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Alba C, Wang X, An R. Are Supplemental Nutrition Assistance Program Restrictions on Sugar-Sweetened Beverages Effective in Reducing Purchase or Consumption? A Systematic Review. Nutrients 2024; 16:1459. [PMID: 38794697 PMCID: PMC11123964 DOI: 10.3390/nu16101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The participants in the Supplemental Nutrition Assistance Program (SNAP) consume greater amounts of sugar and sweetened beverages (SSBs) compared to non-eligible individuals, which could result in potential negative health outcomes. This can be attributed to the lack of restrictions on SSB purchases with SNAP benefits. In view of the increasing calls from advocates and policymakers to restrict the purchase of SSBs with SNAP benefits, we performed a systematic review to assess its impact towards SSB purchases and consumption. We searched articles from five databases-Cochrane, EBSCO, SCOPUS, Web of Science, and PubMed-and selected seven studies, four of which were randomized controlled trials (RCTs) and three were simulation modeling studies. All three simulation studies and one RCT reported outcomes in terms of consumption, while the other three RCTs reported outcomes in terms of purchases. All seven studies found that an SSB restriction led to a decrease in SSB consumption or purchases, with six studies reporting significant results. Nonetheless, limitations exist. These include limited studies on this subject, potential workarounds circumventing SSB restrictions, like making purchases using personal cash, potentially differed estimated effects when combined with incentives or other initiatives, and the limited geographical scope among the selected RCTs.
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Affiliation(s)
- Charles Alba
- Division of Computational & Data Sciences, Washington University in St Louis, St. Louis, MO 63130, USA;
| | - Xi Wang
- Brown School, Washington University in St Louis, St. Louis, MO 63130, USA;
| | - Ruopeng An
- Division of Computational & Data Sciences, Washington University in St Louis, St. Louis, MO 63130, USA;
- Brown School, Washington University in St Louis, St. Louis, MO 63130, USA;
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Colombet Z, Robinson E, Kypridemos C, Jones A, O'Flaherty M. Effect of calorie labelling in the out-of-home food sector on adult obesity prevalence, cardiovascular mortality, and social inequalities in England: a modelling study. Lancet Public Health 2024; 9:e178-e185. [PMID: 38429017 DOI: 10.1016/s2468-2667(23)00326-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND England implemented a menu calorie labelling policy in large, out-of-home food businesses in 2022. We aimed to model the likely policy impact on population-level obesity and cardiovascular disease mortality, as well as the socioeconomic equity of estimated effects, in the adult population in England. METHODS For this modelling analysis, we built a comparative assessment model using two scenarios: the current implementation scenario refers to actual deployment only in large (≥250 employees), out-of-home food businesses, whereas the full implementation scenario refers to deployment in every out-of-home food business. We compared each scenario with a counterfactual: the scenario in which no intervention is implemented (ie, baseline). For both scenarios, we modelled the impact of the policy through assumed changes in energy intake due to either consumer response or product reformulation by retailers. We used data from the Office for National Statistics and the National Diet and Nutrition Survey 2009-19, and modelled the effect over 20 years (ie, 2022-41) to capture the long-term impact of the policy and provided mid-period results after 10 years. We used the Monte Carlo approach (2500 iterations) to estimate the uncertainty of model parameters. For each scenario, the model generated the change in obesity prevalence and the total number of deaths prevented or postponed. FINDINGS The current implementation scenario was estimated to reduce obesity prevalence by 0·31 percentage points (absolute; 95% uncertainty interval [UI] 0·10-0·35), which would prevent or postpone 730 cardiovascular disease deaths (UI 430-1300) of the 830 000 deaths (UI 600 000-1 200 000) expected over 20 years. However, the health benefits would be increased if calorie labelling was implemented in all out-of-home food businesses (2·65 percentage points reduction in obesity prevalence [UI 1·97-3·24] and 9200 cardiovascular disease deaths prevented or postponed [UI 5500-16 000]). Results were similar in the most and the least deprived socioeconomic groups. INTERPRETATION This study offers the first modelled estimation of the impact of the menu calorie labelling regulation on the adult population in England, although we did not include a cost-effectiveness analysis. Calorie labelling might result in a reduction in obesity prevalence and cardiovascular disease mortality without widening health inequalities. However, our results emphasise the need for the government to be more ambitious by applying this policy to all out-of-home food businesses to maximise impact. FUNDING European Research Council.
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Affiliation(s)
- Zoé Colombet
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Andrew Jones
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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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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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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Firoozi R, Weeks HM, Ludwig-Borcyz E, Clayson M, Zawistowski M, Needham B, Bauer KW. Federal Food Program Participation and Beverage Intake Among Families With Low Household Income. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:469-479. [PMID: 37422323 PMCID: PMC10754373 DOI: 10.1016/j.jneb.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Examine beverage intake among families with low income by household participation in federal food assistance programs. DESIGN Cross-sectional study conducted in fall/winter 2020 via an online survey. PARTICIPANTS Mothers of young children insured by Medicaid at the time of the child's birth (N = 493). VARIABLES MEASURED Mothers reported household federal food assistance program participation, later categorized as Supplementation Nutrition Program for Women, Infants, and Children (WIC) only, Supplemental Nutrition Assistance Program-Education (SNAP) only, both WIC and SNAP, and neither. Mothers reported beverage intake for themselves and their children aged 1-4 years. ANALYSIS Negative binomial and ordinal logistic regression. RESULTS After accounting for sociodemographic differences between groups, mothers from households participating in WIC and SNAP consumed sugar-sweetened beverages (incidence rate ratio, 1.63; 95% confidence interval [CI], 1.14-2.30; P = 0.007) and bottled water (odds ratio, 1.76; 95% CI, 1.05-2.96; P = 0.03) more frequently than mothers from households in neither program. Children from households participating in WIC and SNAP also consumed soda (incidence rate ratio, 6.07; 95% CI, 1.80-20.45; P = 0.004) more frequently than children in either program. Few differences in intake were observed for mothers or children participating in only WIC or SNAP vs both programs or neither program. CONCLUSION AND IMPLICATIONS Households participating in both WIC and SNAP may benefit from additional policy and programmatic interventions to limit sugar-sweetened beverage intake and reduce spending on bottled water.
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Affiliation(s)
- Roya Firoozi
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Elizabeth Ludwig-Borcyz
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Michelle Clayson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Matt Zawistowski
- Department of Biostatistics University of Michigan School of Public Health, Ann Arbor, MI
| | - Belinda Needham
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI.
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O'Hearn M, Lara-Castor L, Cudhea F, Miller V, Reedy J, Shi P, Zhang J, Wong JB, Economos CD, Micha R, Mozaffarian D. Incident type 2 diabetes attributable to suboptimal diet in 184 countries. Nat Med 2023; 29:982-995. [PMID: 37069363 PMCID: PMC10115653 DOI: 10.1038/s41591-023-02278-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/28/2023] [Indexed: 04/19/2023]
Abstract
The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8-14.4 million) incident T2D cases, representing 70.3% (68.8-71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0-27.1%)), excess refined rice and wheat intake (24.6% (22.3-27.2%)) and excess processed meat intake (20.3% (18.3-23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4-87.7%)) and Latin America and the Caribbean (81.8% (80.1-83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1-60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.
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Affiliation(s)
- Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Food Systems for the Future Institute, Chicago, IL, USA.
| | - Laura Lara-Castor
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Julia Reedy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jianyi Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - John B Wong
- Tufts University School of Medicine, Boston, MA, USA
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Christina D Economos
- 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
- Department of Food Science and Nutrition, University of Thessaly, Volos, Greece
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Tufts University School of Medicine, Boston, MA, USA.
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.
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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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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 973] [Impact Index Per Article: 973.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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10
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Lou Z, Yi SS, Pomeranz J, Suss R, Russo R, Rummo PE, Eom H, Liu J, Zhang Y, Moran AE, Bellows BK, Kong N, Li Y. The Health and Economic Impact of Using a Sugar Sweetened Beverage Tax to Fund Fruit and Vegetable Subsidies in New York City: A Modeling Study. J Urban Health 2023; 100:51-62. [PMID: 36550343 PMCID: PMC9918717 DOI: 10.1007/s11524-022-00699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
Low fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are independently associated with an increased risk of developing cardiovascular disease (CVD). Many people in New York City (NYC) have low FV intake and high SSB consumption, partly due to high cost of fresh FVs and low cost of and easy access to SSBs. A potential implementation of an SSB tax and an FV subsidy program could result in substantial public health and economic benefits. We used a validated microsimulation model for predicting CVD events to estimate the health impact and cost-effectiveness of SSB taxes, FV subsidies, and funding FV subsidies with an SSB tax in NYC. Population demographics and health profiles were estimated using data from the NYC Health and Nutrition Examination Survey. Policy effects and price elasticity were derived from recent meta-analyses. We found that funding FV subsidies with an SSB tax was projected to be the most cost-effective policy from the healthcare sector perspective. From the societal perspective, the most cost-effective policy was SSB taxes. All policy scenarios could prevent more CVD events and save more healthcare costs among men compared to women, and among Black vs. White adults. Public health practitioners and policymakers may want to consider adopting this combination of policy actions, while weighing feasibility considerations and other unintended consequences.
