The effect of sugar and processed food imports on the prevalence of overweight and obesity in 172 countries

The cost-effectiveness of school-based interventions for chronic diseases: a systematic review

BACKGROUND

Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions.

METHODS

We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French.

RESULTS

Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%).

CONCLUSION

Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.

Background commentary on the Researching the Obesogenic Food Environment (ROFE) project

OBJECTIVE

The objective of this commentary is to provide an overview of the rationale and objectives of the Researching the Obesogenic Food Environment (ROFE) project that was conducted in Ghana and South Africa.

DESIGN

Narration has been used to describe the main objectives, phases as well as the methods used for the conduct of this project.

SETTING

The project described in this commentary was conducted in Khayelitsha and Mount Frere in South Africa and Ahodwo and Ejuratia for Ghana.

PARTICIPANT

Participants of the study described here include households in South Africa and Ghana, stakeholders and policymakers, and various actors within the food chain in both countries.

RESULTS

The ROFE findings provide a good understanding of the extent of the impact of the food environment on consumption, characteristics of value chains of healthy and unhealthy foods, as well as the potential for improved governance and policy that is relevant to the region. The supplement provides the opportunity to share the extensive findings of the ROFE project. Nine papers that describe the process and findings of the three phases of the ROFE project have been presented. Some of the papers focus on phases of the ROFE, while others cut across different phases and explore the linkages between the phases. Briefly descriptions of key findings of some of the papers in the supplement are provided.

CONCLUSION

Together, the findings of the ROFE study presented in this supplement have increased understanding of how communities in SA and Ghana interact with their food supplies and have led to identification of specific opportunities to improve food supply policies, in ways that create incentives for the production and consumption of healthy, relative to unhealthy foods.

Does obesity Kuznets curve exist in developing economies? Evidence from 38 African countries based on heterogeneous panel data analysis on income-level classification

Introduction

The global pandemic disease known as the obesity epidemic has spread throughout the planet. Particularly, Africa is facing a growing problem of obesity, and the trend is rising. This is a result of a ticking time bomb. Given the claim that multiple socio-economic factors significantly affect the diversity in obesity rates between nations, economic development can be seen as a key contributor to this variation.

Methods

Relying on the aforementioned avowal, this extant research examines the relationship between obesity and economic growth using urbanization, trade openness, and unemployment as intermittent variables within the Obesity Kuznets Curve (OKC) framework. Using panel data from 1990 to 2020, a panel of 38 African countries subdivided into income levels (Low income, Lower-middle income, and Upper-middle income) were analyzed. With the presence of residual cross-sectional reliance and slope heterogeneity, the Augmented Mean Group (AMG) econometric approach is employed.

Results

Key outcomes from the mentioned estimation method unveiled that economic growth positively impacts obesity among all the study panels. Variably, unemployment was evidenced to have a palpable positive impact on obesity concerning Low-income economies whereas on the side of the Lower-middle income panel together with Upper-middle income economies and the aggregated panel, a significant negative relationship is observed with obesity. Further, urbanization enhanced obesity in the Low-income panel and the aggregated panel of African nations, whereas an adverse effect is identified in both the Lower-middle and Upper-middle economies in Africa. Moreover, except for Low-income African economies, all the other panels of African nations in terms of income levels were noted to have a significant negative effect on obesity from trade openness.

Discussion

Finally, the long-run coefficients indicated that the OKC is valid among all panels of African countries. The study thus preferably suggests in African economies that addressing the inverted U-shape relationship between obesity and economic growth requires a multifaceted approach that considers the evolving dynamics of both factors. Policy makers should, therefore, aim to balance promoting economic growth and safeguarding public health through targeted interventions and long-term strategies.

Low Cooking Skills Are Associated with Overweight and Obesity in Undergraduates

Culinary skills are defined as the confidence, attitude, and the application of one's individual knowledge in performing culinary tasks, and their development may be associated with better diet quality and better health status. This study aimed to analyze the association between cooking skills, overweight, and obesity in undergraduates. This is a descriptive, observational, and cross-sectional study, with data collected between October 2020 and March 2021, with undergraduate students (n = 823) at the Federal University of Rio Grande do Norte. Participants answered the online Brazilian Cooking Skills and Healthy Eating Questionnaire Evaluation, BCSQ, which included socioeconomic information. Logistic regressions were used to assess the associations of cooking skills with overweight and obesity. From the total of the students, 70.8% were female, with a median age of 23 (21-30) years; 43.6% were with overweight or obesity; 48.8% were eutrophic; and 7.7% underweight. Overweight and obesity were significantly associated with low levels of culinary self-efficacy and self-efficacy in the use of fruits, vegetables, and seasonings in the bivariate analysis. The logistic regressions showed that living with other people and eating out were associated with higher chances of overweight and obesity. Sharing the responsibility for preparing meals and a high self-efficacy in the use of fruits, vegetables, and seasonings were associated with lower chances for overweight/obesity. Overall, our study showed that overweight and obesity were associated with lower cooking skills in the studied undergraduates. Therefore, the study demonstrates that culinary skills can be explored in educational programs that aim to reduce overweight/obesity in students.

The Role of Adipokines in Health and Disease

Adipokines are cell-signaling proteins secreted by adipose tissue that has been related to a low-grade state of inflammation and different pathologies. The present review aims to analyze the role of adipokines in health and disease in order to understand the important functions and effects of these cytokines. For this aim, the present review delves into the type of adipocytes and the cytokines produced, as well as their functions; the relations of adipokines in inflammation and different diseases such as cardiovascular, atherosclerosis, mental diseases, metabolic disorders, cancer, and eating behaviors; and finally, the role of microbiota, nutrition, and physical activity in adipokines is discussed. This information would allow for a better understanding of these important cytokines and their effects on body organisms.

