Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries

Sugar-sweetened beverages (SSBs) are associated with cardiometabolic diseases and social inequities. For most nations, recent estimates and trends of intake are not available; nor variation by education or urbanicity. We investigated SSB intakes among adults between 1990 and 2018 in 185 countries, stratified subnationally by age, sex, education, and rural/urban residence, using data from the Global Dietary Database. In 2018, mean global SSB intake was 2.7 (8 oz = 248 grams) servings/week (95% UI 2.5-2.9) (range: 0.7 (0.5-1.1) in South Asia to 7.8 (7.1-8.6) in Latin America/Caribbean). Intakes were higher in male vs. female, younger vs. older, more vs. less educated, and urban vs. rural adults. Variations by education and urbanicity were largest in Sub-Saharan Africa. Between 1990 and 2018, SSB intakes increased by +0.37 (+0.29, +0.47), with the largest increase in Sub-Saharan Africa. These findings inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of SSBs for public health in Sub-Saharan Africa.

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

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.

Prevalence and predictors of elevated liver enzyme levels in Mexico: The Mexican National Health and Nutrition Survey, 2016

INTRODUCTION AND OBJECTIVE

To determine the prevalence of elevated liver enzyme levels and the fatty liver index according to specific sociodemographic, clinical, anthropometric, and metabolic risk factors in Mexican adult population.

MATERIAL AND METHODS

The present analysis was conducted using data from the Mexican National Health and Nutrition Survey 2016. For the present study, 3,490 adults with complete information on liver enzymes, sociodemographic, lifestyle, and metabolic factors were analyzed. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) levels were determined from blood samples. We computed the fatty liver Index (FLI), as a surrogate marker of non-alcoholic fatty liver disease. The associations are reported as adjusted odds ratios (OR) and 95% confidence intervals (95%CI).

RESULTS

At the national level, the prevalence of high serum levels of ALT, AST, and GGT were 7.9%, 13.5, and 12.9 respectively. We observed that men had higher prevalences of altered ALT, GGT and FLI compared to women. Additionally, we observe that individuals with obesity, metabolic syndrome and insulin resistance are significantly more likely to present elevated concentrations of AST, ALT, GGT and FLI. Finally, we found that the subjects of the lowest socioeconomic level and indigenous population were more likely to present elevated levels of AST, ALT, GGT, and FLI.

CONCLUSION

In Mexico, non-alcoholic fatty liver disease affect people with obesity, diabetes, and metabolic syndrome as well as men, subjects of low socioeconomic status, subjects who live in rural areas and indigenous population. Interventions to reduce this condition should be a public health priority.

Definition of the Traditional Mexican Diet and Its Role in Health: A Systematic Review

Promoting traditional diets could potentially reduce the current high rates of non-communicable diseases (NCDs) globally. While the traditional Mexican diet (TMexD) could be specifically promoted in Mexico, a concise definition of the TMexD and evidence of its association with NCDs are needed before its promotion. To evaluate what constitutes this diet pattern, we aimed to systematically review, for the first time, how the TMexD has been described in the literature to date. A secondary aim was to examine whether the TMexD, as described by available definitions, is associated with NCD outcomes. We searched for records describing a whole TMexD up to July 2019 in 12 electronic databases, reference lists, a relevant journal, and by contacting experts on the topic. We reported the results using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included 61 records for the definition of the diet and six for the association with NCD outcomes. The food groups characterising the TMexD that were consistently mentioned in all the study subgroups were grains and tubers, legumes, and vegetables; specific foods included maize, beans, chile, squash, tomato, and onion. Other groups also mentioned, although with lesser frequency, were maize products, fruits, beverages, fish and seafood, meats, sweets and sweeteners, and herbs and condiments. Only a few studies reported on the frequency of consumption or the amounts in which these foods were consumed in the TMexD. It was not possible to reach strong conclusions for the association between adherence to the TMexD and NCD outcomes. The TMexD was weakly associated with developing breast cancer, not associated with triglyceride levels, and inconsistently associated with obesity and diabetes outcomes. However, results were limited by the small number of studies (n = 6), of which most were of observational nature and evaluated diets using different TMexD definitions. These findings provide systematically identified evidence of the characteristics of the TMexD. More studies are needed to ascertain the exact quantities by which foods were consumed in the TMexD in order to establish whether this dietary pattern is associated with health and should be promoted within the Mexican population.

Harmonizing Dietary Datasets Around the World for Global Diet Monitoring: Methods from the Global Dietary Database and the Global Individual Food Consumption Data Tool (OR06-06-19)

Objectives

To systematically identify, compile, and harmonize national and sub-national individual-level dietary data around the world using a common food classification and description system (FCDS); promote collaboration with data owners worldwide; and publicly disseminate methods and datasets to the global nutrition community.

Methods

The Global Dietary Database (GDD) and the FAO/WHO Global Individual Food consumption data Tool (FAO/WHO GIFT) initiative, in collaboration with the European Food Safety Authority (EFSA), developed a framework to standardize the characterization of 24-hour recall and food record survey data at their finest level, using FoodEx2 (Figure). FoodEx2 is a comprehensive FCDS developed by EFSA, adapted for international high-quality food characterization and methodologically superior to prior international FCDS. Single food items are characterized through a classification system (hierarchical nested food groups) and 32 description elements (facets), such as cooking process. Standardized criteria, procedures, and templates were developed to: (1) identify and (2) prioritize eligible surveys for FoodEx2 mapping; (3) efficiently contact data owners and obtain approval for public dissemination; (4) allocate financial assistance as appropriate; (5) obtain survey information and assess survey and diet tool quality; (6) train data owners on dataset preparation and FoodEx2 mapping; (7) collect harmonized microdata, including structure, sociodemographics, diet metrics, units of measure, and food characterization; and (8) publicly disseminate methods and datasets via the GDD and FAO/WHO GIFT platforms.