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Affiliation(s)
- Zhouyang Lou
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Rachel Suss
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rienna Russo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Pasquale E Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Heesun Eom
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yiyi Zhang
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Andrew E Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Brandon K Bellows
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - Nan Kong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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11
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Vadiveloo MK, Parker HW, Thorndike AN. Participant Characteristics Associated with High Responsiveness to Personalized Healthy Food Incentives: a Secondary Analysis of the Randomized Controlled Crossover Smart Cart Study. J Nutr 2023; 152:2913-2921. [PMID: 36040345 DOI: 10.1093/jn/nxac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/09/2022] [Accepted: 08/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Personalized dietary behavioral interventions could be enhanced by understanding factors accounting for individual variability in dietary decisions. OBJECTIVE This study was a secondary analysis of the Smart Cart randomized controlled trial to determine whether participant characteristics predicted high responsiveness to personalized grocery incentives for purchasing healthy food. METHODS This secondary analysis of a 9-mo crossover study included 192 regular shoppers (86%) from a Rhode Island supermarket. To analyze whether health, behavioral, and/or sociodemographic characteristics predicted responsiveness to a personalized grocery incentive intervention, participants were divided into 3 categories [high (n = 47), moderate (n = 50), and unresponsive (n = 95)] based on percentage changes in their Grocery Purchase Quality Index scores during the intervention versus control period calculated from sales data. We tested whether participant characteristics, including individual, household, and intervention-related factors, differed across responsiveness groups using ANOVA and whether they predicted the likelihood of being high responsive versus unresponsive or moderate responsive using logistic regression. RESULTS Participants had a mean (SD) age of 56.0 (13.8) y and were 89% female. Education, self-reported BMI, income, diet-related medical condition, food insecurity, cooking adequacy, and value consciousness differed across responsiveness categories (P < 0.1). High versus moderate and unresponsive participants increased their percentage of spending on targeted foods (P < 0.0001) and purchased fewer unique items (P = 0.01). In multinomial adjusted models, the odds of being high versus unresponsive or moderate responsive were lower for participants with a BMI (in kg/m2) <25 versus ≥25 (OR: 0.41; 95% CI: 0.19, 0.90) and higher with a diet-related medical condition present (OR: 3.75; 95% CI: 1.20, 11.8). Other characteristics were not associated with responsiveness. CONCLUSIONS Findings demonstrated that a BMI ≥25 and having a diet-related medical condition within the household predicted high responsiveness to a personalized grocery purchasing intervention, suggesting that personalized dietary interventions may be particularly effective for households with higher health risk. This trial is registered at www.clinicaltrials.gov as NCT03748056.
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Affiliation(s)
- Maya K Vadiveloo
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Haley W Parker
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Anne N Thorndike
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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12
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Abstract
PURPOSE OF REVIEW Hypertension represents the most important cardiovascular risk factor, affecting over 4.06 billion adults worldwide. In this review, we will discuss potential barriers and their solutions to improve prevention, detection, and management of hypertension. RECENT FINDINGS The prevalence of hypertension has been increasing in low- and middle-income countries, requiring new strategies to improve its recognition and proper management. The World Heart Federation (WHF) developed a roadmap for hypertension, advising health system policies and clinical practices as part of its commitment to improving global cardiovascular health. The World Health Organization (WHO) has published in 2021 practical guidelines for the pharmacological treatment of hypertension in adults. Identifying potential roadblocks and solutions deserves high priority to improve the detection, management, and control of hypertension.
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Affiliation(s)
- Beatriz Silva
- Faculdade de Medicina, Serviço de Cardiologia, Centro Cardiovascular da Universidade de Lisboa-CCUL, CAML, Universidade de Lisboa, Hospital Universitário de Santa Maria-CHULN, Lisboa, Portugal
| | - Fausto J Pinto
- Faculdade de Medicina, Serviço de Cardiologia, Centro Cardiovascular da Universidade de Lisboa-CCUL, CAML, Universidade de Lisboa, Hospital Universitário de Santa Maria-CHULN, Lisboa, Portugal.
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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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Trends in insulin resistance: insights into mechanisms and therapeutic strategy. Signal Transduct Target Ther 2022; 7:216. [PMID: 35794109 PMCID: PMC9259665 DOI: 10.1038/s41392-022-01073-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
The centenary of insulin discovery represents an important opportunity to transform diabetes from a fatal diagnosis into a medically manageable chronic condition. Insulin is a key peptide hormone and mediates the systemic glucose metabolism in different tissues. Insulin resistance (IR) is a disordered biological response for insulin stimulation through the disruption of different molecular pathways in target tissues. Acquired conditions and genetic factors have been implicated in IR. Recent genetic and biochemical studies suggest that the dysregulated metabolic mediators released by adipose tissue including adipokines, cytokines, chemokines, excess lipids and toxic lipid metabolites promote IR in other tissues. IR is associated with several groups of abnormal syndromes that include obesity, diabetes, metabolic dysfunction-associated fatty liver disease (MAFLD), cardiovascular disease, polycystic ovary syndrome (PCOS), and other abnormalities. Although no medication is specifically approved to treat IR, we summarized the lifestyle changes and pharmacological medications that have been used as efficient intervention to improve insulin sensitivity. Ultimately, the systematic discussion of complex mechanism will help to identify potential new targets and treat the closely associated metabolic syndrome of IR.
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15
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Segal AB, Olney J, Case KK, Sassi F. The benefits and challenges of taxing sugar in a small island state: an interrupted time series analysis. Int J Behav Nutr Phys Act 2022; 19:69. [PMID: 35705983 PMCID: PMC9202202 DOI: 10.1186/s12966-022-01308-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/24/2022] [Indexed: 12/21/2022] Open
Abstract
Background Beverage and food taxes have become a popular ‘best buy’ public health intervention in the global battle to tackle noncommunicable diseases. Though many countries have introduced taxes, mainly targeting products containing sugar, there is great heterogeneity in tax design. For taxes levied as import tariffs, there is limited evidence of effectiveness in changing the price and sale of taxed products, while the evidence base is stronger for excise taxes levied as a fixed amount per quantity of product. This paper examines the effect of the Bermuda Discretionary Foods Tax, which was based on import tariff changes, on retail prices and sales of sugar-sweetened beverages (SSBs), and on selected fruits and vegetables that benefited from a tariff reduction. Methods We used weekly electronic point-of-sale data from a major food retailer in Bermuda. We assessed historical weekly sales and price data using an interrupted time series design on 2,703 unique products between the dates of January 2018 through January 2020, covering 103 weeks. Results By January 2020, the average price per ounce of SSBs increased by 26.0%, while the price of untaxed beverages (including waters and non-added sugar drinks) remained constant. The increasing price of SSBs was the sole observable structural driver of SSB market share, responsible for a decrease in the market share by nearly eight percentage points by the end of the study period. The subsidy on fruits and vegetables was ineffective in changing prices and sales, due to the relatively small 5% import tax decrease. Conclusions The tax was largely passed through to consumers. However, several factors mitigated the impact of the tax on the prices paid for SSBs by consumers, including the specific design of the tax, price promotions and consumer responses. The experience of Bermuda provides important lessons for the planning of similar taxes in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01308-x.