Impact of educational attainment and economic globalization on obesity in adult females and males: Empirical evidence from BRICS economies

Obesity has considerably increased since 1980 and become a global epidemic. Obesity-related health problems and the negative social and economic implications of obesity have led international institutions and countries to combat it. This study investigates the role of educational attainment and economic globalization in the global prevalence of obesity in samples of adult females and males in BRICS economies for 1990-2016 through causality and cointegration tests. The results of the causality tests reveal that educational attainment and economic globalization have a significant influence on obesity in both adult females and males in the short run. Furthermore, cointegration analysis indicates a negative effect of educational attainment on obesity in all BRICS economies in the long run, but the influence of economic globalization on obesity differs among the BRICS economies. Furthermore, the negative influence of educational attainment on obesity is revealed to be relatively higher in females than males.

Consumption of Coffee and Green Tea and the Risk of Colorectal Cancer in Korea: The Health Examinees Study

Coffee and green tea may affect colorectal physiology and contain many bioactive components, such as polyphenol and caffeine, which have antioxidant and anti-carcinogenic activities. However, the association between coffee and green tea consumption and the risk of colorectal cancer (CRC) has been inconclusive. This study examined the association between coffee and green tea consumption and the risk of CRC in a large-scale prospective cohort study in Korea. Data from the Health Examinees study from 2004 to 2013 were analyzed, and 114,243 participants (39,380 men and 74,863 women) aged 40-79 years were included in the final analysis. A Cox proportional hazards regression model using age at time scale was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of coffee and green tea consumption for the risk of CRC by sex. In both men and women, no significant association was found between coffee and green tea consumption and the risk of CRC. Among women, there was a significant increase in the risk of colon cancer (HR, 1.66; 95% CI, 1.13-2.44) in the black coffee drinker group. Our findings suggest that consumption of coffee and green tea may not be associated with the CRC incidence in Korea; instead, the association may differ depending on cancer subsites and coffee types.

Association between Free Sugars Intake and Risk of Metabolic Syndrome in Chinese Adults: Results from the China Health and Nutrition Survey, 2000-2018

The association of free sugars intake with metabolic syndrome (MetS) is controversial. This study aimed to examine the association between free sugars intake and risk of MetS in Chinese adults. The data were from seven waves of the China Health and Nutrition Survey (2000−2018), a longitudinal and open prospective cohort study. Dietary intake was calculated based on the data collected by consecutive 3-day 24-h dietary recalls combined with household weighing for foods or condiments. Cox proportion hazard regressions and restricted cubic spline (RCS) were performed to explore the associations between free sugars intake and the risk of MetS. The present study selected 12,048 adults aged 18 years and above. During a median (IQR) follow-up of 9.0 (7.0, 15.0) years with 131,844.0 person-years, 3970 (32.95%) MetS occurred. After adjusting for all potential confounders, compared to adults with free sugars intake of <5 g/day group, adults with free sugars intake of 5−20 g/day were associated with a higher risk of MetS (HR, 1.094; 95% CI, 1.009−1.186). No significant association was observed between free sugars intake of >20 g/day and the risk of MetS (HR, 1.011; 95% CI, 0.800−1.277). There is an urgent need to pay attention to the intake of free sugars and comprehensive measures such as the improvements in the processing of sugary foods, and sugar composition should be included on food nutrition labels to control intake of free sugars in China.

The global burden of type 2 diabetes attributable to high body mass index in 204 countries and territories, 1990-2019: An analysis of the Global Burden of Disease Study

Background

High body mass index (BMI) plays a critical role in the initiation and development of type 2 diabetes (T2D). Up to now, far too little attention has been paid to the global burden of T2D attributable to high BMI. This study aims to report the deaths and disability-adjusted life years (DALYs) of T2D related to high BMI in 204 countries and territories from 1990 to 2019.

Methods

Data on T2D burden attributable to high BMI were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The global cases, age-standardized rates of mortality (ASMR), and disability-adjusted life years (ASDR) attributable to high BMI were estimated by age, sex, geographical location, and socio-demographic index (SDI). The estimated annual percentage change (EAPC) was calculated to quantify the trends of ASMR and ASDR during the period 1990-2019.

Results

Globally, there were 619,494.8 deaths and 34,422,224.8 DALYs of T2D attributed to high BMI in 2019, more than triple in 1990. Moreover, the pace of increase in ASMR and ASDR accelerated during 1990-2019, with EAPC of 1.36 (95% CI: 1.27 to 1.45) and 2.13 (95% CI: 2.10 to 2.17) separately, especially in men, South Asia, and low-middle SDI regions. Oceania was the high-risk area of standardized T2D deaths and DALYs attributable to high BMI in 2019, among which Fiji was the country with the heaviest burden. In terms of SDI, middle SDI regions had the biggest T2D-related ASMR and ASDR in 2019.

Conclusion

The global deaths and DALYs of T2D attributable to high BMI substantially increased from 1990 to 2019. High BMI as a major public health problem needs to be tackled properly and timely in patients with T2D.

Integrating the effects of sucrose intake on the brain and white adipose tissue: Could autophagy be a possible link?

Excess dietary sucrose is associated with obesity and metabolic diseases. This relationship is driven by the malfunction of several cell types and tissues critical for the regulation of energy balance, including hypothalamic neurons and white adipose tissue (WAT). However, the mechanisms behind these effects of dietary sucrose are still unclear and might be independent of increased adiposity. Accumulating evidence has indicated that dysregulation of autophagy, a fundamental process for maintenance of cellular homeostasis, alters energy metabolism in hypothalamic neurons and WAT, but whether autophagy could mediate the detrimental effects of dietary sucrose on hypothalamic neurons and WAT that contribute to weight gain is a matter of debate. In this review, we examine the hypothesis that dysregulated autophagy in hypothalamic neurons and WAT is an adiposity-independent effect of sucrose that contributes to increased body weight gain. We propose that excess dietary sucrose leads to autophagy unbalance in hypothalamic neurons and WAT, which increases caloric intake and body weight, favoring the emergence of obesity and metabolic diseases.

