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Bhattacharya S. Cultivating health: millets' potential in combating non-communicable diseases and future research avenues in India. Front Nutr 2023; 10:1190111. [PMID: 37810919 PMCID: PMC10551438 DOI: 10.3389/fnut.2023.1190111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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Flexner N, Ahmed M, Mulligan C, Bernstein JT, Christoforou AK, Lee JJ, Khandpur N, L’Abbe MR. The estimated dietary and health impact of implementing the recently approved 'high in' front-of-package nutrition symbol in Canada: a food substitution scenario modeling study. Front Nutr 2023; 10:1158498. [PMID: 37614744 PMCID: PMC10443708 DOI: 10.3389/fnut.2023.1158498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
Background Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy food environments and to help consumers make healthier food choices. Consumer surveys report that after implementation of mandatory 'high in' FOPL symbols between 30 and 70% of consumers choose or were willing to choose products with fewer 'high in' symbols. Health Canada has recently published FOPL regulations that will require prepackaged food and beverages that meet or exceed thresholds for sodium, total sugars, or saturated fat to display a 'high in' FOPL nutrition symbol. Objectives The aims were to estimate the potential (1) dietary impact of substituting foods with similar foods that would display at least one less 'high in' symbol, and (2) the number of diet-related noncommunicable disease (NCD) deaths that could be averted or delayed due to estimated dietary changes. Methods Baseline and counterfactual intakes of sodium, total sugars, saturated fats, and energy were estimated among Canadian adults (n = 11,992) using both available days of 24 h-recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS). Similar foods to those reported in CCHS that would display at least one less 'high in' symbol (n = 239) were identified using a Canadian branded food composition database. Based on current FOPL consumer research, identified foods were substituted for 30, 50, and 70% of randomly selected CCHS-Nutrition adult participants and for all adult participants. Potential health impacts were estimated using the Preventable Risk Integrated ModEl. Results Mean dietary reductions of between 73 and 259 mg/day of sodium, 2.0 and 6.9 g/day of total sugars, 0.2 and 0.5 g/day of saturated fats, and 14 and 46 kcal/day of energy were estimated. Between 2,148 (95% UI 1,913-2,386) and 7,047 (95% UI 6,249-7,886) of deaths due to diet-related NCDs, primarily from cardiovascular diseases (70%), could potentially be averted or delayed if Canadians choose products with fewer 'high in' symbols. Conclusion Results suggest that FOPL could significantly reduce sodium and total sugar intakes among Canadian adults, the consequences of which could avert or delay an important number of diet-related NCD deaths. These findings provide relevant data to support the importance of the impending FOPL regulations.
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Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christine Mulligan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jodi T. Bernstein
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anthea K. Christoforou
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neha Khandpur
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- Center for Epidemiological Research in Nutrition and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Mary R. L’Abbe
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Flexner N, Ng AP, Ahmed M, Khandpur N, Acton RB, Lee JJ, L’Abbe MR. Estimating the dietary and health impact of implementing front-of-pack nutrition labeling in Canada: A macrosimulation modeling study. Front Nutr 2023; 10:1098231. [PMID: 37006927 PMCID: PMC10065472 DOI: 10.3389/fnut.2023.1098231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Background Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy diets. Health Canada has recently published FOPL regulations that will require food and beverages that meet or exceed set thresholds for sodium, sugars, or saturated fat to display a 'high in' symbol on the front of the package. Although a promising measure, its potential impact on dietary intakes and health have not yet been estimated in Canada. Objective This study aims to estimate (1) the potential dietary impact of implementing a mandatory FOPL among Canadian adults; and (2) the number of diet-related non-communicable disease (NCD) deaths that could be averted or delayed due to these estimated dietary changes. Methods Baseline and counterfactual usual intakes of sodium, total sugars, saturated fats, and calories were estimated among Canadian adults (n = 11,992) using both available days of 24 h recalls from the 2015 Canadian Community Health Survey-Nutrition. The National Cancer Institute method was used to estimate usual intakes, and adjusted for age, sex, misreporting status, weekend/weekday, and sequence of recall. Estimated counterfactual dietary intakes were modeled from reductions observed in experimental and observational studies that examined changes in sodium, sugars, saturated fat, and calorie content of food purchases in the presence of a 'high in' FOPL (four counterfactual scenarios). The Preventable Risk Integrated ModEl was used to estimate potential health impacts. Results Estimated mean dietary reductions were between 31 and 212 mg/day of sodium, 2.3 and 8.7 g/day of total sugars, 0.8 and 3.7 g/day of saturated fats, and 16 and 59 kcal/day of calories. Between 2,183 (95% UI 2,008-2,361) and 8,907 (95% UI 8,095-9,667) deaths due to diet-related NCDs, mostly from cardiovascular diseases (~70%), could potentially be averted or delayed by implementing a 'high in' FOPL in Canada. This estimation represents between 2.4 and 9.6% of the total number of diet-related NCD deaths in Canada. Conclusion Results suggest that implementing a FOPL could significantly reduce sodium, total sugar, and saturated fat intakes among Canadian adults and subsequently prevent or postpone a substantial number of diet-related NCD deaths in Canada. These results provide critical evidence to inform policy decisions related to implementing FOPL in Canada.