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Affiliation(s)
- Alexa Blair Segal
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Jack Olney
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Kelsey K Case
- Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, UK
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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16
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Ra JS, Park M. Sex-Based Differences in Factors Associated With Sugar-Sweetened Beverage Consumption Among Korean High School Students. Front Nutr 2022; 9:907922. [PMID: 35774547 PMCID: PMC9237550 DOI: 10.3389/fnut.2022.907922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to identify sex-based differences in the individual and environmental factors associated with sugar-sweetened beverage (SSB) consumption among Korean high school students. Secondary data were obtained from the 15th (2019) Korea Youth Risk Behavior Web-based Survey. In this study, we analyzed data from 13,066 high school students (5,874 boys and 7,192 girls) who answered questions regarding SSB consumption and individual and environmental factors. Complex sampling analysis (descriptive statistics and logistic regression analysis) was conducted using the SPSS Statistics 26.0 software. Most adolescents (97% boys and 95.2% girls) reported having consumed SSBs in the last seven days. Individual factors, such as increased stress, sleep dissatisfaction, and fast-food intake (more than thrice a week) were positively associated with SSB consumption among adolescent boys and girls. Environmental factors like high education levels (above college) of mothers were negatively associated with SSB consumption among both boys and girls. Furthermore, current alcohol consumption, smoking, low vegetable intake (less than thrice a week) in boys, and more than 2 h a day of screen-based sedentary behavior in girls were positively associated with SSB consumption. According to the results, individual factors associated with SSB consumption varied according to the sex of adolescents. Thus, sex differences in factors associated with SSB consumption in adolescents should be considered as basic knowledge for developing strategies for reducing SSB consumption.
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Affiliation(s)
| | - Moonkyoung Park
- College of Nursing, Chungnam National University, Daejeon, South Korea
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17
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2222] [Impact Index Per Article: 1111.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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18
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Valizadeh P, Popkin BM, Ng SW. Linking a sugar-sweetened beverage tax with fruit and vegetable subsidies: A simulation analysis of the impact on the poor. Am J Clin Nutr 2022; 115:244-255. [PMID: 34610088 PMCID: PMC8755035 DOI: 10.1093/ajcn/nqab330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/27/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND US individuals, particularly from low-income subpopulations, have very poor diet quality. Policies encouraging shifts from consuming unhealthy food towards healthy food consumption are needed. OBJECTIVES We simulate the differential impacts of a national sugar-sweetened beverage (SSB) tax and combinations of SSB taxes with fruit and vegetable (FV) subsidies targeted to low-income households on SSB and FV purchases of lower and higher SSB purchasers. METHODS We considered a 1-cent-per-ounce SSB tax and 2 FV subsidy rates of 30% and 50% and used longitudinal grocery purchase data for 79,044 urban/semiurban US households from 2010-2014 Nielsen Homescan data. We used demand elasticities for lower and higher SSB purchasers, estimated via longitudinal quantile regression, to simulate policies' differential effects. RESULTS Higher-SSB-purchasing households made larger reductions (per adult equivalent) in SSB purchases than lower SSB purchasers due to the tax (e.g., 4.4 oz/day at SSB purchase percentile 90 compared with 0.5 oz/day at percentile 25; P < 0.05). Our analyses by household income indicated low-income households would make larger reductions than higher-income households at all SSB purchase levels. Targeted FV subsidies induced similar, but nutritionally insignificant, increases in FV purchases of low-income households, regardless of their SSB purchase levels. Subsidies, however, were effective in mitigating the tax burdens. All low-income households experienced a net financial gain when the tax was combined with a 50% FV subsidy, but net gains were smaller among higher SSB purchasers. Further, low-income households with children gained smaller net financial benefits than households without children and incurred net financial losses under a 30% subsidy rate. CONCLUSIONS SSB taxes can effectively reduce SSB consumption. FV subsidies would increase FV purchases, but nutritionally meaningful increases are limited due to low purchase levels before policy implementation. Expanding taxes beyond SSBs, providing larger FV subsidies, or offering subsidies beyond FVs, particularly for low-income households with children, may be more effective.
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Affiliation(s)
- Pourya Valizadeh
- Agricultural & Food Policy Center, Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
- Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
| | - Barry M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, Lau ESH, Eliasson B, Kong APS, Ezzati M, Aguilar-Salinas CA, McGill M, Levitt NS, Ning G, So WY, Adams J, Bracco P, Forouhi NG, Gregory GA, Guo J, Hua X, Klatman EL, Magliano DJ, Ng BP, Ogilvie D, Panter J, Pavkov M, Shao H, Unwin N, White M, Wou C, Ma RCW, Schmidt MI, Ramachandran A, Seino Y, Bennett PH, Oldenburg B, Gagliardino JJ, Luk AOY, Clarke PM, Ogle GD, Davies MJ, Holman RR, Gregg EW. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 2021; 396:2019-2082. [PMID: 33189186 DOI: 10.1016/s0140-6736(20)32374-6] [Citation(s) in RCA: 285] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China.
| | - Lee-Ling Lim
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Ping Zhang
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric S H Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council Centre for Environment and Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Disease, Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China; Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jean Adams
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paula Bracco
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gabriel A Gregory
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jingchuan Guo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Xinyang Hua
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Boon-Peng Ng
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - David Ogilvie
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jenna Panter
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Meda Pavkov
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nigel Unwin
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Martin White
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Constance Wou
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Maria I Schmidt
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India
| | - Yutaka Seino
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of NCDs, University of Melbourne, Melbourne, VIC, Australia
| | - Juan José Gagliardino
- Centro de Endocrinología Experimental y Aplicada, UNLP-CONICET-CICPBA, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Edward W Gregg
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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Acciai F, Srinivasan M, Ohri-Vachaspati P. Sugar-Sweetened Beverage Consumption in Children: The Interplay of Household SNAP and WIC Participation. Am J Prev Med 2021; 61:665-673. [PMID: 34686300 DOI: 10.1016/j.amepre.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although sugar-sweetened beverage (SSB) consumption is associated with Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, no national studies have examined the interplay between these programs. This study compares children's sugar-sweetened beverage consumption across households enrolled in one, both, or neither program. METHODS A total of 4 waves (2009-2010 to 2015-2016) of the National Health and Nutrition Examination Survey were combined to obtain a sample of 4,772 children aged 0-19 years living in households eligible for both SNAP and WIC (households with income ≤130% of the Federal Poverty Level). Children were grouped as living in 4 household types: SNAP only; WIC only; SNAP + WIC; and neither program. Beverages with any added sugars were classified as SSBs. Two-part regression models examined the adjusted association between SSB consumption and program participation. Analyses were conducted in 2020. RESULTS Compared with the SNAP‒only group, children in all other household types had lower odds of SSB consumption (AOR=0.44, p=0.002 for WIC only; AOR=0.69, p=0.020 for SNAP + WIC; AOR=0.61, p=0.025 for neither program). The lower probability of SSB consumption for children from WIC‒participating households was mostly driven by children aged 0-5 years, with the differences weakening for children aged 6-12 years and completely disappearing for those aged 12-19 years. No significant differences were observed for the amount of added sugar consumed by SSB consumers. CONCLUSIONS Household WIC participation-whether jointly with SNAP or alone-may confer protection against SSB consumption. Unlike SNAP, WIC, by design, provides participating households with more information and opportunities to access and consume healthier diets. Understanding how SNAP and WIC interact can help policymakers improve the design and nutritional benefit of the U.S. food safety net.
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Affiliation(s)
- Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, Arizona.
| | - Mithuna Srinivasan
- Health Care Evaluation Department, NORC at the University of Chicago, Bethesda, Maryland
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21
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Walker RJ, Garacci E, Dawson AZ, Williams JS, Ozieh M, Egede LE. Trends in Food Insecurity in the United States from 2011-2017: Disparities by Age, Sex, Race/Ethnicity, and Income. Popul Health Manag 2021; 24:496-501. [PMID: 32941115 PMCID: PMC8403212 DOI: 10.1089/pop.2020.0123] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The number of individuals in the United States who report food insecurity doubled between 2005 and 2012, with little research investigating possible disparities across time in food-insecure populations. The aim of this study was to investigate trends in food insecurity between 2001-2017 by sex, race/ethnicity, income, and age. Adults participating in the National Health Interview Survey (NHIS) between 2011-2017 were included in the study. Food insecurity was dichotomized based on affirmative responses to the Food Security Survey Module. Statistical analysis included logistic regression to investigate trends in food insecurity over time by each demographic variable (age, sex, race/ethnicity, income) adjusted by survey year and demographic variables. After adjustment, those ages ≥65 years were 39% less likely (OR = 0.61, 95% CI [0.57,0.65]) to report food insecurity compared to those ages 18-34; females were 23% more likely to be food insecure than males (OR = 1.23, 95% CI [1.19,1.27]); non-Hispanic blacks were 1.7 times more likely (OR = 1.69, 95% CI [1.62,1.76]) to be food insecure than non-Hispanic whites; and a clear gradient existed by income, with lower incomes more likely to be food insecure. Disparities in food insecurity exist across age, race/ethnicity, sex, and income and were consistent over time. These results suggest that targeted programs may be necessary to decrease food insecurity in particularly vulnerable subpopulations, and barriers to access and use of existing programs need to be investigated.
