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Nguyen H, Jones A, Barrett EM, Shahid M, Gaines A, Hu M, Pettigrew S, Wu JHY, Coyle DH. Extent of alignment between the Australian Dietary Guidelines and the NOVA classification system across the Australian packaged food supply. Nutr Diet 2024. [PMID: 38738833 DOI: 10.1111/1747-0080.12880] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/14/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
AIMS The Australian Dietary Guidelines are currently being revised and ultra-processed foods have been identified as a high priority action area. To better understand how well the current Dietary Guidelines align with level of processing classifications, the aim of this study was to assess the alignment between the Australian Dietary Guidelines and the NOVA classification system for classifying the healthiness of packaged foods. METHODS Data were sourced from the Australian FoodSwitch dataset, which included 28 071 packaged food and beverage products available in major Australian supermarkets in 2022. Products were classified as (i) core or discretionary (Australian Dietary Guidelines) and (ii) non-ultra-processed or ultra-processed (NOVA). Agreement between the two systems (core vs. non-ultra-processed and discretionary vs. ultra-processed) was evaluated using the kappa statistic. RESULTS There was 'moderate' agreement (κ = 0.41, 95% CI: 0.40-0.42) between the Australian Dietary Guidelines and the NOVA system, with 69.8% of products aligned across the two systems. Alignment was more common for discretionary foods (80.6% were ultra-processed) than core foods (59.9% aligned were not-ultra-processed). Food categories exhibiting the strongest levels of alignment included confectionary, foods for specific dietary use, and egg and egg products. Discordance was most common for convenience foods, sugars, honey and related products, and cereal and grain products. CONCLUSIONS Despite moderate alignment between the Australian Dietary Guidelines and NOVA, the discordance observed for almost one-third of products highlights the opportunity to develop recommendations for ultra-processed foods within the guidelines to advise Australians how these foods should be considered as part of a healthy diet.
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Affiliation(s)
- Hillary Nguyen
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, University of California, Berkeley, California, USA
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Eden M Barrett
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Shahid
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Allison Gaines
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Monica Hu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, University of California, Berkeley, California, USA
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Xue Q, Wu S, He X, Huang Y, Liu Y, Yan T, Wu N, Yang X, Wen Y, Li S, Cravens L, Yang CX, Wu JHY, Pan A, Yang X, Pan XF. Trends in cardiovascular health metrics and associations with long-term mortality among US adults with coronary heart disease. Nutr Metab Cardiovasc Dis 2024:S0939-4753(24)00149-2. [PMID: 38755082 DOI: 10.1016/j.numecd.2024.03.031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND AND AIMS Our study examined the trends of cardiovascular health metrics in individuals with coronary heart disease (CHD) and their associations with all-cause and cardiovascular disease mortality in the US. METHODS AND RESULTS The cohort study was conducted based on the National Health and Nutrition Examination Survey 1999-2018 and their linked mortality files (through 2019). Baseline CHD was defined as a composite of self-reported doctor-diagnosed coronary heart disease, myocardial infarction, and angina pectoris. Cardiovascular health metrics were assessed according to the American Heart Association recommendations. Long-term all-cause and cardiovascular disease mortality were the primary outcomes. Survey-adjusted Cox regression models were used to estimate hazard ratios and corresponding 95% confidence intervals for the associations between cardiovascular health metrics and all-cause and cardiovascular disease mortality. The prevalence of one or fewer ideal cardiovascular health metrics increased from 14.15% to 22.79% (P < 0.001) in CHD, while the prevalence of more than four ideal cardiovascular health metrics decreased from 21.65% to 15.70 % (P < 0.001) from 1999 to 2018, respectively. Compared with CHD participants with one or fewer ideal cardiovascular health metrics, those with four or more ideal cardiovascular health metrics had a 35% lower risk (hazard ratio, 0.65; 95% confidence interval: 0.51, 0.82) and a 44% lower risk (0.56; 0.38, 0.84) in all-cause and cardiovascular disease mortality, respectively. CONCLUSION Substantial declines were noted in ideal cardiovascular health metrics in US adults with CHD. A higher number of cardiovascular health metrics was associated with lower all-cause and cardiovascular disease mortality in them.
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Affiliation(s)
- Qingping Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
| | - Shiyi Wu
- Section of Epidemiology and Population Health, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Chengdu, Sichuan, China
| | - Xingchen He
- Section of Epidemiology and Population Health, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Yanjun Liu
- Center for Obesity and Metabolic Health & Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu & The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Tong Yan
- Center for Obesity and Metabolic Health & Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu & The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Nianwei Wu
- Section of Epidemiology and Population Health, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xue Yang
- Section of Epidemiology and Population Health, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Chengdu, Sichuan, China
| | - Ying Wen
- Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Lauryn Cravens
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chun-Xia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Chengdu, Sichuan, China
| | - Jason H Y Wu
- School of Population Health and The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaohong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China.
| | - Xiong-Fei Pan
- Section of Epidemiology and Population Health, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Shuangliu Institute of Women's and Children's Health, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China.
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Barrett EM, Gaines A, Coyle DH, Pettigrew S, Shahid M, Maganja D, Jones A, Rayner M, Mozaffarian D, Taylor F, Ghammachi N, Wu JHY. Comparing product healthiness according to the Health Star Rating and the NOVA classification system and implications for food labelling systems: An analysis of 25 486 products in Australia. NUTR BULL 2023; 48:523-534. [PMID: 37897130 DOI: 10.1111/nbu.12640] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 10/29/2023]
Abstract
We investigated the extent of alignment between 'healthiness' defined by a food classification system that classifies foods and beverages primarily by their nutrient composition, the Health Star Rating (HSR) and a system that considers only the degree of processing of the product, the NOVA classification system. We used data for 25 486 products contained within the George Institute for Global Health's Australian 2022 FoodSwitch Dataset. Agreement between the two systems in the proportion of products classified as 'healthier' (HSR ≥3.5 or NOVA group 1-3) or 'less healthy' (HSR <3.5 or NOVA group 4) was assessed using the κ statistic. There was 'fair' agreement (κ = 0.30, 95%CI: 0.29-0.31) between both systems in the proportion of all products classified as healthier or less healthy. Approximately one-third (n = 8729) of all products were defined as 'discordant', including 34.3% (n = 5620) of NOVA group 4 products with HSR ≥3.5 (commonly convenience foods, sports/diet foods, meat alternatives, as well as products containing non-sugar sweeteners) and 34.1% (n = 3109) of NOVA group 1-3 products with HSR <3.5 (commonly single-ingredient foods such as sugars/syrups, full-fat dairy and products specially produced to contain no ultra-processed ingredients). Our analysis strengthens the evidence for the similarities and differences in product healthiness according to a nutrient-based classification system and a processing-based classification system. Although the systems' classifications align for the majority of food and beverage products, the discordance found for some product categories indicates potential for confusion if systems are deployed alongside each other within food policies.