Adolescents' Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective

Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents' perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16-18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity.

Does the Prevalence of Obesity Affect the Demand for Soft Drinks? Evidence from Cross-Country Panel Data

The impact of soft drinks on obesity has been widely investigated during the last decades. Conversely, the role of obesity as a factor influencing the demand for soft drinks remains largely unexplored. However, understanding potential changes in the demand for soft drinks, as a result of changes in the spread of obesity, may be useful to better design a comprehensive strategy to curb soft drink consumption. In this paper, we aim to answer the following research question: Does the prevalence of obesity affect the demand for soft drinks? For this purpose, we collected data in a sample of 97 countries worldwide for the period 2005–2019. To deal with problems of reverse causality, an instrumental variable approach and a two-stage least squares method were used to estimate the impact of the age-standardized obesity rate on the market demand for soft drinks. After controlling for several demographic and socio-economic confounding factors, we found that a one percent increase in the prevalence of obesity increases the consumption of soft drinks and carbonated soft drinks by about 2.37 and 1.11 L per person/year, respectively. Our findings corroborate the idea that the development of an obesogenic food environment is a self-sustaining process, in which obesity and unhealthy lifestyles reinforce each other, and further support the need for an integrated approach to curb soft drink consumption by combining sugar taxes with bans, regulations, and nutrition education programs.

Global red and processed meat trade and non-communicable diseases

Introduction

Rapid increases in the trade of global red and processed meat impede international efforts toward sustainable diets by increasing meat consumption. However, little research has examined cross-country variations in diet-related non-communicable diseases (NCDs) because of meat trade. We aimed to examine the impact of red and processed meat trade on diet-related NCDs and to identify which countries are particularly vulnerable to diet-related NCDs due to red and processed meat trade.

Methods

By selecting 14 red meat and six processed meat items, we investigated bilateral meat trade flows across 154 countries. Then, we integrated health data and information on red and processed meat trade to quantify the country-specific burden of diet-related NCDs attributable to the meat trade using a comparative risk assessment framework.

Results

Results show that global increases in red and processed meat trade contributed to the abrupt increase of diet-related NCDs, and the attributable burden of diet-related NCDs had large geographical variations among countries. We also identified responsible exporting countries that increase diet-related NCD risks in importing countries. Over the period from 1993 to 2018, island countries in the Caribbean and Oceania were particularly vulnerable to diet-related NCD incidents and mortality due to large meat imports. In addition, countries in Northern and Eastern Europe have exceedingly increased attributable death and disability-adjusted life year rates via meat imports.

Conclusion

Our findings suggest that both exporters and importers must urgently undertake cross-sectoral actions to reduce the meat trade’s health impacts. To prevent unintended health consequences due to red and processed meat trade, future interventions need to integrate health policies with agricultural and trade policies by cooperating with both responsible exporting and importing countries.

Using Community-Based Prevention Marketing to Generate Demand for Healthy Diets in Jordan

Jordan has been experiencing a nutrition transition with high rates of micronutrient deficiencies and rising overweight and obesity rates. This highlights the need to generate demand for healthy diets. This study used a community-based prevention marketing approach and worked with local communities as partners to develop a set of behavior change interventions to improve healthy eating within vulnerable communities. Individual, family, and paired-friendship interviews, and co-creation workshops were conducted with 120 people. The aim of these interviews was to gain an in-depth understand of school-aged children and their families’ nutrition knowledge, attitudes, and practices, including social and cultural norms and behavioral determinants, and then use this information to co-create interventions, activities and materials targeted at supporting school-aged child nutrition. Analysis of the interviews revealed that dietary habits are both deeply personal and profoundly entwined by emotions and social norms, and that parents often gave in to their children’s demands for unhealthy foods and beverages due to their perception of what a ‘good parent’ looks like and the desire to see their child ‘smile’. These key insights were then shared during the co-creation workshops to develop behavior change interventions—ensuring that interventions were developed by the community, for the community.

Trajectories of Dietary Patterns and Their Associations with Overweight/Obesity among Chinese Adults: China Health and Nutrition Survey 1991-2018

It is essential to understand the impact of different dietary pattern trajectories on health over time. Therefore, we aimed to explore the long-term trajectories of dietary patterns among Chinese adults and examine the prospective association between different trajectory groups and the risk of overweight/obesity. The sample was 9299 adults aged 18 years or older from the China Health and Nutrition Survey (CHNS) between 1991 and 2018. We used factor analysis to identify dietary patterns and group-based trajectory modeling to identify dietary pattern trajectories. Three trajectories of a southern pattern and a modern pattern and four trajectories of a meat pattern were identified. Participants who followed the highest initial score and a slight decrease trajectory (OR = 1.63; 95% CI: 1.04, 2.54) of the meat dietary pattern were positively associated with risk of overweight/obesity when compared with the lowest initial score trajectory. The southern dietary pattern and the modern dietary pattern trajectories of participants in Group 2 (OR = 0.64; 95% CI: 0.51, 0.81; OR = 0.76; 95% CI: 0.63, 0.91) and Group 3 (OR = 0.71; 95% CI: 0.54, 0.91; OR = 0.64; 95% CI: 0.44, 0.90) were associated with lower risk of overweight/obesity when compared with Group 1. We observed that dietary pattern trajectories have different associations with overweight/obesity among Chinese adults.