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Affiliation(s)
- Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Aprill Z. Dawson
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joni S. Williams
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mukoso Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Nephrology, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Requero B, Santos D, Cancela A, Briñol P, Petty RE. Promoting Healthy Eating Practices through Persuasion Processes. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1080/01973533.2021.1929987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Conrad Z, Blackstone NT. Identifying the links between consumer food waste, nutrition, and environmental sustainability: a narrative review. Nutr Rev 2021; 79:301-314. [PMID: 32585005 DOI: 10.1093/nutrit/nuaa035] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Emerging research demonstrates unexpected relationships between food waste, nutrition, and environmental sustainability that should be considered when developing waste reduction strategies. In this narrative review, we synthesize these linkages and the evidence related to drivers of food waste and reduction strategies at the consumer level in the United States. Higher diet quality is associated with greater food waste, which results in significant quantities of wasted resources (e.g., energy, fertilizer) and greenhouse gas emissions. Food waste also represents waste of micronutrients that could otherwise theoretically fill nutritional gaps for millions of people. To make progress on these multiple fronts simultaneously, nutrition professionals must expand beyond their traditional purview, into more interdisciplinary arenas that make connections with food waste and environmental sustainability.
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Affiliation(s)
- Zach Conrad
- Department of Health Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Nicole Tichenor Blackstone
- Division of Agriculture, Food, and Environment, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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24
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 2920] [Impact Index Per Article: 973.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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25
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Huang X, Zhao X, Zhu K, Ding S, Shao B. Sodium dehydroacetate induces cardiovascular toxicity associated with Ca 2+ imbalance in zebrafish. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 208:111613. [PMID: 33396133 DOI: 10.1016/j.ecoenv.2020.111613] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
The environmental effects of additives have attracted increasing attention. Sodium dehydroacetate (DHA-S), as an approved preservative, is widely added in processed foods, cosmetics and personal care products. However, DHA-S has been recently reported to induce hemorrhage and coagulation aberration in rats. Yet little is known about the ecotoxicological effect and underlying mechanisms of DHA-S. Here, we utilized the advantage of zebrafish model to evaluate such effects. DHA-S induced cerebral hemorrhage, mandibular dysplasia and pericardial edema in zebrafish after 24 h exposure (48-72 hpf) at 50 mg/L. We also observed the defective heart looping and apoptosis in DHA-S-treated zebrafish through o-dianisidine and acridine orange staining. Meanwhile, DHA-S induced the deficiency of Ca2+ and vitamin D3 in zebrafish. We further demonstrated that DHA-S stimulated Ca2+ influx resulting in Ca2+-dependent mitochondrial damage in cardiomyocytes. Additionally, DHA-S inhibited glucose uptake and repressed the biosynthesis of amino acids. Finally, we identified that sodium bicarbonate could rescue zebrafish from DHA-S induced cardiovascular toxicity. Altogether, our results suggest that DHA-S is a potential risk for cardiovascular system.
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Affiliation(s)
- Xiaoyong Huang
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China; Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Centers for Disease Control and Preventative Medical Research, Beijing 100013, China
| | - Xiaole Zhao
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China
| | - Kui Zhu
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China
| | - Shuangyang Ding
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China.
| | - Bing Shao
- Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Centers for Disease Control and Preventative Medical Research, Beijing 100013, China.
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26
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Healthy Diet Assistance for the Most Deprived in Post-Crisis Greece: An Evaluation of the State Food Provision Program. SUSTAINABILITY 2020. [DOI: 10.3390/su13010099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2016, the European Union set up the Fund for European Aid to the Most Deprived (FEAD) as its first structured food provision program to combat food insecurity. Computational analysis and a cross-sectional survey took place from January 2016 to June 2018 to calculate FEAD’s contribution to its beneficiaries’ diets and to collect beneficiary satisfaction data. Dairy, fresh meat, legumes, sugar, olive oil, and tomato concentrate were the most commonly procured items. The program’s contribution to vegetable, dairy, and grains intake was 3.4%, 6.1%, and 6.0%, respectively, as opposed to discretionary calories (12.2%) and fats/oils (24.5%). The program’s algorithm greatly favors (almost 3-fold) single-person applications, compared with applications with four or more people. Beneficiaries valued each food provision at 21.23 ± 23.4 euros, which, for 64.4% of them, translated to a high positive impact on the household budget. FEAD had a highly positive impact on feelings of anxiety and security, for 50.7% and 41.6% of its beneficiaries. Satisfaction with the foods provided was also high for ~70% of the beneficiaries. The program is met with high beneficiary satisfaction and is perceived as a substantial assistance. Increases in the amounts and variety of foods delivered, with a focus on fruit, vegetables, and fish, should be considered to further improve the program’s dietary impact.
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Russo RG, Northridge ME, Wu B, Yi SS. Characterizing Sugar-Sweetened Beverage Consumption for US Children and Adolescents by Race/Ethnicity. J Racial Ethn Health Disparities 2020; 7:1100-1116. [PMID: 32152835 PMCID: PMC7483241 DOI: 10.1007/s40615-020-00733-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/07/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine racial/ethnic differences in type of SSB most frequently consumed and in correlates of youth sugar-sweetened beverage (SSB) intake. METHODS Data were obtained from the National Health and Nutrition Examination Survey (NHANES), 2011-2016, for children and adolescents aged 5-17 years (n = 6507). The main outcome was SSB consumption (i.e., sodas, sweetened fruit drinks, nectars, sports and energy drinks, sweetened coffees and teas, enhanced waters). Mean and proportions of SSB intake were estimated accounting for complex sampling strategy and weighting. Multivariable regression models were developed for each race/ethnicity and age group. RESULTS Two-thirds of children and adolescents reported consuming SSB on a given day. Among consumers, mean SSB consumption was greatest for Black children and White adolescents and lowest for Asian American children and adolescents. The most popular type of SSB consumed was sweetened fruit drinks among children and soda among adolescents, except among White and Mexican American children for whom soda and Black adolescents for whom sweetened fruit drinks were most popular. Female sex and water intake were negatively associated with SSB consumption across most races/ethnicities. Screen time, dentist visits, nativity, and guardian education were associated with SSB intake among a subset of races/ethnicities. CONCLUSIONS Associations between covariates and SSB intake as well as types of beverages preferred vary by race/ethnicity, as such chronic disease policies should not be 'one size fits all'. Targeted interventions for specific groups of vulnerable youths hold promise for further reducing SSB consumption, including directing efforts towards reducing sweetened fruit drinks for Black children.
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Affiliation(s)
- Rienna G Russo
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.