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Affiliation(s)
- Eden M Barrett
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Food is Medicine Institute, Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA
| | - Allison Gaines
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Daisy H Coyle
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Simone Pettigrew
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Shahid
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Damian Maganja
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexandra Jones
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA
- Division of Cardiology, Tufts School of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Fraser Taylor
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Nadine Ghammachi
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason H Y Wu
- Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Maganja D, Davies T, Sanavio L, Louie JCY, Huffman MD, Trieu K, Wu JHY. Current food labelling practices in online supermarkets in Australia. Int J Behav Nutr Phys Act 2023; 20:105. [PMID: 37749593 PMCID: PMC10521447 DOI: 10.1186/s12966-023-01504-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/16/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Food product labelling can support consumer decision-making. Several food product labels (nutrition information panels (NIPs), ingredients lists, allergen declarations and country-of-origin) are mandated for physical product packaging in Australia, with a voluntary front-of-pack nutrition labelling system, Health Star Ratings (HSRs), also available. However, labelling requirements are not explicitly extended to online settings and the extent to which this information is available in these increasingly important food environments has not been assessed. METHODS Data from all individual food product pages was collected from the online stores of the two dominant supermarket retailers in Australia using automated web scraping in April-May 2022 (n = 22,077 products collected). We assessed the proportion of pages displaying NIPs, ingredients, allergens, country-of-origin and HSRs after excluding products ineligible to display the respective label. We also assessed whether HSRs were differentially available for higher- (healthier) and lower-scoring (less healthy) products, with HSR scores drawn from a comprehensive Australian food composition database, FoodSwitch. A manual inspection of randomly selected product pages (n = 100 for each label type per supermarket), drawn from products displaying the relevant label, was conducted to assess whether the labels were immediately visible to users (i.e. without scrolling or clicking). Differences in labelling prevalence and visibility were compared using chi-squared tests. RESULTS Across both supermarkets, country-of-origin labelling was almost complete (displayed on 93% of food product pages), but NIPs (49%), ingredients (34%) and allergens (53%) were less frequently displayed. HSRs were infrequently displayed (14% across both supermarkets) and more likely to be applied to higher-scoring products (22% on products with ≥ 3.5HSR v 0.4% on products with < 3.5HSR, p < 0.001). One supermarket was far more likely to make NIPs (100% v 2%, p < 0.001), ingredients (100% v 19%, p < 0.001) and allergens (97% v 0%, p < 0.001) information immediately visible, though the other made HSRs more apparent (22% v 75%, p < 0.001). Both supermarkets displayed country-of-origin labels prominently (100% v 86%, p < 0.001). CONCLUSIONS Food product labelling varies in online supermarkets in Australia overall and between supermarkets, while the design of online stores resulted in differences in labelling visibility. The near-complete display of country-of-origin labels and differential application of HSRs to higher-scoring products may reflect their use as marketing tools. Our findings highlight an urgent need for food labelling regulations to be updated to better account for online retail food environments.
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Affiliation(s)
- Damian Maganja
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia.
| | - Tazman Davies
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
| | | | - Jimmy C Y Louie
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, John St, Hawthorn, VIC, 3122, Australia
| | - Mark D Huffman
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
- Global Health Center, Cardiovascular Division, Washington University in St. Louis, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St, Newtown, Sydney, NSW, 2042, Australia
- School of Population Health, The University of New South Wales, Samuels Building, Samuel Terry Ave, Kensington, NSW, 2033, Australia
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5
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Law KK, Coyle DH, Neal B, Huang L, Barrett EM, Arnott C, Chow CK, Di Tanna GL, Lung T, Mozaffarian D, Berkowitz SA, Wong J, Wu T, Twigg S, Gauld A, Simmons D, Piya MK, MacMillan F, Khoo CL, Tian M, Trieu K, Wu JHY. Protocol for a randomized controlled trial of medically tailored meals compared to usual care among individuals with type 2 diabetes in Australia. Contemp Clin Trials 2023; 132:107307. [PMID: 37516164 DOI: 10.1016/j.cct.2023.107307] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND 'Food is medicine' strategies aim to integrate food-based nutrition interventions into healthcare systems and are of growing interest to healthcare providers and policy makers. 'Medically Tailored Meals' (MTM) is one such intervention, which involves the 'prescription' by healthcare providers of subsidized, pre-prepared meals for individuals to prevent or manage chronic conditions, combined with nutrition education. OBJECTIVE This study will test the efficacy of an MTM program in Australia among participants with type 2 diabetes (T2D) and hyperglycemia, who experience difficulties accessing and eating nutritious food. METHODS This study will be a two-arm parallel trial (goal n = 212) with individuals randomized in a 1:1 ratio to a MTM intervention group or a control group (106 per arm). Over 26 weeks, the intervention group will be prescribed 20 MTM per fortnight and up to 3 sessions with an accredited dietitian. Controls will continue with their usual care. The primary outcome is glycated hemoglobin (HbA1c, %) and secondary outcomes include differences in blood pressure, blood lipids and weight, all measured at 26 weeks. Process and economic data will be analyzed to assess the feasibility, acceptability, scalability, and cost-effectiveness of the intervention. Recruitment commenced in the first quarter of 2023, with analyses and results anticipated to be available by March 2025. DISCUSSION Few randomized controlled trials have assessed the impact of MTM on clinical outcomes. This Australian-first trial will generate robust data to inform the case for sustained, large-scale implementation of MTM to improve the management of T2D among vulnerable populations. ANZCTR ACTRN12622000852752. PROTOCOL VERSION Version 1.1, July 2023.