The Association between Coffee Consumption and Risk of Colorectal Cancer in a Korean Population

This study was performed to investigate the association between coffee consumption and risk of colorectal cancer in a Korean population and examine whether the association can be altered by adjustment for intake of coffee additives. We conducted a case-control study involving 923 colorectal cancer cases and 1846 controls matched by sex and age (within 5 years). A semi-quantitative food frequency questionnaire was used to assess coffee intakes. High coffee consumption was associated with lower odds of developing colorectal cancer (≥3 cups/day vs. no drinks, OR = 0.68; 95% CI: 0.49–0.96). When we additionally controlled for consumption of coffee additives including sugar and cream, the inverse association became stronger (≥3 cups/day vs. no drinks, OR = 0.22; 95% CI: 0.14–0.33), and a significant inverse linear trend was shown (P_trend < 0.0001). The inverse associations were observed for proximal (P_trend = 0.0001) and distal (P_trend = 0.0003) colon cancer, and rectal cancer (P_trend < 0.0001) in the stratified analysis by anatomical sub-sites. Regarding sex, inverse associations between coffee consumption and colorectal cancer were found for men (P_trend < 0.0001) and women (P_trend = 0.0021). In the stratified analysis by obese status of subjects, inverse linear trends were observed in both non-obese and obese people (P_trend < 0.0001). High coffee consumption may be associated with a lower risk of colorectal cancer in the Korean population and the degree of decrease in the odds of developing colorectal cancer changes by adjustment for intake of coffee additives.

Poor Dietary Habits: A Function of Online Food Delivery Fad among Medical and Dental College Students in India

Background

Globalization has impacted our food choice and the booming online food industry has made it available at the click of a button. Students staying away from home often fail to maintain a healthy diet and lifestyle, impacting their health.

Methods

A survey was conducted amongst interns of medical and dental colleges in Delhi. Simple Random Sampling was done to select every alternate intern as per the list provided by the colleges. The survey included questions on dietary, fitness and food hygiene habits and dental history. Demographic details such as height weight and living arrangements were collected. Dietary habits score and Fitness & Food hygiene score was calculated based on pre-set criteria. Association of poor dietary habits and hygiene with BMI, living conditions and dental history was determined.

Results

One-fourth of the population was either overweight or obese. Poor, fair and good dietary habits was seen in 8.9%, 69.8% and 21.4% respectively. Poor, fair and good fitness and food hygiene was seen in 56.3%, 39.6% and 4.2% respectively. Obesity was significantly associated with poor fitness scores and with tendency to order junk food. Consumption of sugary food was associated with positive dental history, and those living with parents displayed good dietary habit score.

Conclusion

Students with high stress levels and living away from home are susceptible to poor dietary routine which impacts both their health and academic performance. Identifying these problems and triggers which induce such unhealthy lifestyle behaviour can go a long way in controlling the resultant health problems.

The International Diet-Health Index: a novel tool to evaluate diet quality for cardiometabolic health across countries

Introduction

Diet is a major modifiable risk factor for cardiometabolic disease; however, interpretable measures capturing impacts of overall diet on health that can be easily used by policymakers at the global/national levels are not readily available.

Methods

We developed the International Diet-Health Index (IDHI) to measure health impacts of dietary intake across 186 countries in 2010, using age-specific and sex-specific data on country-level dietary intake, effects of dietary factors on cardiometabolic diseases and country-specific cardiometabolic disease profiles. The index encompasses the impact of 11 foods/nutrients on 12 cardiometabolic diseases, the mediation of health effects of specific dietary intakes through blood pressure and body mass index and background disease prevalence in each country–age–sex group. We decomposed the index into IDHI_beneficial for risk-reducing factors, and IDHI_adverse for risk-increasing factors. The flexible functional form of the IDHI allows inclusion of additional risk factors and diseases as data become available.

Results

By sex, women experienced smaller detrimental cardiometabolic effects of diet than men: (females IDHI_adverse range: −0.480 (5th percentile, 95th percentile: −0.932, –0.300) to −0.314 (−0.543, –0.213); males IDHI_adverse range: (−0.617 (−1.054, –0.384) to −0.346 (−0.624, –0.222)). By age, middle-aged adults had highest IDHI_beneficial (females: 0.392 (0.235, 0.763); males: 0.415 (0.243, 0.949)) and younger adults had most extreme IDHI_adverse (females: −0.480 (−0.932, –0.300); males: −0.617 (−1.054, –0.384)). Regionally, Central Latin America had the lowest IDHI_overall (−0.466 (−0.892, –0.159)), while Southeast Asia had the highest IDHI_overall (0.272 (−0.224, 0.903)). IDHI_overall was highest in low-income countries and lowest in upper middle-income countries (−0.039 (−0.317, 0.227) and −0.146 (−0.605, 0.303), respectively). Among 186 countries, Honduras had lowest IDHI_overall (−0.721 (−0.916, –0.207)), while Malaysia had highest IDHI_overall (0.904 (0.435, 1.190)).

Conclusion

IDHI encompasses dietary intakes, health effects and country disease profiles into a single index, allowing policymakers a useful means of assessing/comparing health impacts of diet quality between populations.

A binge high sucrose diet provokes systemic and cerebral inflammation in rats without inducing obesity

While the dire cardiometabolic consequences of the hypercaloric modern 'Western' diet are well known, there is not much information on the health impact of a high sucrose diet not inducing weight gain. Here, we tested the hypothesis that rats reared with intermittent binge access to sucrose in addition to normal chow would develop an inflammatory response in brain. To test this hypothesis, we undertook serial PET/MRI scans with the TSPO ligand [18F]DPA714 in a group of (n=9) rats at baseline and again after voluntarily consuming 5% sucrose solution three days a week for three months. Compared to a control group fed with normal chow (n=9), the sucrose rats indeed showed widespread increases in the availability of cerebral binding sites for the microglial marker, despite normal weight gain compared to the control diet group. Subsequent immunofluorescence staining of the brains confirmed the PET findings, showing a widespread 20% increase in the abundance of IBA-1-positive microglia with characteristic 'semi-activated' morphology in the binge sucrose rats, which had 23% lower density of microglial endpoints and 25% lower mean process length compared to microglia in the control rats with ordinary feeding. GFAP immunofluorescence showed no difference in astroglial coverage in the sucrose rats, except for a slight reduction in hypothalamus. The binge sucrose diet-induced neuroinflammation was associated with a significant elevation of white blood cell counts. Taking these results together, we find that long-term intake of sucrose in a binge paradigm, similar in sucrose content to the contemporary Western diet, triggered a low-grade systemic and central inflammation in non-obese rats. The molecular mechanism of this phenomenon remains to be established.

