Points There is growing understanding of how manufacturers of harmful products influence health policy. The strategies, approaches, and influences from such manufacturers that are detrimental to health have been termed the "corporate" or "commercial" determinants of health. However, while partnerships with the tobacco industry are clearly unacceptable for public health organizations, ties to other industries continue to be pursued. Such partnerships may influence health organizations in a number of ways detrimental to population health. However, with the exception of tobacco industry tactics as revealed by internal documents, we know relatively little about how this influence operates. This article uses emails between the Coca-Cola Company and the Centers for Disease Control and Prevention, which we obtained through Freedom of Information Act requests, to explore the nature of corporate influence, conflicts of interest, and lobbying "in their own words," and highlights the need for greater transparency and clearer policies on engaging with such industries. CONTEXT There is a continuing debate about the appropriateness of contacts between manufacturers of some harmful products and health researchers, as well as practitioners and policymakers. Some argue that such contacts may be a means of exerting undue influence, while others present them as an opportunity to pursue shared health goals. This article examines interactions between the Centers for Disease Control and Prevention (CDC) and the Coca-Cola Company (Coca-Cola) as revealed by communications obtained through Freedom of Information Act (FOIA) requests. METHODS We sent 10 US FOIA requests in 2016/2017 for communications between employees at the CDC and Coca-Cola. We then performed a thematic content analysis of the documents provided. FINDINGS Of our 10 FOIA requests, 3 requests are still pending (at the time of this publication); 5 were rejected as too broad or because no records were found; and 3 returned 295 pages from 86 emails. The CDC withheld 102 pages to "protect commercial or financial information which is privileged or confidential." The returned emails demonstrate three main themes in Coca-Cola's contact with CDC employees: to gain and expand access, to lobby, and to shift attention and blame away from sugar-sweetened beverages. CONCLUSIONS The emails we obtained using FOIA requests reveal efforts by Coca-Cola to lobby the CDC to advance corporate objectives rather than health, including to influence the World Health Organization. Our findings provide a rare example of the ways in which corporate interests attempt to influence public health practitioners "in their own words," and they demonstrate a need for clearer policies on avoiding partnerships with manufacturers of harmful products.
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Franco-Arellano B, Kim MA, Vandevijvere S, Bernstein JT, Labonté MÈ, Mulligan C, L'Abbé MR. Assessment of Packaged Foods and Beverages Carrying Nutrition Marketing against Canada's Food Guide Recommendations. Nutrients 2019; 11:E411. [PMID: 30781351 PMCID: PMC6412409 DOI: 10.3390/nu11020411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 02/07/2023] Open
Abstract
Canadians' food purchases consist largely of packaged processed and ultra-processed products, which typically fall outside the "core" foods recommended by Canada's Food Guide (CFG). Almost half of packaged products in Canada carry nutrition marketing (i.e., nutrient content and health claims). This study assessed whether packaged foods carrying nutrition marketing align with recommendations outlined in the 2007 CFG. Label data (n = 9376) were extracted from the 2013 Food Label Information Program (FLIP). Label components (including nutrition marketing) were classified using the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) labelling taxonomy. The Health Canada Surveillance Tool (HCST) was used to assess the alignment of products to CFG. Each food or beverage was classified into one of five groups (i.e., Tier 1, Tier 2, Tier 3, Tier 4, "Others"). Products in Tier 1, 2 or water were considered "in line with CFG". Most products in the analyzed sample were classified as Tier 2 (35%) and Tier 3 (27%). Although foods with nutrition marketing were significantly more likely to align to CFG recommendations (p < 0.001), many products not "in line with CFG" still carried nutrition marketing. This study provides important baseline data that could be used upon the implementation of the new CFG.
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Affiliation(s)
- Beatriz Franco-Arellano
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Min Ah Kim
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada.
| | - Stefanie Vandevijvere
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland 1010, New Zealand.
| | - Jodi T Bernstein
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Marie-Ève Labonté
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- School of Nutrition & Institute of Nutrition and Functional Foods, Laval University, Québec, QC G1V 0A6, Canada.
| | - Christine Mulligan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Mary R L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
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Schönbach JK, Thiele S, Lhachimi SK. What are the potential preventive population-health effects of a tax on processed meat? A quantitative health impact assessment for Germany. Prev Med 2019; 118:325-331. [PMID: 30468795 DOI: 10.1016/j.ypmed.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 11/07/2018] [Accepted: 11/17/2018] [Indexed: 01/28/2023]
Abstract
The International Agency for Research on Cancer considers processed meat to be carcinogenic. Further, processed meat is associated with diabetes, ischemic heart disease (IHD) and all-cause mortality. We aimed to assess health gains of four processed meat taxation scenarios in comparison to the reference and a minimum-risk-exposure-scenario. To estimate the shift in processed meat intake following respective taxes, we calculated price elasticities for processed meat. DYNAMO-HIA was used to dynamically project policy-attributable differences in the prevalence of diseases and deaths. In projection year 10, an extra 9300 males and 4500 females would be alive under the lowest tax scenario (4% tax), compared to the reference scenario. Prevalent IHD, diabetes and colorectal cancer cases in males would be 8400, 9500 and 500 lower, respectively, and there would be 4600, 7800 and 300 less cases in females. Of the respective death and disease reduction that would be achieved under the minimum-risk-exposure-scenario, the lowest tax reaches 2.84% (colorectal cancer in males) to 6.02% (diabetes in females). Under the highest tax scenario (33.3% tax), an extra 76,700 males and 37,100 females would be alive, compared to the reference scenario. Prevalent IHD, diabetes and colorectal cancer cases would be 70,800, 77,900 and 4900 lower in males and 29,900, 48,900 and 2300 lower in females, which represents 27.84% (colorectal cancer in males) to 37.76% (diabetes in females) of the maximal preventable death and disease burden. Further research needs to examine to what extent these health benefits are outweighed by a simultaneous tax-induced decrease in fish intake.