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Affiliation(s)
- Kristy K Law
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | - Daisy H Coyle
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Liping Huang
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Eden M Barrett
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Clare Arnott
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Clara K Chow
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Thomas Lung
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
| | - Seth A Berkowitz
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jencia Wong
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, Central Clinical School, Central Sydney (Patyegarang) Precinct, University of Sydney, NSW, Australia
| | - Ted Wu
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Stephen Twigg
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, Central Clinical School, Central Sydney (Patyegarang) Precinct, University of Sydney, NSW, Australia
| | - Amanda Gauld
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia
| | - Freya MacMillan
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia.; School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Chee L Khoo
- Healthfocus Family Practice, Sydney, NSW, Australia
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, Harbin Medical University, Harbin, China
| | - Kathy Trieu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Sydney, NSW, Australia
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Qian F, Tintle N, Jensen PN, Lemaitre RN, Imamura F, Feldreich TR, Nomura SO, Guan W, Laguzzi F, Kim E, Virtanen JK, Steur M, Bork CS, Hirakawa Y, O'Donoghue ML, Sala-Vila A, Ardisson Korat AV, Sun Q, Rimm EB, Psaty BM, Heckbert SR, Forouhi NG, Wareham NJ, Marklund M, Risérus U, Lind L, Ärnlöv J, Garg P, Tsai MY, Pankow J, Misialek JR, Gigante B, Leander K, Pester JA, Albert CM, Kavousi M, Ikram A, Voortman T, Schmidt EB, Ninomiya T, Morrow DA, Bayés-Genís A, O'Keefe JH, Ong KL, Wu JHY, Mozaffarian D, Harris WS, Siscovick DS. Omega-3 Fatty Acid Biomarkers and Incident Atrial Fibrillation. J Am Coll Cardiol 2023; 82:336-349. [PMID: 37468189 DOI: 10.1016/j.jacc.2023.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The relationship between omega-3 fatty acids and atrial fibrillation (AF) remains controversial. OBJECTIVES This study aimed to determine the prospective associations of blood or adipose tissue levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with incident AF. METHODS We used participant-level data from a global consortium of 17 prospective cohort studies, each with baseline data on blood or adipose tissue omega-3 fatty acid levels and AF outcomes. Each participating study conducted a de novo analyses using a prespecified analytical plan with harmonized definitions for exposures, outcome, covariates, and subgroups. Associations were pooled using inverse-variance weighted meta-analysis. RESULTS Among 54,799 participants from 17 cohorts, 7,720 incident cases of AF were ascertained after a median 13.3 years of follow-up. In multivariable analysis, EPA levels were not associated with incident AF, HR per interquintile range (ie, the difference between the 90th and 10th percentiles) was 1.00 (95% CI: 0.95-1.05). HRs for higher levels of DPA, DHA, and EPA+DHA, were 0.89 (95% CI: 0.83-0.95), 0.90 (95% CI: 0.85-0.96), and 0.93 (95% CI: 0.87-0.99), respectively. CONCLUSIONS In vivo levels of omega-3 fatty acids including EPA, DPA, DHA, and EPA+DHA were not associated with increased risk of incident AF. Our data suggest the safety of habitual dietary intakes of omega-3 fatty acids with respect to AF risk. Coupled with the known benefits of these fatty acids in the prevention of adverse coronary events, our study suggests that current dietary guidelines recommending fish/omega-3 fatty acid consumption can be maintained.
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Affiliation(s)
- Frank Qian
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathan Tintle
- Department of Mathematics and Statistics, Dordt University, Sioux Center, Iowa, USA; Fatty Acid Research Institute, Sioux Falls, South Dakota, USA
| | - Paul N Jensen
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Tobias Rudholm Feldreich
- School of Health and Social Sciences, Dalarna University, Falun, Sweden; Center for Clinical Research Dalarna, Region Dalarna, Falun, Sweden
| | - Sarah Oppeneer Nomura
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Weihua Guan
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Federica Laguzzi
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eunjung Kim
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marinka Steur
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Christian S Bork
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Yoichiro Hirakawa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michelle L O'Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aleix Sala-Vila
- Fatty Acid Research Institute, Sioux Falls, South Dakota, USA; Cardiovascular Risk and Nutrition - Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Andres V Ardisson Korat
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Matti Marklund
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden; Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Ärnlöv
- Center for Clinical Research Dalarna, Region Dalarna, Falun, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden
| | - Parveen Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Michael Y Tsai
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - James Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bruna Gigante
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Julie A Pester
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningenn, the Netherlands
| | - Erik B Schmidt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Antoni Bayés-Genís
- Department of Cardiology, Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - James H O'Keefe
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Kwok Leung Ong
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA; Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - William S Harris
- Fatty Acid Research Institute, Sioux Falls, South Dakota, USA; Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
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Karlsson K, Rådholm K, Dunford E, Wu JHY, Neal B, Sundström J. Sodium content in processed food items in Sweden compared to other countries: a cross-sectional multinational study. Front Public Health 2023; 11:1182132. [PMID: 37361177 PMCID: PMC10287089 DOI: 10.3389/fpubh.2023.1182132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/08/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
Background Dietary sodium has a dose-response relationship with cardiovascular disease, and sodium intake in Sweden exceeds national and international recommendations. Two thirds of dietary sodium intake comes from processed foods, and adults in Sweden eat more processed foods than any other European country. We hypothesized that sodium content in processed foods is higher in Sweden than in other countries. The aim of this study was to investigate sodium content in processed food items in Sweden, and how it differs from Australia, France, Hong Kong, South Africa, the United Kingdom and the United States. Methods Data were collected from retailers by trained research staff using standardized methods. Data were categorized into 10 food categories and compared using Kruskal-Wallis test of ranks. Sodium content in the food items was compared in mg sodium per 100 g of product, based on the nutritional content labels on the packages. Results Compared to other countries, Sweden had among the highest sodium content in the "dairy" and "convenience foods" categories, but among the lowest in "cereal and grain products," "seafood and seafood products" and "snack foods" categories. Australia had the overall lowest sodium content, and the US the overall highest. The highest sodium content in most analyzed countries was found in the "meat and meat products" category. The highest median sodium content in any category was found among "sauces, dips, spreads and dressings" in Hong Kong. Conclusion The sodium content differed substantially between countries in all food categories, although contrary to our hypothesis, processed foods overall had lower sodium content in Sweden than in most other included countries. Sodium content in processed food was nonetheless high also in Sweden, and especially so in increasingly consumed food categories, such as "convenience foods".
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Affiliation(s)
- Karin Karlsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Rådholm
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elizabeth Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason H. Y. Wu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Ho CKW, Tjhin A, Barrett E, Coyle DH, Wu JHY, Louie JCY. The Nutritional Quality of Gluten-Free versus Non-Gluten-Free Pre-Packaged Foods and Beverages Sold in Hong Kong. Ann Nutr Metab 2023; 79:301-312. [PMID: 37285813 DOI: 10.1159/000530857] [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] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The consumption of gluten-free foods has continued to increase in recent years. Given their higher intake among individuals both with and without a medically diagnosed gluten allergy or sensitivity, it is important to understand how the nutritional quality of these foods compares against non-gluten-free foods. As such, we aimed to compare the nutritional quality of gluten-free and non-gluten-free pre-packaged foods sold in Hong Kong. METHODS Data from 18,292 pre-packaged food and beverage items in the 2019 FoodSwitch Hong Kong database were used. These products were categorized as (1) "declared gluten-free"; (2) "gluten-free by ingredient or naturally gluten-free"; and (3) "non-gluten-free" according to information presented on the package. One-way ANOVA was used to compare the differences in the Australian Health Star Rating (HSR), energy, protein, fibre, total fat, saturated fat, trans-fat, carbohydrates, sugars, and sodium content between products in different gluten categories, overall and by major food category (e.g., bread and bakery products) and region of origin (e.g., America, Europe). RESULTS Products declared gluten-free (mean ± SD: 2.9 ± 1.3; n = 7%) had statistically significantly higher HSR than those gluten-free by ingredient or naturally gluten-free (2.7 ± 1.4; n = 51.9%) and non-gluten-free (2.2 ± 1.4; n = 41.2%) (all pairwise comparisons p < 0.001). Overall, non-gluten-free products have higher energy, protein, saturated fat, trans-fat, free sugar and sodium, and less fibre compared with products in the other two gluten categories. Similar differences were observed across major food groups and by region of origin. CONCLUSIONS Non-gluten-free products sold in Hong Kong were generally less healthy than gluten-free products (regardless of the presence of gluten-free declaration). Consumers should be better educated on how to identify gluten-free foods, given that many gluten-free foods do not declare this information on the label.