Dietary agrobiodiversity for improved nutrition and health outcomes within a transitioning indigenous Solomon Island food system

Indigenous food systems of Pacific Small Island Developing Countries contain vast biological and cultural diversity. However, a nutrition transition is underway, characterized by shifts away from traditional diets in favour of imported and modern foods, contributing to some of the highest rates of obesity and Diabetes Type 2 Mellitus in the world. Using a mixed method approach, this study aimed to assess dietary agrobiodiversity’s relationship with nutrition indicators related to diet quality and anthropometrics within the context of the rural and Indigenous food system of Baniata village, located in the Western Province of Solomon Islands (Melanesia). A secondary aim was to evaluate the contribution of agrobiodiversity from the local food system to diet quality. A comprehensive nutrition survey was administered to the women primarily responsible for cooking of randomly selected households (n = 30). Additionally, 14 participatory focus group discussions captured the historical narrative of food system transitions, were hosted over a period of seven days, and included men, women and youth. Dietary intakes of the participants were reported below the estimated average requirement (EAR) for several essential nutrients, including protein (53%), calcium (96.6%), vitamin B1 (86.6%), vitamin B2 (80%), vitamin A (80%), zinc (40%) and fibre (77%). Focus group participants built a timeline of key historical and climatic transitions perceived to be drivers of dietary shifts away from traditional foods and towards imported and processed foods. Participants identified 221 species and varieties of agrobiodiverse foods available for cultivation or wild collection. Based on 24 h diet recalls, 87 were found to be utilised. Participants who consumed foods of a wider diversity of species richness had a higher probability of achieving recommended nutrition intakes and a lower body fat percentage (r2 = 0.205; p = 0.012). Our results suggest a nutrition transition is underway, and strategies harnessing traditional knowledge of nutrient-dense, agrobiodiverse foods can help improve food and nutrition security.

Street Food Stand Availability, Density, and Distribution Across Income Levels in Mexico City

Street food stands (SFS) are an understudied element of the food environment. Previous SFS studies have not used a rigorous approach to document the availability, density, and distribution of SFS across neighborhood income levels and points of access in Mexico City. A random sample (n = 761) of street segments representing 20 low-, middle-, and high-income neighborhoods were assessed using geographic information system (GIS) and ground-truthing methods. All three income levels contained SFS. However, SFS availability and density were higher in middle-income neighborhoods. The distribution of SFS showed that SFS were most often found near homes, transportation centers, and worksites. SFS availability near schools may have been limited by local school policies. Additional studies are needed to further document relationships between SFS availability, density, and distribution, and current structures and processes.

Gustatory Function Can Improve after Multimodal Lifestyle Intervention: A Longitudinal Observational Study in Pediatric Patients with Obesity

Introduction: Obesity is a major health burden in children and adolescents. One influential factor is the choice of food, which is partly determined by gustatory perception. Cross-sectional studies have provided evidence that gustatory function is reduced in patients with obesity compared to individuals with normal weight. This longitudinal study was aimed at investigating potential effects of a multimodal lifestyle intervention program on gustatory function in pediatric patients with obesity. Methods: Gustatory perception of five different taste qualities (sweet, sour, salty, bitter, and umami) was assessed in n = 102 patients (age 6-18) with obesity (BMI >97th percentile). Testing was performed before (T0) and after (T1) a residential multimodal weight reduction program between June and December 2015 using well-established taste strips. Results: Overall, identification performance increased between T0 and T1. Patients were most successful at identifying the taste quality sweet at both time points and reached higher scores at identifying umami and bitter at T1 compared to T0. Moreover, patients rated the highest concentration of sweet significantly sweeter at T1 compared to T0. Conclusion: Gustatory function can improve after a multimodal lifestyle intervention program in pediatric patients with obesity. This may lead to a modified choice of food, possibly resulting in a long-term therapeutic success. Therefore, these findings underline the importance of professional nutritional counseling as part of treatment for obesity.

An Analysis of Healthy Food Access Amongst Women in Peri-urban Honiara

Highly processed and energy-dense foods are contributing to the high and rising rates of non-communicable diseases and nutrient deficiencies in Solomon Islands. Non-communicable diseases currently cause 69% of deaths in Solomon Islands, and the rate is rising, fuelled in part by limited health system capacity to treat these conditions. Solomon Islands also has the highest reported undernourishment rate in the Pacific. Recent decades have seen several factors change the food and economic environment in Solomon Islands. Importantly, rural-to-urban migration has caused a disconnect between urban residents and access to land and home gardens. This study aimed to examine the complexities of nutritious food access in urban Solomon Islands. Data were collected from 32 women in Honiara, the islands' capital, using a novel survey instrument. There were 3 important findings: (1) the dominant influencers of the diet patterns described by participants in this study were food affordability and access to land on which to grow it, (2) all participants experienced food insecurity, and (3) reported diet patterns reflected unhealthy diets which were particularly high in processed and sugary foods. These findings suggest a need for improvements in the food environment in Honiara.