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Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alena P. Ng
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neha Khandpur
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- Center for Epidemiological Research in Nutrition and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Rachel B. Acton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mary R. L’Abbe
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Bhattacharya S, Heidler P, Varshney S. Incorporating neglected non-communicable diseases into the national health program-A review. Front Public Health 2023; 10:1093170. [PMID: 36703821 PMCID: PMC9871457 DOI: 10.3389/fpubh.2022.1093170] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 01/12/2023] Open
Abstract
Poor nations are already facing the heat of double burden of communicable and non-communicable diseases (NCDs), often known as chronic illnesses, which are characterized by a protracted course and are multifactorial in causation. In addition to this, neglected non-communicable diseases (NNCD) in the form of gout, sickle cell disease, accidents and many more are likely to be one of the biggest public health challenges soon. Nearly three-quarters (31.4 million) of all NCD-related fatalities occur in developing nations. In terms of morbidity and mortality, the "BIG FOUR" NCDs-diabetes, cancer, chronic respiratory diseases, and cardiovascular diseases-are widely acknowledged as the main contributors to global health loss. However, other NCDs account for 55% of the global burden of NCDs and are frequently neglected in terms of premature death, increased Disability Adjusted Life Years (DALY), and decreased Quality-Adjusted Life Year (QALY). We have briefly discussed the disease burden of a few significant, yet neglected NCDs in this paper.
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Affiliation(s)
- Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Petra Heidler
- Department for Economy and Health, University for Continuing Education Krems, Krems an der Donau, Austria
- Department of International Business and Export Management, IMC University of Applied Sciences Krems, Krems an der Donau, Austria
- Department of Health Sciences, St. Pölten University of Applied Sciences, Sankt Pölten, Austria
| | - Saurabh Varshney
- Department of ENT (Otorhinolaryngology), All India Institute of Medical Sciences, Deoghar (AIIMS Deoghar), Deoghar, India
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Goiana-da-Silva F, Cruz-e-Silva D, Rito A, Lopes C, Muc M, Darzi A, Araújo F, Miraldo M, Morais Nunes A, Allen LN. Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study. Front Public Health 2022; 10:876827. [PMID: 36176524 PMCID: PMC9513608 DOI: 10.3389/fpubh.2022.876827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/20/2022] [Indexed: 01/21/2023] Open
Abstract
Background Excessive salt consumption-associated with a range of adverse health outcomes-is very high in Portugal, and bread is the second largest source. Current Portuguese legislation sets a maximum limit of 1.4 g salt per 100 g bread, but imported and traditional breads are exempted. In 2017 the Ministry of Health proposed reducing the salt threshold to 1.0/100 g by 2022, however the legislation was vetoed by the European Commission on free-trade grounds. Aims To estimate the health impact of subjecting imported and traditional breads to the current 1.4 g threshold, and to model the potential health impact of implementing the proposed 1.0 g threshold. Methods We gathered bread sales, salt consumption, and epidemiological data from robust publicly available data sources. We used the open source WHO PRIME modeling tool to estimate the number of salt-related deaths that would have been averted in 2016 (the latest year for which all data were available) from; (1) Extending the 1.4 g threshold to all types of bread, and (2) Applying the 1.0 g threshold to all bread sold in Portugal. We used Monte Carlo simulations to generate confidence intervals. Results Applying the current 1.4 g threshold to imported and traditional bread would have averted 107 deaths in 2016 (95% CI: 43-172). Lowering the current threshold from 1.4 to 1.0 g and applying it to all bread products would reduce daily salt consumption by 3.6 tons per day, saving an estimated 286 lives a year (95% CI: 123-454). Conclusions Salt is an important risk factor in Portugal and bread is a major source. Lowering maximum permissible levels and removing exemptions would save lives. The European Commission should revisit its decision on the basis of this new evidence.