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Affiliation(s)
- Carrie Ka Wai Ho
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Anna Tjhin
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Eden Barrett
- Food Policy Division, The George Institute for Global Health Australia, Faculty of Medicine, UNSW, Camperdown, New South Wales, Australia
| | - Daisy H Coyle
- Food Policy Division, The George Institute for Global Health Australia, Faculty of Medicine, UNSW, Camperdown, New South Wales, Australia
| | - Jason H Y Wu
- Food Policy Division, The George Institute for Global Health Australia, Faculty of Medicine, UNSW, Camperdown, New South Wales, Australia
| | - Jimmy Chun Yu Louie
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong, Hong Kong, China
- Food Policy Division, The George Institute for Global Health Australia, Faculty of Medicine, UNSW, Camperdown, New South Wales, Australia
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Coyle DH, Sanavio L, Barrett E, Huang L, Law KK, Nanayakkara P, Hodgson JM, O’Connell M, Meggitt B, Tsai C, Pettigrew S, Wu JHY. A Cross-Sectional Evaluation of the Food Environment at an Australian University Campus. Nutrients 2023; 15:nu15071623. [PMID: 37049463 PMCID: PMC10097222 DOI: 10.3390/nu15071623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
University food environments have a strong influence on the dietary choices of students and staff. The aim of this study was to assess the food environment at a large university in Sydney, Australia. Data were collected between March and July 2022 from 27 fixed food outlets and 24 vending machines. The healthiness of the food environment was evaluated using the Healthy Food and Drink in NSW Health Facilities for Staff and Visitors Framework (‘Framework’), which assesses food environment parameters including the availability, placement, and promotion of ‘Everyday’ (healthy) and ‘Occasional’ (less healthy) products. Each parameter was evaluated overall and across each food outlet type. Across all outlets, Everyday foods and drinks made up 43.9% of all products. Only two outlets met the Framework’s product availability benchmark of ≥75% Everyday foods and drinks. A total of 43 outlets (84.3%) sold sugary drinks as part of their product range. Occasional products made up 68.4%, 53.3%, and 59.9% of all items for sale at checkout areas, countertops, and eye-level shelves, respectively. Finally, 79.7% of meal deals included Occasional products. Our findings highlight the need to improve the availability, placement, and promotion of foods and drinks sold at a major university campus in Sydney, Australia.
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Trieu K, Coyle DH, Rosewarne E, Shahid M, Yamamoto R, Nishida C, Neal B, He FJ, Marklund M, Wu JHY. Estimated Dietary and Health Impact of the World Health Organization's Global Sodium Benchmarks on Packaged Foods in Australia: a Modeling Study. Hypertension 2023; 80:541-549. [PMID: 36625256 DOI: 10.1161/hypertensionaha.122.20105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In 2021, the World Health Organization (WHO) set sodium benchmarks for packaged foods to guide countries in setting feasible and effective sodium reformulation programs. We modeled the dietary and health impact of full compliance with the WHO's sodium benchmarks in Australia and compared it to the potential impact of Australia's 2020 sodium reformulation targets. METHODS We used nationally representative data on food and sodium intake, sodium levels in packaged foods, and food sales volume to estimate sodium intake pre- and post-implementation of the WHO and Australia's sodium benchmarks for 24 age-sex groups. Using comparative risk assessment models, we then estimated the potential deaths, incidence, and disability-adjusted life years averted from cardiovascular disease, chronic kidney disease, and stomach cancer based on the reductions in sodium intake. RESULTS Compliance with the WHO's sodium benchmarks for packaged foods in Australia could lower mean adult sodium intake by 404 mg/day, corresponding to a 12% reduction. This could prevent about 1770 deaths/year (95% uncertainty interval 1168-2587), corresponding to 3% of all cardiovascular disease, chronic kidney disease, and stomach cancer deaths in Australia, and prevent some 6900 (4603-9513) new cases, and 25 700 (17 655-35 796) disability-adjusted life years/year. Compared with Australian targets, the WHO benchmarks will avert around 3 and a half times more deaths each year (1770 versus 510). CONCLUSIONS Substantially greater health impact could be achieved if the Australian government strengthened its current sodium reformulation program by adopting WHO's more stringent and comprehensive sodium benchmarks.
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Affiliation(s)
- Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Maria Shahid
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Rain Yamamoto
- World Health Organization, Geneva, Switzerland (R.Y., C.N.)
| | | | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.).,Department of Epidemiology and Biostatistics, Imperial College London, United Kingdom (B.N.)
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (F.J.H.)
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.).,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.M.)
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.).,School of Population Health, University of New South Wales, Australia (J.H.Y.W.)
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Huang L, Ojo AE, Kimiywe J, Kibet A, Ale BM, Okoro CE, Louie J, Taylor F, Huffman MD, Ojji DB, Wu JHY, Marklund M. Presence of trans-Fatty Acids Containing Ingredients in Pre-Packaged Foods and the Availability of Reported trans-Fat Levels in Kenya and Nigeria. Nutrients 2023; 15:nu15030761. [PMID: 36771466 PMCID: PMC9919578 DOI: 10.3390/nu15030761] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
In most African countries, the prevalence of industrially produced trans-fatty acids (iTFA) in the food supply is unknown. We estimated the number and proportion of products containing specific (any hydrogenated edible oils) and non-specific (vegetable fat, margarine, and vegetable cream) ingredients potentially indicative of iTFAs among pre-packaged foods collected in Kenya and Nigeria. We also summarized the number and proportion of products that reported trans-fatty acids levels and the range of reported trans-fatty acids levels. In total, 99 out of 5668 (1.7%) products in Kenya and 310 out of 6316 (4.9%) products in Nigeria contained specific ingredients indicative of iTFAs. Bread and bakery products and confectioneries in both countries had the most foods that contained iTFAs-indicative ingredients. A total of 656 products (12%) in Kenya and 624 products (10%) in Nigeria contained non-specific ingredients that may indicate the presence of iTFAs. The reporting of levels of trans-fatty acids was low in both Kenya and Nigeria (11% versus 26%, respectively, p < 0.001). With the increasing burden of ischemic heart disease in Kenya and Nigeria, the rapid adoption of WHO best-practice policies and the mandatory declaration of trans-fatty acids are important for eliminating iTFAs.