When Leptin Is Not There: A Review of What Nonsyndromic Monogenic Obesity Cases Tell Us and the Benefits of Exogenous Leptin

Obesity is a pandemic condition of complex etiology, resulting from the increasing exposition to obesogenic environmental factors combined with genetic susceptibility. In the past two decades, advances in genetic research identified variants of the leptin-melanocortin pathway coding for genes, which are related to the potentiation of satiety and hunger, immune system, and fertility. Here, we review cases of congenital leptin deficiency and the possible beneficial effects of leptin replacement therapy. In summary, the cases presented here show clinical phenotypes of disrupted bodily energy homeostasis, biochemical and hormonal disorders, and abnormal immune response. Some phenotypes can be partially reversed by exogenous administration of leptin. With this review, we aim to contribute to the understanding of leptin gene mutations as targets for obesity diagnostics and treatment strategies.

Adipokines and Obesity. Potential Link to Metabolic Disorders and Chronic Complications

The World Health Organization (WHO) has recognized obesity as one of the top ten threats to human health. It is estimated that the number of obese and overweight people worldwide exceeds the number of those who are undernourished. Obesity is not only a state of abnormally increased adipose tissue in the body, but also of increased release of biologically active adipokines. Adipokines released into the circulating blood, due to their specific receptors on the surface of target cells, act as classic hormones affecting the metabolism of tissues and organs. What is more, adipokines and cytokines may decrease the insulin sensitivity of tissues and induce inflammation and development of chronic complications. Certainly, it can be stated that in an era of a global obesity pandemic, adipokines may gain more and more importance as regards their use in the diagnostic evaluation and treatment of diseases. An extensive search for materials on the role of white, brown and perivascular fatty tissue and obesity-related metabolic and chronic complications was conducted online using PubMed, the Cochrane database and Embase.

A scoping review on economic globalization in relation to the obesity epidemic

This study reviewed evidence linking economic globalization to the obesity epidemic. Keyword/reference search was performed in PubMed, Web of Science, Cochrane Library, Scopus, EconLit, Google Scholar, and BMC Globalization and Health. A total of 16 studies were identified, in which six adopted a cross-sectional study design, nine adopted a longitudinal study design, and the remaining one adopted a case-control study design. Thirteen studies assessed the relationship between economic globalization and obesity at the country level, whereas the remaining three analyzed individual-level data. Fourteen studies found at least one aspect and/or measure of economic globalization to be positively associated with overweight/obesity, one found an inverse association, and the remaining one reported a null finding. Through market deregulation, tariff reduction, and investment liberalization, economic globalization tends to accelerate the market entry of modern food manufacturers, supermarket chains, and fast-food restaurants, resulting in substantially increased supply of high-sugar/fat energy-dense foods with enhanced variety and accessibility and reduced price. The potential impact of economic globalization on obesity through the adoption of modern workplace and domestic technologies and motorized transportation and through changes in social norms and culture were hypothesized in the literature but not empirically examined, which warrants future data-driven research.

Pre-acculturation as a risk factor for obesity: Findings from the Health of Philippine Emigrants Study (HoPES)

Immigrants to the United States may have an advantage in terms of healthier weight, but tend to gain excessive weight after arrival, and may suffer from obesity and related health conditions. Acculturation theory suggests that this increase in obesity risk is due to adoption of unhealthy western dietary behaviors, and assumes that "eastern/traditional" dietary behaviors prior to migration are healthier. While this assumption is supported by studies conducted several decades ago, the phenomenon of globalization that has risen since the 1990s has increased exposure to western ideas and behaviors in communities worldwide. Hence, today's immigrants are more likely to have already adopted less healthy behaviors that increase obesity risk prior to their arrival in the U.S., a phenomenon we term "pre-acculturation." The present study investigates the role of pre-acculturation in obesity development among immigrants from the Philippines. Data come from the Health of Philippine Emigrants Study, fielded in 2017 (n = 1632). Pre-acculturation was measured with English proficiency, preparation to migrate, receiving care packages, texting, telephone, or internet contact with friends/family in the U.S. Outcomes included the body mass index (BMI, kg/m2), waist circumference (WC, cm), waist-to-height ratio (WHtR) and waist-to-hip-ratio (WHR). Covariates included age, gender, education, financial strain, physical activity, and diet. Migrants reported greater English proficiency, preparation, and a slightly lower WHtR than non-migrants, but did not differ on BMI, WC, or WHR. Preparation was associated with greater BMI, WC, and WHtR, and the effects of preparation status differed by migration status. Among migrants, more preparation was associated with greater BMI, WC, and WtHR. Further, among non-migrants, texting and telephone communications was related to lower BMI, WC, and WHR. In summary, pre-acculturation may be a risk factor for obesity in the Philippines, suggesting that binary notions of "Western" versus "eastern/traditional" cultures may be too simplistic.

A multidisciplinary review of the policy, intellectual property rights, and international trade environment for access and affordability to essential cancer medications

In 2015, the World Health Organization (WHO) Expert Committee approved the addition of 16 cancer medicines to the WHO Model List of Essential Medicines (EML), bringing the total number of cancer medicines on the list to 46. This change represented the first major revision to the EML oncology section in recent history and reinforces international recognition of the need to ensure access and affordability for cancer treatments. Importantly, many low and middle-income countries rely on the EML, as well as the children’s EML, as a guide to establish national formularies, and moreover use these lists as tools to negotiate medicine pricing. However, EML inclusion is only one component that impacts cancer treatment access. More specifically, factors such as intellectual property rights and international trade agreements can interact with EML inclusion, drug pricing, and accessibility. To better understand this dynamic, we conducted an interdisciplinary review of the patent status of EML cancer medicines compared to other EML noncommunicable disease medicines using the 17th, 18th, 19th, 20th, and 21st editions of the list. We also explored the interaction of intellectual property rights with the international trade regime and how trade agreements can and do impact cancer treatment access and affordability. Based on this analysis, we conclude that patent status is simply one factor in the complex international environment of health systems, IPR policies, and trade regimes and that aligning these oftentimes disparate interests will require shared global governance across the cancer care continuum.

d-amino Acids in Health and Disease: A Focus on Cancer

d-amino acids, the enantiomeric counterparts of l-amino acids, were long considered to be non-functional or not even present in living organisms. Nowadays, d-amino acids are acknowledged to play important roles in numerous physiological processes in the human body. The most commonly studied link between d-amino acids and human physiology concerns the contribution of d-serine and d-aspartate to neurotransmission. These d-amino acids and several others have also been implicated in regulating innate immunity and gut barrier function. Importantly, the presence of certain d-amino acids in the human body has been linked to several diseases including schizophrenia, amyotrophic lateral sclerosis, and age-related disorders such as cataract and atherosclerosis. Furthermore, increasing evidence supports a role for d-amino acids in the development, pathophysiology, and treatment of cancer. In this review, we aim to provide an overview of the various sources of d-amino acids, their metabolism, as well as their contribution to physiological processes and diseases in man, with a focus on cancer.