Results

A total of 151 surveys have been identified as high priority. Harmonization has been completed for 24 European surveys by EFSA, which will be incorporated in the GDD and FAO/WHO GIFT platforms upon approval of data owners; 8 surveys by FAO/WHO GIFT; and is ongoing for another 4. Thus far, the data owners of 53 surveys from 41 countries, including Brazil, India, and Iran, confirmed interest in joining; all surveys either used none or a local FCDS.

Conclusions

These new methods developed will provide the most comprehensive and standardized databases of dietary intakes worldwide. Such global dietary data harmonization is imperative for global diet monitoring and informed priority setting.

Funding Sources

Gates Foundation.

Supporting Tables, Images and/or Graphs

Global, Regional and National Consumption of Plant-Source Foods in 2015: Systematic Analysis of Country-Specific Nutrition Surveys Worldwide (OR21-01-19)

Objectives

Estimating plant-source food (PSF) intake is crucial for evaluating associated health and environmental impacts; yet, worldwide consumption remains largely uncharacterized. Our aim was to quantify global distributions of daily intakes of fruits, vegetables (non-starchy, potatoes, other starchy), legumes, grains (refined, whole), and nuts/seeds by country (n = 188), super-region (n = 6), key population characteristics (all ages, sex, education, urban/rural location), and time (1990, 2015).

Methods

The primary data sources of PSF intake in the Global Dietary Database were from national and subnational surveys identified by systematic searches of electronic databases and communications with data owners from 1980 through 2015, including 1137 survey-years representing 185 countries (97.5% of the world's population). To address missingness and estimate national and stratum-specific intake distributions worldwide, we used a Bayesian hierarchical imputation model. The model combined stratum-specific individual-level intakes with time-varying country- and survey-level covariates, and accounted for differences in intakes vs per capita availability from FAO food disappearance data.

Results

In 2015, global fruit intake was 114 g/d (1.1 servings (100 g)/d), with highest intakes reported in Latin America (146 g/d) and lowest in the Middle East and North Africa (MENA) region (97 g/d) (Figure). Non-starchy vegetable global intake was 203 g/d (2 servings (100 g)/d); highest intakes were seen in Asia (269 g/d) and lowest in the Former Soviet Union (FSU) (135 g/d) and High-Income (136 g/d) regions. Global legume intake was 17 g/d (0.2 servings (100 g)/d), highest in Latin America (52 g/d) and lowest in FSU (3 g/d). For refined grains global average was 215 g/d (4.3 servings (50 g)/d), varying from 254 g/d in MENA to 117 g/d in Sub-Saharan Africa. Intakes were generally similar by sex and urban/rural location, and higher at older ages and higher education levels. Findings for potatoes, other starchy vegetables, whole grains and nuts/seeds, and over time, will be presented at the meeting.

Conclusions

Such global data, showing substantial variation in PSF consumption by nation and population worldwide, inform and highlight the need for country-specific priority setting and nutrition policies.

Funding Sources

Gates Foundation.

Supporting Tables, Images and/or Graphs

Global, Regional and National Consumption of Major Beverages in 2015: Systematic Analysis of Country-Specific Nutrition Surveys Worldwide (P10-038-19)

Objectives

Assessing the impact of beverage intake on health has been limited by lack of reliable and standardized individual-level data on a global scale. We aimed to quantify global distributions of intakes of sugar-sweetened beverages (SSBs), fruit juices, milk, coffee, and tea by country (n = 188), super-region (n = 6), key population characteristics (all ages, sex, education, urban/rural location) and time (1990, 2015).

Methods

Primary national and subnational survey data on beverage intake in the Global Dietary Database (GDD) were identified through systematic searches of electronic databases and communications with data owners worldwide. This includes 1137 survey-years representing 6.78B people from 185 countries worldwide (97.5% of the world's population). To address missing data and estimate distributions of intake for each diet factor and by country-, age-, sex-, education-, urban/rural- and year-specific stratum we developed a Bayesian hierarchical imputation model. The model combined primary intake data with time-varying country-level and survey-level covariates and further accounted for differences in intakes vs availability from FAO food disappearance data.

Results

In 2015, global SSB intake in adults (20 + y) was 0.37 servings (8-oz)/day (Fig 1). The Latin-American region had the highest SSB intake (1.15 servings/day) and Asia the lowest (0.14 servings/day). For fruit juices, global intake across all ages was 0.19 servings (8-oz)/day; highest intakes were seen in Latin America (0.64 servings/day) and lowest in Asia (0.06 servings/day) (Fig 2). Global milk intake was 0.39 servings (8-oz)/day, ranging from 0.64 servings/day in the High-Income region to 0.20 servings/day in Asia (Fig 3). Intakes were generally similar by sex and higher at younger ages, urban areas, and higher education levels. Findings for coffee and tea, and over time, will be presented at the meeting.

Conclusions

These novel global dietary data highlight substantial variation in beverage intake worldwide, further informing global diet surveillance, priority setting and nutrition strategies.

Funding Sources

Bill & Melinda Gates Foundation.

Supporting Tables, Images and/or Graphs