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Affiliation(s)
- Liping Huang
- The George Institute for Global Health Australia, University of New South Wales, 1 King Street, Newtown, Sydney, NSW 2042, Australia
- Correspondence:
| | - Adedayo E. Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, University of Abuja, Abuja 902101, Nigeria
- Department of Epidemiology and Global Health, University Medical Centre, Utrecht University, 3508 Utrecht, The Netherlands
| | - Judith Kimiywe
- Center For Research Ethics and Safety, Kenyatta University, Nairobi P.O. Box 43844-00100, Kenya
| | - Alex Kibet
- Department of Nutrition and Dietetics, Kenya Medical Training College Karen Campus, Nairobi P.O. Box 24921, Kenya
| | - Boni M. Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, University of Abuja, Abuja 902101, Nigeria
- Holo Healthcare, Nairobi P.O. Box 22003-00400, Kenya
| | - Clementina E. Okoro
- Federal Capital Territory (FCT) Primary Health Care Board, Abuja 900001, Nigeria
| | - Jimmy Louie
- School of Biological Sciences, The University of Hong Kong, Hong Kong, China
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, 1 John St., Hawthorn, VIC 3122, Australia
| | - Fraser Taylor
- The George Institute for Global Health Australia, University of New South Wales, 1 King Street, Newtown, Sydney, NSW 2042, Australia
| | - Mark D. Huffman
- The George Institute for Global Health Australia, University of New South Wales, 1 King Street, Newtown, Sydney, NSW 2042, Australia
- Department of Medicine and Global Health Center, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Dike B. Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, University of Abuja, Abuja 902101, Nigeria
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja 900211, Nigeria
| | - Jason H. Y. Wu
- The George Institute for Global Health Australia, University of New South Wales, 1 King Street, Newtown, Sydney, NSW 2042, Australia
- School of Population Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Matti Marklund
- The George Institute for Global Health Australia, University of New South Wales, 1 King Street, Newtown, Sydney, NSW 2042, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Public Health and Caring Sciences, Uppsala University, 75122 Uppsala, Sweden
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12
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Melville H, Shahid M, Gaines A, McKenzie BL, Alessandrini R, Trieu K, Wu JHY, Rosewarne E, Coyle DH. The nutritional profile of plant-based meat analogues available for sale in Australia. Nutr Diet 2023; 80:211-222. [PMID: 36651788 DOI: 10.1111/1747-0080.12793] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 10/10/2022] [Revised: 11/24/2022] [Accepted: 12/09/2022] [Indexed: 01/19/2023]
Abstract
AIM To assess the nutritional quality of plant-based meat analogues in Australia, compared to equivalent meat products, and to assess levels of micronutrient fortification in meat analogues. METHODS This cross-sectional study used nutrition composition data for products collected in 2021 from major supermarkets in Australia. Nutritional quality was assessed using the Health Star Rating, energy (kJ), protein (g), saturated fat (g), sodium (mg), total sugars (g), and fibre content (g) per 100 g, and level of food processing using the NOVA classification. Proportion of products fortified with iron, vitamin B12 and zinc were reported. Differences in health star rating and nutrients between food categories were assessed using independent t-tests. RESULTS Seven hundred ninety products (n = 132 plant-based and n = 658 meat) across eight food categories were analysed. Meat analogues had a higher health star rating (mean 1.2 stars, [95% CI: 1.0-1.4 stars], p < 0.001), lower mean saturated fat (-2.4 g/100 g, [-2.9 to -1.8 g/100 g], p < 0.001) and sodium content (-132 mg/100 g, [-186 to -79 mg/100 g], p < 0.001), but higher total sugar content (0.7 g/100 g, [0.4-1.1 g/100 g], p < 0.001). Meat analogues and meat products had a similar proportion of ultra-processed products (84% and 89%, respectively). 12.1% of meat analogues were fortified with iron, vitamin B12 and zinc. CONCLUSION Meat analogues generally had a higher health star rating compared with meat equivalents, however, the nutrient content varied. Most meat analogues were also ultra-processed and few are fortified with key micronutrients found in meat. More research is needed to understand the health impact of these foods.
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Affiliation(s)
- Hannah Melville
- The University of Sydney, Children's Hospital at Westmead Clinical School, Westmead, Australia
| | - Maria Shahid
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Allison Gaines
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Briar L McKenzie
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Roberta Alessandrini
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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de Oliveira Otto MC, Wu JHY, Thacker EL, Lai HTM, Lemaitre RN, Padhye N, Song X, King IB, Lopez O, Siscovick DS, Mozaffarian D. Circulating Omega-3 and Omega-6 Fatty Acids, Cognitive Decline, and Dementia in Older Adults. J Alzheimers Dis 2023; 95:965-979. [PMID: 37638432 PMCID: PMC10765383 DOI: 10.3233/jad-230083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Comprising nearly 35% of brain lipids, polyunsaturated fatty acids (PUFA) are essential for optimal brain function. However, the role of PUFA on cognitive health outcomes later in life is largely unknown. OBJECTIVE We investigated prospective associations of plasma phospholipid omega-3 (ALA [18 : 3], EPA [20 : 5], DPA [22 : 5], DHA [22 : 6]) and omega-6 (LA [18 : 2], AA [20 : 4]) PUFA with cognitive decline, risk of cognitive impairment and dementia among adults aged≥65 years in the Cardiovascular Health Study. METHODS Circulating fatty acid concentrations were measured serially at baseline (1992/1993), 6 years, and 13 years later. Cognitive decline and impairment were assessed using the 100-point Modified Mini-Mental State Examination (3MSE) up to 7 times. Clinical dementia was identified using adjudicated neuropsychological tests, and ICD-9 codes. RESULTS Among 3,564 older adults free of stroke and dementia at baseline, cognitive function declined annually by approximately -0.5 3MSE points; 507 participants developed cognitive impairment and 499 dementia over up to 23 years of follow-up. In multivariable models, higher circulating arachidonic acid (AA) concentrations were associated with slower cognitive decline and lower dementia risk, with associations growing stronger with greater length of follow-up (hazard ratio [HR,95% CI] of dementia per interquintile range, 0.74 [0.56-0.97] at 5 years, and 0.53 [0.37-0.77] at 15 years). Circulating docosapentaenoic (DPA) concentrations were associated with slower cognitive decline and lower risk of cognitive impairment (extreme-quintile HR, 0.72 [95% CI: 0.55, 0.95]). Findings were generally null or inconsistent for other omega-3 or omega-6 PUFA. CONCLUSION Circulating AA and DPA, but not other PUFA, are associated with slower rate of cognitive decline and lower risk of dementia or cognitive impairment later in life.