| | - Mary E Northridge
- Department of Plastic Surgery, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Bei Wu
- NYU Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA
| | - Stella S Yi
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
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28
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Suvorova EI, Kontsevaya AV, Ryzhov AP, Myrzamatova AO, Mukaneeva DK, Khudyakov MB, Drapkina OM. Systematization of effective population-based preventive measures under uncertainty: an ontological approach. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- E. I. Suvorova
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. V. Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. P. Ryzhov
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. O. Myrzamatova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. K. Mukaneeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. B. Khudyakov
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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29
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Pinho-Gomes AC, Knight A, Critchley J, Pennington M. Addressing the low consumption of fruit and vegetables in England: a cost-effectiveness analysis of public policies. J Epidemiol Community Health 2020; 75:282-288. [PMID: 33070113 DOI: 10.1136/jech-2020-214081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/16/2020] [Accepted: 09/28/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Most adults do not meet the recommended intake of five portions per day of fruit and vegetables (F&V) in England, but economic analyses of structural policies to change diet are sparse. METHODS Using published data from official statistics and meta-epidemiological studies, we estimated the deaths, years-of-life lost (YLL) and the healthcare costs attributable to consumption of F&V below the recommended five portions per day by English adults. Then, we estimated the cost-effectiveness from governmental and societal perspectives of three policies: a universal 10% subsidy on F&V, a targeted 30% subsidy for low-income households and a social marketing campaign (SMC). FINDINGS Consumption of F&V below the recommended five portions a day accounted for 16 321 [10 091-23 516] deaths and 238 767 [170 350-311 651] YLL in England in 2017, alongside £705 951 [398 761-1 061 559] million in healthcare costs. All policies would increase consumption and reduce the disease burden attributable to low intake of F&V. From a societal perspective, the incremental cost-effectiveness ratios were £22 891 [22 300-25 079], £16 860 [15 589-19 763] and £25 683 [25 237-28 671] per life-year saved for the universal subsidy, targeted subsidy and SMC, respectively. At a threshold of £20 000 per life-year saved, the likelihood that the universal subsidy, the targeted subsidy and the SMC were cost-effective was 84%, 19% and 5%, respectively. The targeted subsidy would additionally reduce inequalities. CONCLUSIONS Low intake of F&V represents a heavy health and care burden in England. All dietary policies can improve consumption of F&V, but only a targeted subsidy to low-income households would most likely be cost-effective.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alec Knight
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Julia Critchley
- Population Health Research Institute, St George's University of London, London, UK
| | - Mark Pennington
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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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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Seferidi P, Laverty AA, Collins B, Bandosz P, Capewell S, O’Flaherty M, Millett C, Pearson-Stuttard J. Potential impacts of post-Brexit agricultural policy on fruit and vegetable intake and cardiovascular disease in England: a modelling study. BMJ Nutr Prev Health 2020; 3:3-10. [PMID: 33235965 PMCID: PMC7664506 DOI: 10.1136/bmjnph-2019-000057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/29/2019] [Accepted: 12/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Current proposals for post-Brexit agricultural policy do not explicitly incorporate public health goals. The revised agricultural policy may be an opportunity to improve population health by supporting domestic production and consumption of fruits and vegetables (F&V). This study aims to quantify the potential impacts of a post-Brexit agricultural policy that increases land allocated to F&V on cardiovascular disease (CVD) mortality and inequalities in England, between 2021 to 2030. Methods We used the previously validated IMPACT Food Policy model and probabilistic sensitivity analysis to translate changes in land allocated to F&V into changes in F&V intake and associated CVD deaths, stratified by age, sex and Index of Multiple Deprivation. The model combined data on F&V agriculture, waste, purchases and intake, CVD mortality projections and appropriate relative risks. We modelled two scenarios, assuming that land allocated to F&V would gradually increase to 10% and 20% of land suitable for F&V production. Results We found that increasing land use for F&V production to 10% and 20% of suitable land would increase fruit intake by approximately 3.7% (95% uncertainty interval: 1.6% to 8.6%) and 17.4% (9.1% to 36.9%), and vegetable intake by approximately 7.8% (4.2% to 13.7%) and 37% (24.3% to 55.7%), respectively, in 2030. This would prevent or postpone approximately 3890 (1950 to 7080) and 18 010 (9840 to 28 870) CVD deaths between 2021 and 2030, under the first and second scenario, respectively. Both scenarios would reduce inequalities, with 16% of prevented or postponed deaths occurring among the least deprived compared with 22% among the most deprived. Conclusion Post-Brexit agricultural policy presents an important opportunity to improve dietary intake and associated cardiovascular mortality by supporting domestic production of F&V as part of a comprehensive strategy that intervenes across the supply chain.
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Affiliation(s)
- Paraskevi Seferidi
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Jonathan Pearson-Stuttard
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Abstract
PURPOSE OF REVIEW This review is an assessment of the state of the science on nutrition disparities and their contribution to disparities in cardiovascular health. RECENT FINDINGS Nutrition disparities remain pervasive by race/ethnicity, sex/gender, socioeconomic status, and geography. They are rooted in differences in social, cultural, and environmental determinants of health, behavioral and lifestyle factors, and the impact of policy interventions. Systematic differences in diet quality, dietary patterns, and nutrient intakes contribute to cardiovascular disparities and are mediated by microbiota, and CVD risk factors including high levels of blood pressure, low density lipoprotein cholesterol (LDL), and glucose; oxidative stress, pro-inflammatory cytokines, and endothelial dysfunction. Despite the progress made in nutrition research, important gaps persist that signal the need for more effective interventions at multiple levels to reduce cardiovascular disparities. Research opportunities include (1) exploring the gene-nutrient-environment interactions in the context of ancestral diversity; (2) investigating the causal link between diet and gut microbiota and impact of social determinants of health; (3) understanding resilience; (4) testing the effectiveness of multi-level interventions that address social and environmental determinants; and (4) supporting intervention research informed by validated implementation science frameworks.
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Affiliation(s)
- George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Suite 6070, Bethesda, MD, 20892, USA.
| | - Alison G M Brown
- Division of Cardiovascular Sciences, NHLBI, NIH, 6710 Rockledge Drive, Suite 10115, Bethesda, MD, 20892, USA
| | - Charlotte A Pratt
- Division of Cardiovascular Sciences, NHLBI, NIH, 6710 Rockledge Drive, Suite 10115, Bethesda, MD, 20892, USA
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Juarez PD, Tabatabai M, Burciaga Valdez R, Hood DB, Im W, Mouton C, Colen C, Al-Hamdan MZ, Matthews-Juarez P, Lichtveld MY, Sarpong D, Ramesh A, Langston MA, Rogers GL, Phillips CA, Reichard JF, Donneyong MM, Blot W. The Effects of Social, Personal, and Behavioral Risk Factors and PM 2.5 on Cardio-Metabolic Disparities in a Cohort of Community Health Center Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3561. [PMID: 32438697 PMCID: PMC7277630 DOI: 10.3390/ijerph17103561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/30/2020] [Accepted: 05/15/2020] [Indexed: 12/26/2022]
Abstract
(1) Background: Cardio-metabolic diseases (CMD), including cardiovascular disease, stroke, and diabetes, have numerous common individual and environmental risk factors. Yet, few studies to date have considered how these multiple risk factors together affect CMD disparities between Blacks and Whites. (2) Methods: We linked daily fine particulate matter (PM2.5) measures with survey responses of participants in the Southern Community Cohort Study (SCCS). Generalized linear mixed modeling (GLMM) was used to estimate the relationship between CMD risk and social-demographic characteristics, behavioral and personal risk factors, and exposure levels of PM2.5. (3) Results: The study resulted in four key findings: (1) PM2.5 concentration level was significantly associated with reported CMD, with risk rising by 2.6% for each µg/m3 increase in PM2.5; (2) race did not predict CMD risk when clinical, lifestyle, and environmental risk factors were accounted for; (3) a significant variation of CMD risk was found among participants across states; and (4) multiple personal, clinical, and social-demographic and environmental risk factors played a role in predicting CMD occurrence. (4) Conclusions: Disparities in CMD risk among low social status populations reflect the complex interactions of exposures and cumulative risks for CMD contributed by different personal and environmental factors from natural, built, and social environments.
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Affiliation(s)
- Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (W.I.); (P.M.-J.)
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN 37208, USA;
| | - Robert Burciaga Valdez
- RWJF Professor, Department of Family & Community Medicine AND Economics, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Darryl B. Hood
- Department of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA;
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (W.I.); (P.M.-J.)
| | - Charles Mouton
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Cynthia Colen
- Department of Sociology, Ohio State University, Columbus, OH 43210, USA;
| | - Mohammad Z. Al-Hamdan
- Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL 35805, USA;
| | - Patricia Matthews-Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (W.I.); (P.M.-J.)
| | - Maureen Y. Lichtveld
- Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA;
| | - Daniel Sarpong
- Department of Biostatistics, Xavier University, Cincinnati, OH 45207, USA;
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN 37208, USA;
| | - Michael A. Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA; (M.A.L.); (C.A.P.)
| | - Gary L. Rogers
- National Institute for Computational Sciences, University of Tennessee, Knoxville, TN 37996, USA;
| | - Charles A. Phillips
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA; (M.A.L.); (C.A.P.)
| | - John F. Reichard
- Department of Environmental Health, Risk Science Center, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Macarius M. Donneyong
- Division of Outcomes and Translational Sciences, College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
| | - William Blot
- Center for Population-based Research, Vanderbilt University, Nashville, TN 37235, USA;
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Sigmund CD, Carey RM, Appel L, Arnett D, Bosworth HB, Cushman WC, Galis ZS, Parker MG, Hall JE, Harrison DG, McDonough AA, Nicastro HL, Oparil S, Osborn JW, Raizada MK, Wright JD, Oh YS. Report of the National Heart, Lung, and Blood Institute Working Group on Hypertension: Barriers to Translation. Hypertension 2020; 75:902-917. [PMID: 32063061 PMCID: PMC7067675 DOI: 10.1161/hypertensionaha.119.13887] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The National Heart, Lung, and Blood Institute convened a multidisciplinary working group of hypertension researchers on December 6 to 7, 2018, in Bethesda, MD, to share current scientific knowledge in hypertension and to identify barriers to translation of basic into clinical science/trials and implementation of clinical science into clinical care of patients with hypertension. The goals of the working group were (1) to provide an overview of recent discoveries that may be ready for testing in preclinical and clinical studies; (2) to identify gaps in knowledge that impede translation; (3) to highlight the most promising scientific areas in which to pursue translation; (4) to identify key challenges and barriers for moving basic science discoveries into translation, clinical studies, and trials; and (5) to identify roadblocks for effective dissemination and implementation of basic and clinical science in real-world settings. The working group addressed issues that were responsive to many of the objectives of the National Heart, Lung, and Blood Institute Strategic Vision. The working group identified major barriers and opportunities for translating research to improved control of hypertension. This review summarizes the discussion and recommendations of the working group.