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Affiliation(s)
- Francisco Goiana-da-Silva
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom,Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - David Cruz-e-Silva
- Center for Innovation, Technology and Policy Research, IN+, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Rito
- National Institute of Health, Porto, Portugal
| | - Carla Lopes
- Department of Public Health and Forensic Sciences, and Medical Education, University of Porto Medical School, Porto, Portugal,Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Magdalena Muc
- Appetite and Obesity Research Group, Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Fernando Araújo
- Centro Hospitalar Universitário São João, Faculty of Medicine, Porto University, Porto, Portugal
| | - Marisa Miraldo
- Department of Management, Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Alexandre Morais Nunes
- Centro de Administração e Políticas Públicas, Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa, Lisboa, Portugal
| | - Luke N. Allen
- London School of Hygiene and Tropical Medicine, London, United Kingdom,*Correspondence: Luke N. Allen
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Bhattacharya S, Bera OP, Shah V. Consumers' Perception About Front of Package Food Labels (FOPL) in India: A Survey of 14 States. Front Public Health 2022; 10:936802. [PMID: 35910921 PMCID: PMC9336528 DOI: 10.3389/fpubh.2022.936802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Front of Package Food Labels (FoP) help consumers make healthier food choices at the point of purchase by giving details about the nutrients available in the packaged food items. Aim and Objective A prospective multi-centric cross-sectional study was conducted in 2021 across India to evaluate the existing knowledge and attitude regarding food labels on packaged foods and beverages. Also, the objective understanding of the consumers' knowledge on different types of FoP label practiced across the world was determined. Methodology A self-administered questionnaire was given to the respondents to gather their attitudes regarding the FoP label. Besides, they were given colored pictures of different FoP labels to seek their perception and preference for different FoP label designs. Results Results found that packaged food and beverages were consumed by 91.3% of the participants. Awareness about the food package labeling was widely held by 95% of the participants and 88.6% of them considered this information helpful. Over half (55.4%) of the respondents considered packaged foods as healthy. Warning Labels (WL) were the most preferred food labels (93%), followed by Multiple Traffic Lights (MTL) and the difference between the two was statistically significant (p-value < 0.05). Conclusions The awareness about FoP labels is low among the consumers. Recommendations Evidence-based research is recommended regarding the knowledge and perception of people on the feasibility of FoP label design which may lay a foundation to formulate laws and policies regarding the front of pack labeling.
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Affiliation(s)
- Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Madurai, India
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Karim MN, Zaman MM, Rahman MM, Chowdhury MAJ, Ahsan HAMN, Hassan MM, Karim SR, Hossain MZ, Billah B. Sociodemographic Determinants of Low Fruit and Vegetable Consumption Among Bangladeshi Adults: Results From WHO-STEPS Survey 2010. Asia Pac J Public Health 2017; 29:189-198. [PMID: 28434246 DOI: 10.1177/1010539517699059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to investigate factors affecting fruit and vegetables (FAVs) intake among Bangladeshi adults. Dietary data of 9275 adults from the Bangladesh Noncommunicable Disease Risk Factor Survey 2010 were analyzed. The mean age of the respondents was 42.4 (±13.5) years. Multistage cluster sampling was applied to identify samples. Demographics, personal habits, physical activity, diet, and anthropometric data were collected using the WHO-STEPs questionnaire. Average daily intake of <5 servings of FAVs combined was considered to be low FAV consumption, and its prevalence was 82.8%. A mixed-effect logistic regression model was fitted to assess association of factors with low FAV intake. Higher educational attainment, greater wealth, female sex, low physical activity, body mass index >25 kg/m2, and smokeless tobacco consumption were significantly associated with higher FAV consumption. Frequency of low FAV intake increased with increasing age and decreased with increasing educational attainment. Programs targeting people at risk of low FAV consumption are needed to promote consumption.
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Affiliation(s)
- Md Nazmul Karim
- 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,2 World Health Organizations, Country Office for Bangladesh, Dhaka, Bangladesh
| | - M Mostafa Zaman
- 2 World Health Organizations, Country Office for Bangladesh, Dhaka, Bangladesh
| | | | | | | | | | | | | | - Baki Billah
- 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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