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Affiliation(s)
- Marcia C de Oliveira Otto
- Division of Epidemiology, Human Genetics and Environmental Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Jason H Y Wu
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Evan L Thacker
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - Heidi Tsz Mung Lai
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nikhil Padhye
- Center for Nursing Research, The University of Texas Health Science Center, School of Nursing, Houston, TX, USA
| | - Xiaoling Song
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Irena B King
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Oscar Lopez
- Department of Neurology, University of Pittsburg School of Medicine, Pittsburg, PA, USA
| | | | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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14
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Coyle DH, Huang L, Shahid M, Gaines A, Di Tanna GL, Louie JCY, Pan X, Marklund M, Neal B, Wu JHY. Socio-economic difference in purchases of ultra-processed foods in Australia: an analysis of a nationally representative household grocery purchasing panel. Int J Behav Nutr Phys Act 2022; 19:148. [PMID: 36503612 PMCID: PMC9742014 DOI: 10.1186/s12966-022-01389-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/22/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Consumption of ultra-processed foods is associated with increased risk of obesity and non-communicable diseases. Little is known about current patterns of ultra-processed foods intake in Australia. The aim of this study was to examine the amount and type of ultra-processed foods purchased by Australian households in 2019 and determine whether purchases differed by socio-economic status (SES). We also assessed whether purchases of ultra-processed foods changed between 2015 and 2019. METHODS: We used grocery purchase data from a nationally representative consumer panel in Australia to assess packaged and unpackaged grocery purchases that were brought home between 2015 to 2019. Ultra-processed foods were identified according to the NOVA system, which classifies foods according to the nature, extent and purpose of industrial food processing. Purchases of ultra-processed foods were calculated per capita, using two outcomes: grams/day and percent of total energy. The top food categories contributing to purchases of ultra-processed foods in 2019 were identified, and differences in ultra-processed food purchases by SES (Index of Relative Social Advantage and Disadvantage) were assessed using survey-weighted linear regression. Changes in purchases of ultra-processed foods between 2015 to 2019 were examined overall and by SES using mixed linear models. RESULTS In 2019, the mean ± SD total grocery purchases made by Australian households was 881.1 ± 511.9 g/d per capita. Of this, 424.2 ± 319.0 g/d per capita was attributable to purchases of ultra-processed foods, which represented 56.4% of total energy purchased. The largest food categories contributing to total energy purchased included mass-produced, packaged breads (8.2% of total energy purchased), chocolate and sweets (5.7%), biscuits and crackers (5.7%) and ice-cream and edible ices (4.3%). In 2019, purchases of ultra-processed foods were significantly higher for the lowest SES households compared to all other SES quintiles (P < 0.001). There were no major changes in purchases of ultra-processed foods overall or by SES over the five-year period. CONCLUSIONS Between 2015 and 2019, ultra-processed foods have consistently made up the majority of groceries purchased by Australians, particularly for the lowest SES households. Policies that reduce ultra-processed food consumption may reduce diet-related health inequalities.
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Affiliation(s)
- Daisy H. Coyle
- grid.1005.40000 0004 4902 0432Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042 Australia
| | - Liping Huang
- grid.1005.40000 0004 4902 0432Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042 Australia
| | - Maria Shahid
- grid.1005.40000 0004 4902 0432Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042 Australia
| | - Allison Gaines
- grid.1005.40000 0004 4902 0432Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042 Australia ,grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London, London, SW7 2AZ UK
| | - Gian Luca Di Tanna
- grid.1005.40000 0004 4902 0432Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042 Australia
| | - Jimmy Chun Yu Louie
- grid.1005.40000 0004 4902 0432Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042 Australia ,grid.194645.b0000000121742757School of Biological Science, Faculty of Science, The University of Hong Kong, Hong Kong, 999077 China
| | - Xiongfei Pan
- grid.461863.e0000 0004 1757 9397Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Matti Marklund
- grid.1005.40000 0004 4902 0432Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042 Australia
| | - Bruce Neal
- grid.1005.40000 0004 4902 0432Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042 Australia ,grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London, London, SW7 2AZ UK
| | - Jason H. Y. Wu
- grid.1005.40000 0004 4902 0432Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042 Australia
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15
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Marklund M, Tullu F, Raj Thout S, Yu J, Brady TM, Appel LJ, Neal B, Wu JHY, Gupta R. Estimated Benefits and Risks of Using a Reduced-Sodium, Potassium-Enriched Salt Substitute in India: A Modeling Study. Hypertension 2022; 79:2188-2198. [PMID: 35880525 DOI: 10.1161/hypertensionaha.122.19072] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Salt substitution (ie, replacement of table and cooking salt with potassium-enriched salt substitutes) is a promising strategy to reduce blood pressure and prevent cardiovascular disease, particularly in countries like India where there is high sodium intake, mainly from discretionary salt, and low potassium intake. Life-threatening hyperkalemia from increased potassium intake is a postulated concern for individuals with chronic kidney disease. METHODS We used comparative risk assessment models to estimate the number of (1) cardiovascular deaths averted due to blood pressure reductions; (2) potential hyperkalemia-related deaths from increased potassium intake in individuals with advanced chronic kidney disease; and (3) net averted deaths from nationwide salt substitution in India. We evaluated a conservative scenario, based on a large, long-term pragmatic trial in rural China; and an optimistic scenario informed by our recent trial in India. Sensitivity analyses were conducted to assess the robustness of the findings. RESULTS In the conservative scenario, a nationwide salt substitution intervention was estimated to result in ≈214 000 (95% uncertainty interval, 92 764-353 054) averted deaths from blood pressure reduction in the total population and ≈52 000 (22 961-80 211) in 28 million individuals with advanced chronic kidney disease, while ≈22 000 (15 221-31 840) hyperkalemia-deaths might be caused by the intervention. The corresponding estimates for the optimistic scenario were ≈351 000 (130 470-546 255), ≈66 000 (24 925-105 851), and ≈9000 (4251-14 599). Net benefits were consistent across sensitivity analyses. CONCLUSIONS Modeling nationwide salt substitution in India consistently estimated substantial net benefits, preventing around 8% to 14% of annual cardiovascular deaths. Even allowing for potential hyperkalemia risks there were net benefits estimated for individuals with chronic kidney disease.
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Affiliation(s)
- Matti Marklund
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (M.M., J.Y., B.N., J.H.Y.W.)
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.M., L.J.A.)