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Affiliation(s)
| | | | | | | | | | | | | | | | - John E. Hall
- University of Mississippi Medical Center, Jackson, MS
| | | | | | | | | | | | | | | | - Young S. Oh
- Vascular Biology & Hypertension Branch, DCVS, NHLBI
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Vadiveloo MK, Guan X, Parker HW, Perraud E, Buchanan A, Atlas S, Thorndike AN. Evaluating the effect of individually-targeted food incentives on grocery purchases: The smart cart study protocol for a randomized controlled cross-over trial. Contemp Clin Trials 2020; 91:105966. [PMID: 32092439 DOI: 10.1016/j.cct.2020.105966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND/AIMS Health stakeholders are interested in the promise of healthy food incentives to improve dietary quality. The Smart Cart Study tested whether targeting healthful food incentives based on customer preferences and purchase history was effective for improving grocery purchase quality. DESIGN Randomized controlled crossover design of 224 adults who shopped at an independent supermarket for ≥50% of their groceries, participated in the store's loyalty program, and completed validated diet and sociodemographic/behavioral questionnaires. Participants were randomized using 1:1 blocked randomization; all participants received a 5% discount on their purchases with their loyalty card. For the first 13-weeks, the intervention group received individually-targeted weekly coupons (valued up to $10) with brief nutrition education to improve grocery purchase quality. The study team developed healthy food coupons, and the study algorithm allocated targeted coupons to participants' loyalty cards using purchase history, dietary preferences/allergies, and baseline diet quality. Control participants received weekly untargeted nutrition education and occasional generic coupons. Following a 2-4 week washout period, the two groups crossed over. The primary study outcomes were purchases of targeted products and grocery purchase quality measured using the validated Grocery Purchase Quality Index-2016; the study was powered to detect a minimum 3% difference in purchase quality. CONCLUSIONS The Smart Cart Study tested a novel application of automated individually-targeted marketing using customer purchase history, dietary quality, and preferences to identify and deliver targeted incentives to improve grocery purchase quality. Future research could scale this program through collaboration between multiple stakeholders, including supermarkets, workplace wellness initiatives and insurance companies.
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Affiliation(s)
- Maya K Vadiveloo
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI, United States of America.
| | - Xintong Guan
- Marketing Area, College of Business Administration, University of Rhode Island, Kingston, RI, United States of America
| | - Haley W Parker
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI, United States of America
| | - Elie Perraud
- AgroParis Tech., 75231 Paris, Ile-de-France, France
| | - Ashley Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, United States of America
| | - Stephen Atlas
- Marketing Area, College of Business Administration, University of Rhode Island, Kingston, RI, United States of America
| | - Anne N Thorndike
- General Internal Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4641] [Impact Index Per Article: 1160.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Bandosz P, Ahmadi-Abhari S, Guzman-Castillo M, Pearson-Stuttard J, Collins B, Whittaker H, Shipley MJ, Capewell S, Brunner EJ, O'Flaherty M. Potential impact of diabetes prevention on mortality and future burden of dementia and disability: a modelling study. Diabetologia 2020; 63:104-115. [PMID: 31732789 PMCID: PMC6890625 DOI: 10.1007/s00125-019-05015-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/09/2019] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Diabetes is associated with an increased risk of dementia. We estimated the potential impact of trends in diabetes prevalence upon mortality and the future burden of dementia and disability in England and Wales. METHODS We used a probabilistic multi-state, open cohort Markov model to integrate observed trends in diabetes, cardiovascular disease and dementia to forecast the occurrence of disability and dementia up to the year 2060. Model input data were taken from the English Longitudinal Study of Ageing, Office for National Statistics vital data and published effect estimates for health-state transition probabilities. The baseline scenario corresponded to recent trends in obesity: a 26% increase in the number of people with diabetes by 2060. This scenario was evaluated against three alternative projected trends in diabetes: increases of 49%, 20% and 7%. RESULTS Our results suggest that changes in the trend in diabetes prevalence will lead to changes in mortality and incidence of dementia and disability, which will become visible after 10-15 years. If the relative prevalence of diabetes increases 49% by 2060, expected additional deaths would be approximately 255,000 (95% uncertainty interval [UI] 236,000-272,200), with 85,900 (71,500-101,600) cumulative additional cases of dementia and 104,900 (85,900-125,400) additional cases of disability. With a smaller relative increase in diabetes prevalence (7% increase by 2060), we estimated 222,200 (205,700-237,300) fewer deaths, and 77,000 (64,300-90,800) and 93,300 (76,700-111,400) fewer additional cases of dementia and disability, respectively, than the baseline case of a 26% increase in diabetes. CONCLUSIONS/INTERPRETATION Reducing the burden of diabetes could result in substantial reductions in the incidence of dementia and disability over the medium to long term.
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Affiliation(s)
- Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
- Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, Poland.
| | - Sara Ahmadi-Abhari
- Institute of Epidemiology and Health Care, University College London, London, UK
- Ageing Epidemiology (AGE) Research Unit, Imperial College London, London, UK
| | - Maria Guzman-Castillo
- Department of Public Health and Policy, University of Liverpool, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
- Department of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jonathan Pearson-Stuttard
- Department of Public Health and Policy, University of Liverpool, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
- School of Public Health, Imperial College London, London, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Hannah Whittaker
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Martin J Shipley
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Eric J Brunner
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5174] [Impact Index Per Article: 1034.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Olstad DL, McIntyre L. Reconceptualising precision public health. BMJ Open 2019; 9:e030279. [PMID: 31519678 PMCID: PMC6747655 DOI: 10.1136/bmjopen-2019-030279] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023] Open
Abstract
As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalisation, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalisation within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualisations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalising these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to the identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualised thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalization, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalization within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualizations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalizing these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualized thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.
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Affiliation(s)
- Dana Lee Olstad
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynn McIntyre
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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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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Gruss SM, Nhim K, Gregg E, Bell M, Luman E, Albright A. Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond. Curr Diab Rep 2019; 19:78. [PMID: 31385061 PMCID: PMC6682852 DOI: 10.1007/s11892-019-1200-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW This article highlights foundational evidence, translation studies, and current research behind type 2 diabetes prevention efforts worldwide, with focus on high-risk populations, and whole-population approaches as catalysts to global prevention. RECENT FINDINGS Continued focus on the goals of foundational lifestyle change program trials and their global translations, and the targeting of those at highest risk through both in-person and virtual modes of program delivery, is critical. Whole-population approaches (e.g., socioeconomic policies, healthy food promotion, environmental/systems changes) and awareness raising are essential complements to efforts aimed at high-risk populations. Successful type 2 diabetes prevention strategies are being realized in the USA through the National Diabetes Prevention Program and elsewhere in the world. A multi-tiered approach involving appropriate risk targeting and whole-population efforts is essential to curb the global diabetes epidemic.
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Affiliation(s)
- Stephanie M. Gruss
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Kunthea Nhim
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Edward Gregg
- 0000 0001 2113 8111grid.7445.2Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Miriam Bell
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Elizabeth Luman
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
| | - Ann Albright
- 0000 0001 2163 0069grid.416738.fDivision of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F75, Atlanta, GA 30341 USA
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Collins B, Kypridemos C, Pearson-Stuttard J, Huang Y, Bandosz P, Wilde P, Kersh R, Capewell S, Mozaffarian D, Whitsel LP, Micha R, O'Flaherty M. FDA Sodium Reduction Targets and the Food Industry: Are There Incentives to Reformulate? Microsimulation Cost-Effectiveness Analysis. Milbank Q 2019; 97:858-880. [PMID: 31332837 PMCID: PMC6739614 DOI: 10.1111/1468-0009.12402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Policy Points The World Health Organization has recommended sodium reduction as a “best buy” to prevent cardiovascular disease (CVD). Despite this, Congress has temporarily blocked the US Food and Drug Administration (FDA) from implementing voluntary industry targets for sodium reduction in processed foods, the implementation of which could cost the industry around $16 billion over 10 years. We modeled the health and economic impact of meeting the two‐year and ten‐year FDA targets, from the perspective of people working in the food system itself, over 20 years, from 2017 to 2036. Benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, and the value of CVD‐related health gains and cost savings are together greater than the government and industry costs of reformulation.