Cancer control in the Pacific: big challenges facing small island states

This Series paper describes the current state of cancer control in Pacific island countries and territories (PICTs). PICTs are diverse but face common challenges of having small, geographically dispersed, isolated populations, with restricted resources, fragile ecological and economic systems, and overburdened health services. PICTs face a triple burden of infection-related cancers, rapid transition to lifestyle-related diseases, and ageing populations; additionally, PICTs are increasingly having to respond to natural disasters associated with climate change. In the Pacific region, cancer surveillance systems are generally weaker than those in high-income countries, and patients often present at advanced cancer stage. Many PICTs are unable to provide comprehensive cancer services, with some patients receiving cancer care in other countries where resources allow. Many PICTs do not have, or have poorly developed, cancer screening, pathology, oncology, surgical, and palliative care services, although some examples of innovative cancer planning, prevention, and treatment approaches have been developed in the region. To improve cancer outcomes, we recommend prioritising regional collaborative approaches, enhancing cervical cancer prevention, improving cancer surveillance and palliative care services, and developing targeted treatment capacity in the region.

Telecoupled impacts of livestock trade on non-communicable diseases

Background

Non-communicable diseases (NCDs)—chronic human health problems such as cardiovascular diseases linked to poor diets—are significant challenges for sustainable development and human health. The international livestock trade increases accessibility to cheap animal products that may expand diet-related NCDs worldwide. However, it is not well understood how the complex interconnections among livestock production, trade, and consumption affect NCD risks around the world.

Method

Our global dataset included 33 livestock products (meat, offal, and animal fats) in 156 countries from 1992 to 2011. We employed path analysis to uncover how livestock trade contributes to diet-related NCDs and identify underlying environmental and socioeconomic factors of livestock trade. Then we performed trend analyses to investigate long-term changes in livestock production and trade at a country level.

Results

We found that livestock consumption through livestock import increased diet-related NCD risks. This was especially true in developing countries, which in general were not well prepared in terms of policies for NCD risk reduction, and where there was a lack of funding to implement the policies. Population size and income level were the main factors affecting global livestock import activities.

Conclusions

Our results suggest that new governance structures to incorporate separate international efforts, improved national policies, and bolstering individual efforts are needed to decrease NCD risks, particularly in developing countries.

Electronic supplementary material

The online version of this article (10.1186/s12992-019-0481-y) contains supplementary material, which is available to authorized users.

Processed Foods and Nutrition Transition in the Pacific: Regional Trends, Patterns and Food System Drivers

Background: The role of processed foods in nutrition transition in the Pacific is receiving some attention in the context of a significant obesity and diet-related noncommunicable disease health burden. However, trends, patterns and underlying drivers of processed food markets in the Pacific are not well understood. The aim of this study was to investigate recent trends and patterns of processed food markets in the region and interpret the findings by engaging key literature on relevant food systems drivers. Methods: We conducted a mixed-methods approach involving two steps; (1) We analysed Euromonitor market sales data for processed food and beverage products sold from 2004–2018 for 16 countries differentiated by income level, and (2) guided by a food systems conceptual framework, we drew upon key literature to understand the likely drivers of our observations. Results: We observed plateaus and declines in processed food sales in some high-income countries but increases in upper-middle and lower-middle income countries, and most rapidly in the latter. Beverage markets appear to be stagnating across all income groups. Carbonated soft drinks, baked goods, vegetable oils, processed meats, noodles and sweet biscuits made up the majority of sales in transitioning countries. These observations are likely a result of income growth, urbanising populations, trade and globalisation, and various policies implemented by Pacific governments. Conclusions: A processed foods nutrition transition is well underway in the Pacific region and accelerating most prominently in lower-middle income countries.

Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries

Background

A key component of ‘obesogenic environments’ is the ready availability of convenient, calorie-dense foods, in the form of hyper-palatable and relatively inexpensive ultra-processed products. Compelling evidence indicates that the regular consumption of soft drinks, specifically carbonated and non-carbonated sugar-sweetened beverages (SSBs), has a significant impact on the prevalence of overweight and obesity. However, to implement country-level effective prevention programmes we need to supplement this evidence with quantitative knowledge of the relationships between overweight/obesity and the main determinants of SSB consumption, notably SSB prices and consumers’ disposable income.

Method

Affordability considers the simultaneous effects of both price and disposable income on the buying decision. The purpose of this study was to investigate the effect of SSB affordability on the consumers’ purchasing behaviour and weight-related health outcomes. Our study was divided into three parts. First, we computed SSB consumption and affordability for approximately 150 countries worldwide. Second, we estimated a demand function for SSBs to assess the impact of affordability on consumption at the country level. Third, we used a multivariate regression model and country data on the prevalence of overweight and obesity to test the role of SSB affordability in the current obesity epidemic.