- Department of Public Health and Caring Sciences, Uppsala University, Sweden (M.M.)
| | - Fikru Tullu
- World Health Organization, Country Office India, New Delhi (F.T., R.G.)
| | - Sudhir Raj Thout
- Research and Development Division, The George Institute for Global Health, Hyderabad, India (S.R.T.)
- Indian Institute of Technology Hyderabad, Kandi, Sangareddy, Telangana, India (S.R.T.)
| | - Jie Yu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (M.M., J.Y., B.N., J.H.Y.W.)
- Department of Cardiology, Peking University Third Hospital, Beijing, China (J.Y.)
| | - Tammy M Brady
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., L.J.A.)
| | - Lawrence J Appel
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.M., L.J.A.)
- Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B., L.J.A.)
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (M.M., J.Y., B.N., J.H.Y.W.)
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (M.M., J.Y., B.N., J.H.Y.W.)
- Imperial College London, London, United Kingdom (B.N.)
| | - Rachita Gupta
- World Health Organization, Country Office India, New Delhi (F.T., R.G.)
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16
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Yin X, Rodgers A, Perkovic A, Huang L, Li KC, Yu J, Wu Y, Wu JHY, Marklund M, Huffman MD, Miranda JJ, Di Tanna GL, Labarthe D, Elliott P, Tian M, Neal B. Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis. Heart 2022; 108:1608-1615. [PMID: 35945000 DOI: 10.1136/heartjnl-2022-321332] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/06/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES The Salt Substitute and Stroke Study (SSaSS) recently reported blood pressure-mediated benefits of a potassium-enriched salt substitute on cardiovascular outcomes and death. This study assessed the effects of salt substitutes on a breadth of outcomes to quantify the consistency of the findings and understand the likely generalisability of the SSaSS results. METHODS We searched PubMed, Embase and the Cochrane Library up to 31 August 2021. Parallel group, step-wedge or cluster randomised controlled trials reporting the effect of salt substitute on blood pressure or clinical outcomes were included. Meta-analyses and metaregressions were used to define the consistency of findings across trials, geographies and patient groups. RESULTS There were 21 trials and 31 949 participants included, with 19 reporting effects on blood pressure and 5 reporting effects on clinical outcomes. Overall reduction of systolic blood pressure (SBP) was -4.61 mm Hg (95% CI -6.07 to -3.14) and of diastolic blood pressure (DBP) was -1.61 mm Hg (95% CI -2.42 to -0.79). Reductions in blood pressure appeared to be consistent across geographical regions and population subgroups defined by age, sex, history of hypertension, body mass index, baseline blood pressure, baseline 24-hour urinary sodium and baseline 24-hour urinary potassium (all p homogeneity >0.05). Metaregression showed that each 10% lower proportion of sodium choloride in the salt substitute was associated with a -1.53 mm Hg (95% CI -3.02 to -0.03, p=0.045) greater reduction in SBP and a -0.95 mm Hg (95% CI -1.78 to -0.12, p=0.025) greater reduction in DBP. There were clear protective effects of salt substitute on total mortality (risk ratio (RR) 0.89, 95% CI 0.85 to 0.94), cardiovascular mortality (RR 0.87, 95% CI 0. 81 to 0.94) and cardiovascular events (RR 0.89, 95% CI 0.85 to 0.94). CONCLUSIONS The beneficial effects of salt substitutes on blood pressure across geographies and populations were consistent. Blood pressure-mediated protective effects on clinical outcomes are likely to be generalisable across population subgroups and to countries worldwide. TRIAL REGISTRATION NUMBER CRD42020161077.
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Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Adam Perkovic
- School of Health Science, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Ka-Chun Li
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Jie Yu
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - J H Y Wu
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.,Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri, USA
| | - J Jaime Miranda
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.,CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Darwin Labarthe
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Paul Elliott
- School of Public Health, Imperial College of Science Technology and Medicine, London, UK
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia .,School of Public Health, Harbin Medical University, Harbin, China
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.,School of Public Health, Imperial College of Science Technology and Medicine, London, UK
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17
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Liu Y, Xiao S, Yin X, Gao P, Wu J, Xiong S, Hockham C, Hone T, Wu JHY, Pearson SA, Neal B, Tian M. Nation-Wide Routinely Collected Health Datasets in China: A Scoping Review. Public Health Rev 2022; 43:1605025. [PMID: 36211230 PMCID: PMC9532513 DOI: 10.3389/phrs.2022.1605025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives: The potential for using routinely collected data for medical research in China remains unclear. We sought to conduct a scoping review to systematically characterise nation-wide routinely collected datasets in China that may be of value for clinical research. Methods: We searched public databases and the websites of government agencies, and non-government organizations. We included nation-wide routinely collected databases related to communicable diseases, non-communicable diseases, injuries, and maternal and child health. Database characteristics, including disease area, data custodianship, data volume, frequency of update and accessibility were extracted and summarised. Results: There were 70 databases identified, of which 46 related to communicable diseases, 20 to non-communicable diseases, 1 to injury and 3 to maternal and child health. The data volume varied from below 1000 to over 100,000 records. Over half (64%) of the databases were accessible for medical research mostly comprising communicable diseases. Conclusion: There are large quantities of routinely collected data in China. Challenges to using such data in medical research remain with various accessibility. The potential of routinely collected data may also be applicable to other low- and middle-income countries.