Context The US Food and Drug Administration (FDA) set draft voluntary targets to reduce sodium levels in processed foods. We aimed to determine cost effectiveness of meeting these draft sodium targets, from the perspective of US food system workers. Methods We employed a microsimulation cost‐effectiveness analysis using the US IMPACT Food Policy model with two scenarios: (1) short term, achieving two‐year FDA reformulation targets only, and (2) long term, achieving 10‐year FDA reformulation targets. We modeled four close‐to‐reality populations: food system “ever” workers; food system “current” workers in 2017; and subsets of processed food “ever” and “current” workers. Outcomes included cardiovascular disease cases prevented and postponed as well as incremental cost‐effectiveness ratio per quality‐adjusted life year (QALY) gained from 2017 to 2036. Findings Among food system ever workers, achieving long‐term sodium reduction targets could produce 20‐year health gains of approximately 180,000 QALYs (95% uncertainty interval [UI]: 150,000 to 209,000) and health cost savings of approximately $5.2 billion (95% UI: $3.5 billion to $8.3 billion), with an incremental cost‐effectiveness ratio (ICER) of $62,000 (95% UI: $1,000 to $171,000) per QALY gained. For the subset of processed food industry workers, health gains would be approximately 32,000 QALYs (95% UI: 27,000 to 37,000); cost savings, $1.0 billion (95% UI: $0.7bn to $1.6bn); and ICER, $486,000 (95% UI: $148,000 to $1,094,000) per QALY gained. Because many health benefits may occur in individuals older than 65 or the uninsured, these health savings would be shared among individuals, industry, and government. Conclusions The benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, with the value of health gains and health care cost savings outweighing the costs of reformulation, although not for the processed food industry.
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Affiliation(s)
| | | | | | - Yue Huang
- Friedman School of Nutrition Science and Policy, Tufts University
| | - Piotr Bandosz
- University of Liverpool.,Medical University of Gdansk
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University
| | | | | | | | | | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University
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Patetta MA, Pedraza LS, Popkin BM. Improvements in the nutritional quality of US young adults based on food sources and socioeconomic status between 1989-1991 and 2011-2014. Nutr J 2019; 18:32. [PMID: 31242913 PMCID: PMC6595624 DOI: 10.1186/s12937-019-0460-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/18/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Fast food and other away from home food sources are linked with poorer diet quality and adverse health outcomes. The diet quality of young adults, major consumers of fast food, is understudied in terms of long-term shifts based on food sources for key subpopulation disparities. METHODS The study included young adults ages 18-39 (n = 8012) from the Continuing Survey of Food Intakes by Individuals 1989-1991 (n = 4217) and the National Health and Nutrition Examination Survey 2011-2012 and 2013-2014 (n = 3795). We stratified individuals based on their combination of food sources, race/ethnicity, and socioeconomic status. Using 24-h dietary recall data, we measured diet quality with the Healthy Eating Index-2015 (HEI-2015). Differences in diet quality were determined using 95% confidence intervals. RESULTS Overall, diet quality increased across all food sources between the 1989-1991 and 2011-2014 surveys. The restaurant category overtook the at home category as the healthiest food source, while the fast food category remained the unhealthiest on days it was consumed. Vegetable intake decreased, while added sugar intake increased across all sources. Non-Hispanic whites and non-Hispanic blacks experienced similar increases in HEI-2015 scores across all food sources except restaurants, while Mexican American diet quality remained unchanged. Although all income levels experienced an increase in diet quality, the disparity between low- and high-income groups increased considerably. CONCLUSIONS US young adults consume healthier foods from all food sources, however, fast food consumers have significantly lower quality in the remainder of their diets. Additionally, Mexican Americans and low-income individuals emerge as high-risk groups for poor diet quality.
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Affiliation(s)
- Matthew A Patetta
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, CB #8120 Carolina Square, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516-2524, USA
| | - Lilia S Pedraza
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, CB #8120 Carolina Square, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516-2524, USA.,National Institute of Public Health in Mexico, Cuernavaca, Mexico
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, CB #8120 Carolina Square, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516-2524, USA. .,Cornell University, Ithaca, USA.
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Freedman DA, Ngendahimana D, Shon EJ, Merritt K, Pon J. Predictors of Supplemental Nutrition Assistance Program Use at Farmers' Markets With Monetary Incentive Programming. Am J Health Promot 2019; 33:1039-1048. [PMID: 31159565 DOI: 10.1177/0890117119854708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Healthy food incentive program implementation targeting people receiving Supplemental Nutrition Assistance Program (SNAP) benefits is supported by the federal Food Insecurity Nutrition Incentive (FINI) grant program. This study examined factors contributing to increased SNAP use at farmers' markets with an FINI-funded incentive program. DESIGN Implementation evaluation. SETTING Sixteen states and District of Columbia. PARTICIPANTS Two hundred eighty-two FINI-funded farmers' markets open in 2016. MEASURES Weekly SNAP sales and transactions per 1000 SNAP households in the Zip Code Tabulation Areas around markets. ANALYSIS Two-level hierarchical regression modeling. RESULTS Most farmers' markets (53%) had less than 100 SNAP transactions in 2016. Weekly SNAP sales and transactions per 1000 SNAP households were 69.9% and 47.7% higher, respectively, if more than 1 incentive was available versus 1. Not having paid market staff resulted in declines in these sales (-34.3%) and transactions (-38.1%) compared to markets with paid staff. There was a 6.2% and 5.1% increase in SNAP sales and transactions for each additional produce vendor. Weekly SNAP sales and transactions were about 2 to 3 times higher in rural areas compared to metropolitan. Clustering of markets within states explained 10% of the variation in weekly SNAP sales and transactions. CONCLUSION Four implementation factors were identified that may facilitate the reach of SNAP-based monetary incentive programs at farmers' markets to maximize reach and impact among SNAP shoppers.
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Affiliation(s)
- Darcy A Freedman
- 1 Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - David Ngendahimana
- 1 Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - En-Jung Shon
- 2 Department of Family Science and Social Work, Miami University, Oxford, OH, USA
| | | | - Julia Pon
- 3 Wholesome Wave, Bridgeport, CT, USA
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Anderson CA, Thorndike AN, Lichtenstein AH, Van Horn L, Kris-Etherton PM, Foraker R, Spees C. Innovation to Create a Healthy and Sustainable Food System: A Science Advisory From the American Heart Association. Circulation 2019; 139:e1025-e1032. [DOI: 10.1161/cir.0000000000000686] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current dietary intakes of North Americans are inconsistent with the
Dietary Guidelines for Americans
. This occurs in the context of a food system that precludes healthy foods as the default choices. To develop a food system that is both healthy and sustainable requires innovation. This science advisory from the American Heart Association describes both innovative approaches to developing a healthy and sustainable food system and the current evidence base for the associations between these approaches and positive changes in dietary behaviors, dietary intakes, and when available, health outcomes. Innovation can occur through policy, private sector, public health, medical, community, or individual-level approaches and could ignite and further public-private partnerships. New product innovations, reformulations, taxes, incentives, product placement/choice architecture, innovative marketing practices, menu and product labeling, worksite wellness initiatives, community campaigns, nutrition prescriptions, mobile health technologies, and gaming offer potential benefits. Some innovations have been observed to increase the purchasing of healthy foods or have increased diversity in food choices, but there remains limited evidence linking these innovations with health outcomes. The demonstration of evidence-based improvements in health outcomes is challenging for any preventive interventions, especially those related to diet, because of competing lifestyle and environmental risk factors that are difficult to quantify. A key next step in creating a healthier and more sustainable food system is to build innovative system-level approaches that improve individual behaviors, strengthen industry and community efforts, and align policies with evidence-based recommendations. To enable healthier food choices and favorably impact cardiovascular health, immediate action is needed to promote favorable innovation at all levels of the food system.