Results

The analysis reveals that SSB affordability: 1) showed both a large variability across countries and a clear tendency to increase substantially with the level of economic development; 2) played a key role in determining cross-country differences in the amount of soft drink consumed per capita; and 3) was significantly associated with the prevalence rates of both overweight and obesity. Specifically, we show that a 10 % increase in SSB affordability was associated, on average, with approximately 0.4 more overweight/obese adults per 100 inhabitants.

Conclusions

By controlling for the main possible confounding factors, our results clearly indicate that affordability is a major driver of purchasing behaviours and is significantly associated with the prevalence rates of both overweight and obesity. We thus suggest a fiscal approach to curb SSB consumption based on the effectiveness of ‘soda taxes’ to affect the long-term dynamic of SSB affordability.

Electronic supplementary material

The online version of this article (10.1186/s12992-019-0474-x) contains supplementary material, which is available to authorized users.

Food processing, gut microbiota and the globesity problem

In the context of diseases of affluence, western diets have in the past years mainly been studied on their fat and sugar content and lack of dietary fiber. Yet, the more general aspect of food processing has recently sparked scientific interest as well. In addition, the gut microbiota have been put forward as an important link between diet, obesity and non-communicable diseases (NCD). Western dietary patterns, containing large amounts of processed foods might create an imbalance in the gut system by affecting gut bacteria and their metabolism. Here we discuss what has been already published regarding the relationship between several recently researched features of processed foods and the etiology of obesity and NCD. The addressed features concern micronutrient and energy density, several types of food additives and the generation of advanced glycation end products by thermal treatment during food processing. Overall, literature indicates that all discussed aspects can be linked to western ailments and that they can have a potential negative impact on human microbiota. Therefore, we propose that the thesis that a distressed gut microbiota is a mechanism that might explain how food processing features could harm human health is gaining empirical evidence. Future research will need to address the question whether the alteration of the gut microbiota is a direct or an indirect (via the host) effect. These conclusions are important assets in the fight against the continuing worldwide upsurge of obesity and NCD.

Sugar-sweetened beverage consumption in the early years and implications for type-2 diabetes: a sub-Saharan Africa context

This review aims to explore trends of early consumption of sugar-sweetened beverages (SSB) in sub-Saharan Africa (SSA), within the context of growing child and adolescent obesity and escalating type-2 diabetes prevalence. We explore efforts to mitigate these, drawing on examples from Africa and elsewhere. SSB, including carbonated drinks and fruit juices, play a contributory role in the development of obesity and associated non-communicable diseases (NCD). SSA is an attractive market for beverage companies owing to its rapid economic growth, growing middle class and youthful populations. SSB already contribute significantly to total sugar and energy consumption in SSA where a plethora of marketing techniques targeted at younger people are utilised to ensure brand recognition and influence purchasing and brand loyalty. Coupled with a general lack of nutrition knowledge or engagement with preventative health, this can lead to frequent consumption of sugary drinks at a young age. Public health efforts in many high income and some middle-income countries address increasing prevalence of obesity and type-2 diabetes by focusing on strategies to encourage reduction in sugar consumption via health policy and public education campaigns. However, similar efforts are not as developed or forthcoming in low-income countries. Health care systems across SSA are ill-prepared to cope with epidemic proportions of NCD, particularly when contextualised with the ongoing battle with infectious diseases. We conclude that greater efforts by governments and the nutrition community to educate the public on the health effects of increased and excessive consumption of SSB are necessary to help address this issue.

Moderate coffee consumption is inversely associated with the metabolic syndrome in the Korean adult population

Results from studies investigating the association between coffee consumption and the metabolic syndrome in Koreans have been inconsistent and remain controversial. We examined coffee intake in relation to the metabolic syndrome using data from the Korea National Health and Nutrition Examination Survey 2012-2015, with 8387 adults aged 19-64 years. Furthermore, we conducted a stratified analysis by obesity status (BMI <25 v. ≥25 kg/m2) to examine whether the association varied by obesity status. A 112-item FFQ was used to assess diet. Multivariable logistic regression models were used to determine the association of coffee consumption (<1, 1-2, 3-4 and ≥5 times/d) and the metabolic syndrome. Compared to people who consumed <1 time/d of coffee, the OR for the metabolic syndrome in those who consumed 3-4 times/d of coffee was 0·75 (95 % CI 0·58, 0·97). However, ≥5 times/d of coffee consumption was not significantly associated with the metabolic syndrome. By obesity status, in non-obese people, those consuming more coffee had lower odds of the metabolic syndrome, showing a significant linear trend (P-trend=0·0248). In obese people, the OR for the metabolic syndrome in people with 3-4 times/d of coffee consumption v. <1 time/d was 0·68 (95 % CI 0·50, 0·93), but ≥5 times/d of coffee consumption showed a non-significant positive association. Our findings suggest that moderate coffee consumption of 3-4 times/d is inversely associated with the metabolic syndrome in Korean adults. The association between heavy coffee consumption of ≥5 times/d and the metabolic syndrome varied by obesity status.

Overweight, obesity, and food consumption in Galapagos, Ecuador: a window on the world

BACKGROUND

In order to understand why rates of overweight and obesity are so high in the Ecuadorian province of Galapagos, this study analyzes changes in household food expenditures and perceptions and practices related to food consumption patterns. Galapagos is understood as an unusual but not unique case because conditions there graphically illustrate trends observed in communities and countries worldwide. A mixed methods approach was employed: a quantitative component was based on expenditures for foods classified according to the NOVA system, and a qualitative component utilized focus group discussions, key informant interviews, and structured observations.

RESULTS

Galapagos residents increased consumption of processed and ultra-processed foods and decreased consumption of unprocessed and minimally processed foods. Perceived barriers to healthy diets include price, availability, and quality of fresh produce, as well as easy access to industrialized processed and ultra-processed foods.

CONCLUSIONS

Changes in consumption patterns represent both local conditions and global trends; in that sense, the factors that affect Galapagos residents are not unique. Hence, these findings help elucidate processes observed in communities around the world.