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Affiliation(s)
- Johanna-Katharina Schönbach
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany; Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany.
| | - Silke Thiele
- ife Institute of Food Economics, Science Park Kiel, Fraunhoferstraße 13, 24118 Kiel, Germany
| | - Stefan K Lhachimi
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany; Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
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Pandian JD, Gall SL, Kate MP, Silva GS, Akinyemi RO, Ovbiagele BI, Lavados PM, Gandhi DBC, Thrift AG. Prevention of stroke: a global perspective. Lancet 2018; 392:1269-1278. [PMID: 30319114 DOI: 10.1016/s0140-6736(18)31269-8] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/04/2018] [Accepted: 05/29/2018] [Indexed: 12/16/2022]
Abstract
Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries. Our findings reveal that effective tobacco control, adequate nutrition, and development of healthy cities are important strategies for primordial prevention, whereas polypill strategies, use of mobile technology (mHealth), along with salt reduction and other dietary interventions, are effective in the primary prevention of stroke. An effective collaboration between various health-care sectors, government policies, and campaigns can successfully implement secondary prevention strategies, through surveillance and registries, such as the WHO's non-communicable diseases programmes, across high-income and low-income countries.
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Affiliation(s)
- Jeyaraj D Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India.
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Mahesh P Kate
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Gisele S Silva
- Programa Integrado de Neurologia, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce I Ovbiagele
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pablo M Lavados
- Vascular Neurology Unit, Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Santiago, Chile; Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Department of Neurological Sciences, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Dorcas B C Gandhi
- College of Physiotherapy, Christian Medical College and Hospital Ludhiana, Ludhiana, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Huang Y, Pomeranz J, Wilde P, Capewell S, Gaziano T, O'Flaherty M, Kersh R, Whitsel L, Mozaffarian D, Micha R. Adoption and Design of Emerging Dietary Policies to Improve Cardiometabolic Health in the US. Curr Atheroscler Rep 2018; 20:25. [PMID: 29654423 PMCID: PMC6248872 DOI: 10.1007/s11883-018-0726-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains-food prices, reformulation, marketing, labeling, and government food assistance programs-appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the US and key elements crucial to define in designing such policies are not well established. We created an inventory of recent US dietary policy cases aiming to improve cardiometabolic health and assessed the extent of their proposal and adoption at federal, state, local, and tribal levels; and categorized and characterized the key elements in their policy design. RECENT FINDINGS Recent federal dietary policies adopted to improve cardiometabolic health include reformulation (trans-fat elimination), marketing (mass-media campaigns to increase fruits and vegetables), labeling (Nutrition Facts Panel updates, menu calorie labeling), and food assistance programs (financial incentives for fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant and Children (WIC) program). Federal voluntary guidelines have been proposed for sodium reformulation and food marketing to children. Recent state proposals included sugar-sweetened beverage (SSB) taxes, marketing restrictions, and SNAP restrictions, but few were enacted. Local efforts varied significantly, with certain localities consistently leading in the proposal or adoption of relevant policies. Across all jurisdictions, most commonly selected dietary targets included fruits and vegetables, SSBs, trans-fat, added sugar, sodium, and calories; other healthy (e.g., nuts) or unhealthy (e.g., processed meats) factors were largely not addressed. Key policy elements to define in designing these policies included those common across domains (e.g., level of government, target population, dietary target, dietary definition, implementation mechanism), and domain-specific (e.g., media channels for food marketing domain) or policy-specific (e.g., earmarking for taxes) elements. Characteristics of certain elements were similarly defined (e.g., fruit and vegetable definition, warning language used in SSB warning labels), while others varied across cases within a policy (e.g., tax base for SSB taxes). Several key elements were not always sufficiently characterized in government documents, and dietary target selections and definitions did not consistently align with the evidence-base. These findings highlight recent action on dietary policies to improve cardiometabolic health in the US; and key elements necessary to design such policies.
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Affiliation(s)
- Yue Huang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Jennifer Pomeranz
- College of Global Public Health, New York University, New York, NY, USA
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Tom Gaziano
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Rogan Kersh
- Wake Forest University, Winston-Salem, NC, USA
| | | | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
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