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Huang Y, Kypridemos C, Liu J, Lee Y, Pearson-Stuttard J, Collins B, Bandosz P, Capewell S, Whitsel L, Wilde P, Mozaffarian D, O'Flaherty M, Micha R. Cost-Effectiveness of the US Food and Drug Administration Added Sugar Labeling Policy for Improving Diet and Health. Circulation 2019; 139:2613-2624. [PMID: 30982338 DOI: 10.1161/circulationaha.118.036751] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Excess added sugars, particularly from sugar-sweetened beverages, are a major risk factor for cardiometabolic diseases including cardiovascular disease and type 2 diabetes mellitus. In 2016, the US Food and Drug Administration mandated the labeling of added sugar content on all packaged foods and beverages. Yet, the potential health impacts and cost-effectiveness of this policy remain unclear. METHODS A validated microsimulation model (US IMPACT Food Policy model) was used to estimate cardiovascular disease and type 2 diabetes mellitus cases averted, quality-adjusted life-years, policy costs, health care, informal care, and lost productivity (health-related) savings and cost-effectiveness of 2 policy scenarios: (1) implementation of the US Food and Drug Administration added sugar labeling policy (sugar label), and (2) further accounting for corresponding industry reformulation (sugar label+reformulation). The model used nationally representative demographic and dietary intake data from the National Health and Nutrition Examination Survey, disease data from the Centers for Disease Control and Prevention Wonder Database, policy effects and diet-disease effects from meta-analyses, and policy and health-related costs from established sources. Probabilistic sensitivity analysis accounted for model parameter uncertainties and population heterogeneity. RESULTS Between 2018 and 2037, the sugar label would prevent 354 400 cardiovascular disease (95% uncertainty interval, 167 000-673 500) and 599 300 (302 400-957 400) diabetes mellitus cases, gain 727 000 (401 300-1 138 000) quality-adjusted life-years, and save $31 billion (15.7-54.5) in net healthcare costs or $61.9 billion (33.1-103.3) societal costs (incorporating reduced lost productivity and informal care costs). For the sugar label+reformulation scenario, corresponding gains were 708 800 (369 200-1 252 000) cardiovascular disease cases, 1.2 million (0.7-1.7) diabetes mellitus cases, 1.3 million (0.8-1.9) quality-adjusted life-years, and $57.6 billion (31.9-92.4) and $113.2 billion (67.3-175.2), respectively. Both scenarios were estimated with >80% probability to be cost saving by 2023. CONCLUSIONS Implementing the US Food and Drug Administration added sugar labeling policy could generate substantial health gains and cost savings for the US population.
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Affiliation(s)
- Yue Huang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (Y.H., J.L., Y.L., P.W., D.M., R.M.)
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, UK (C.K., J.P.-S., B.C., P.B., S.C., M.O.)
| | - Junxiu Liu
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (Y.H., J.L., Y.L., P.W., D.M., R.M.)
| | - Yujin Lee
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (Y.H., J.L., Y.L., P.W., D.M., R.M.)
| | - Jonathan Pearson-Stuttard
- Department of Public Health and Policy, University of Liverpool, UK (C.K., J.P.-S., B.C., P.B., S.C., M.O.).,School of Public Health, Imperial College London, UK (J.P.-S.)
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, UK (C.K., J.P.-S., B.C., P.B., S.C., M.O.)
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, UK (C.K., J.P.-S., B.C., P.B., S.C., M.O.).,Department of Preventive Medicine and Education, Medical University of Gdansk, Poland (P.B.)
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK (C.K., J.P.-S., B.C., P.B., S.C., M.O.)
| | | | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (Y.H., J.L., Y.L., P.W., D.M., R.M.)
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (Y.H., J.L., Y.L., P.W., D.M., R.M.)
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, UK (C.K., J.P.-S., B.C., P.B., S.C., M.O.)
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (Y.H., J.L., Y.L., P.W., D.M., R.M.)
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Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLoS Med 2019; 16:e1002761. [PMID: 30889188 PMCID: PMC6424388 DOI: 10.1371/journal.pmed.1002761] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Economic incentives through health insurance may promote healthier behaviors. Little is known about health and economic impacts of incentivizing diet, a leading risk factor for diabetes and cardiovascular disease (CVD), through Medicare and Medicaid. METHODS AND FINDINGS A validated microsimulation model (CVD-PREDICT) estimated CVD and diabetes cases prevented, quality-adjusted life years (QALYs), health-related costs (formal healthcare, informal healthcare, and lost-productivity costs), and incremental cost-effectiveness ratios (ICERs) of two policy scenarios for adults within Medicare and Medicaid, compared to a base case of no new intervention: (1) 30% subsidy on fruits and vegetables ("F&V incentive") and (2) 30% subsidy on broader healthful foods including F&V, whole grains, nuts/seeds, seafood, and plant oils ("healthy food incentive"). Inputs included national demographic and dietary data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014, policy effects and diet-disease effects from meta-analyses, and policy and health-related costs from established sources. Overall, 82 million adults (35-80 years old) were on Medicare and/or Medicaid. The mean (SD) age was 68.1 (11.4) years, 56.2% were female, and 25.5% were non-whites. Health and cost impacts were simulated over the lifetime of current Medicare and Medicaid participants (average simulated years = 18.3 years). The F&V incentive was estimated to prevent 1.93 million CVD events, gain 4.64 million QALYs, and save $39.7 billion in formal healthcare costs. For the healthy food incentive, corresponding gains were 3.28 million CVD and 0.12 million diabetes cases prevented, 8.40 million QALYs gained, and $100.2 billion in formal healthcare costs saved, respectively. From a healthcare perspective, both scenarios were cost-effective at 5 years and beyond, with lifetime ICERs of $18,184/QALY (F&V incentive) and $13,194/QALY (healthy food incentive). From a societal perspective including informal healthcare costs and lost productivity, respective ICERs were $14,576/QALY and $9,497/QALY. Results were robust in probabilistic sensitivity analyses and a range of one-way sensitivity and subgroup analyses, including by different durations of the intervention (5, 10, and 20 years and lifetime), food subsidy levels (20%, 50%), insurance groups (Medicare, Medicaid, and dual-eligible), and beneficiary characteristics within each insurance group (age, race/ethnicity, education, income, and Supplemental Nutrition Assistant Program [SNAP] status). Simulation studies such as this one provide quantitative estimates of benefits and uncertainty but cannot directly prove health and economic impacts. CONCLUSIONS Economic incentives for healthier foods through Medicare and Medicaid could generate substantial health gains and be highly cost-effective.
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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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Seferidi P, Laverty AA, Pearson-Stuttard J, Bandosz P, Collins B, Guzman-Castillo M, Capewell S, O'Flaherty M, Millett C. Impacts of Brexit on fruit and vegetable intake and cardiovascular disease in England: a modelling study. BMJ Open 2019; 9:e026966. [PMID: 30692079 PMCID: PMC6352794 DOI: 10.1136/bmjopen-2018-026966] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To estimate the potential impacts of different Brexit trade policy scenarios on the price and intake of fruits and vegetables (F&V) and consequent cardiovascular disease (CVD) deaths in England between 2021 and 2030. DESIGN Economic and epidemiological modelling study with probabilistic sensitivity analysis. SETTING The model combined publicly available data on F&V trade, published estimates of UK-specific price elasticities, national survey data on F&V intake, estimates on the relationship between F&V intake and CVD from published meta-analyses and CVD mortality projections for 2021-2030. PARTICIPANTS English adults aged 25 years and older. INTERVENTIONS We modelled four potential post-Brexit trade scenarios: (1) free trading agreement with the EU and maintaining half of non-EU free trade partners; (2) free trading agreement with the EU but no trade deal with any non-EU countries; (3) no-deal Brexit; and (4) liberalised trade regime that eliminates all import tariffs. OUTCOME MEASURES Cumulative coronary heart disease and stroke deaths attributed to the different Brexit scenarios modelled between 2021 and 2030. RESULTS Under all Brexit scenarios modelled, prices of F&V would increase, especially for those highly dependent on imports. This would decrease intake of F&V between 2.5% (95% uncertainty interval: 1.9% to 3.1%) and 11.4% (9.5% to 14.2%) under the different scenarios. Our model suggests that a no-deal Brexit scenario would be the most harmful, generating approximately 12 400 (6690 to 23 390) extra CVD deaths between 2021 and 2030, whereas establishing a free trading agreement with the EU would have a lower impact on mortality, contributing approximately 5740 (2860 to 11 910) extra CVD deaths. CONCLUSIONS Trade policy under all modelled Brexit scenarios could increase price and decrease intake of F&V, generating substantial additional CVD mortality in England. The UK government should consider the population health implications of Brexit trade policy options, including changes to food systems.
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Affiliation(s)
- Paraskevi Seferidi
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Jonathan Pearson-Stuttard
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
- Department of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Brendan Collins
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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