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Affiliation(s)
- Yishu Liu
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Shaoming Xiao
- The George Institute for Global Health, Health Science Centre, Peking University, Beijing, China
| | - Xuejun Yin
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Pei Gao
- School of Public Health, Health Science Center, Peking University, Beijing, China
| | - Jing Wu
- National Center for Chronic and Non-Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shangzhi Xiong
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Carinna Hockham
- The George Institute for Global Health, UK, London, United Kingdom
| | - Thomas Hone
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jason H. Y. Wu
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Sallie Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bruce Neal
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Maoyi Tian
- George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
- School of Public Health, Harbin Medical University, Harbin, China
- *Correspondence: Maoyi Tian,
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18
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Hoorn EJ, Marklund M, Wu JHY. Salt substitution: opportunities and challenges for nephrology. Nat Rev Nephrol 2022; 18:539-540. [PMID: 35750864 DOI: 10.1038/s41581-022-00599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Matti Marklund
- The George Institute for Global Health and School of Public Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Jason H Y Wu
- The George Institute for Global Health and School of Public Health, University of New South Wales, Sydney, New South Wales, Australia
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19
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Yan T, Huang Y, Wu JHY, Zhuang XD, Pan XF. Editorial: Insulin Resistance, Metabolic Syndrome, and Cardiovascular Disease. Front Cardiovasc Med 2022; 9:959680. [PMID: 35811727 PMCID: PMC9257250 DOI: 10.3389/fcvm.2022.959680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Tong Yan
- Department of General Surgery, Center for Obesity and Metabolic Health, The Third People's Hospital of Chengdu and the Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Guangzhou, China
| | - Jason H. Y. Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Xiao-Dong Zhuang
- Cardiology Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiong-Fei Pan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- Shuangliu Institute of Women's and Children's Health, Shuangliu Maternal and Child Health Hospital, Chengdu, China
- *Correspondence: Xiong-Fei Pan
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20
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Bhat S, Maganja D, Huang L, Wu JHY, Marklund M. Influence of Heating during Cooking on Trans Fatty Acid Content of Edible Oils: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14071489. [PMID: 35406103 PMCID: PMC9002916 DOI: 10.3390/nu14071489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/12/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 01/18/2023] Open
Abstract
Consumption of trans fatty acids (TFA) is associated with adverse health outcomes and is a considerable burden on morbidity and mortality globally. TFA may be generated by common cooking practices and hence contribute to daily dietary intake. We performed a systematic review and meta-analysis to investigate the relationship between heating edible oils and change in their TFA content. A systematic search of experimental studies investigating the effect of various methods of heating on TFA content of edible oils was conducted in Medline and Embase since their inception up to 1 October 2020 without language restrictions. Comparable data were analysed using mixed multilevel linear models taking into account individual study variation. Thirty-three studies encompassing twenty-one different oils were included in this review. Overall, heating to temperatures <200 °C had no appreciable impact on different TFA levels. Between 200 and 240 °C, levels of C18:2 t (0.05% increase per 10 °C rise in temperature, 95% CI: 0.02 to 0.05%), C18:3t (0.18%, 95% CI: 0.14 to 0.21%), and total TFA (0.38%, 95% CI: 0.20 to 0.55%) increased with temperature. A further increase in total TFA was observed with prolonged heating between 200 and 240 °C. Our findings suggest that heating edible oils to common cooking temperatures (≤200 °C) has minimal effect on TFA generation whereas heating to higher temperatures can increase TFA level. This provides further evidence in favour of public health advice that heating oils to very high temperatures and prolonged heating of oils should be avoided.
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Affiliation(s)
- Saiuj Bhat
- Department of Vascular Surgery, Royal Perth Hospital, Victoria Square, Perth, WA 6000, Australia;
| | - Damian Maganja
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (D.M.); (L.H.); (J.H.Y.W.)
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (D.M.); (L.H.); (J.H.Y.W.)
| | - Jason H. Y. Wu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (D.M.); (L.H.); (J.H.Y.W.)
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (D.M.); (L.H.); (J.H.Y.W.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Public Health and Caring Sciences, Uppsala University, SE75105 Uppsala, Sweden
- Correspondence:
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21
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Bhat S, Coyle DH, Trieu K, Neal B, Mozaffarian D, Marklund M, Wu JHY. Reply to A Coskun and B Oz. Adv Nutr 2022; 13:692-693. [PMID: 37270210 PMCID: PMC8970822 DOI: 10.1093/advances/nmac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Saiuj Bhat
- From the School of Medicine, the University of Western Australia, Crawley, Australia
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; School of Public Health, Imperial College London, London, United Kingdom
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
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22
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Maganja D, Miller M, Trieu K, Scapin T, Cameron A, Wu JHY. Evidence Gaps in Assessments of the Healthiness of Online Supermarkets Highlight the Need for New Monitoring Tools: a Systematic Review. Curr Atheroscler Rep 2022; 24:215-233. [PMID: 35138570 PMCID: PMC9023389 DOI: 10.1007/s11883-022-01004-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Online grocery shopping is increasingly popular, but the extent to which these food environments encourage healthy or unhealthy purchases is unclear. This review identifies studies assessing the healthiness of real-world online supermarkets and frameworks to support future efforts. RECENT FINDINGS A total of 18 studies were included and 17 assessed aspects of online supermarkets. Pricing and promotional strategies were commonly applied to unhealthy products, while nutrition labelling may not meet regulated requirements or support consumer decision-making. Few studies investigated the different and specific ways online supermarkets can influence consumers. One framework for comprehensively capturing the healthiness of online supermarkets was identified, particularly highlighting the various ways retailers can tailor the environment to target individuals. Comprehensive assessments of online supermarkets can identify the potential to support or undermine healthy choices and dietary patterns. Common, validated instruments to facilitate consistent analysis and comparison are needed, particularly to investigate the new opportunities the online setting offers to influence consumers.
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Affiliation(s)
- Damian Maganja
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, 2042, Australia.
| | - Mia Miller
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, 2042, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, 2042, Australia
| | - Tailane Scapin
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Adrian Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, 2042, Australia
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23
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Yang X, Xie Y, Wang Y, Yu Y, Jin X, Xiu P, Wu JHY, Yu D, Pan A, Zhao J, Yang CX, Pan XF. Arthritis is associated with an increased risk of incident diabetes in Chinese adults: A nationwide cohort study and updated meta-analysis. Diabetes Metab Res Rev 2022; 38:e3487. [PMID: 34289224 DOI: 10.1002/dmrr.3487] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/19/2021] [Accepted: 05/29/2021] [Indexed: 02/05/2023]
Abstract
AIMS To prospectively examine the association between arthritis and type 2 diabetes (T2D) in the Chinese population and confirm this association through a comprehensive meta-analysis of cohort studies. METERIALS AND METHODS Data were from the China Health and Retirement Longitudinal Study which was started in 2011-2013 and followed up in 2013-2014 and 2015-2016. Arthritis was defined as self-reported physician diagnosis at baseline, and incident T2D was determined by self-reported physician diagnosis, fasting blood glucose ≥7.0 mmol/L or glycosylated haemoglobin ≥6.5% during the follow-ups. Cox proportional hazards regression models were used to assess the association between arthritis and risk for T2D. A meta-analysis was conducted to pool our effect estimate and those from other cohort studies using a random-effects model. RESULTS Eleven thousand four hundred and eight participants (47.9% men; mean age: 59.3 years) were included in final analyses. During a 4-year follow-up, 981 participants reported incident T2D. Compared with individuals without arthritis, those with arthritis at baseline had an 18% higher risk for incident T2D (multivariable-adjusted hazard ratio: 1.18; 95% confidence interval: 1.04, 1.34). In the meta-analysis of 13 cohort studies including ours, a total of 2,473,514 participants were included with 121,851 incident diabetes. The pooling HR was 1.32 (95% CI: 1.21, 1.44) for the association between arthritis and diabetes. CONCLUSION Arthritis was associated with an increased risk of incident diabetes in Chinese adults, and the positive association was confirmed in the meta-analysis of cohort studies. Our work can inform clinical trials to assess the effectiveness of arthritis treatments in reducing risk of diabetes.
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Affiliation(s)
- Xue Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Xie
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Yu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingzhong Jin
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Peng Xiu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian Zhao
- The Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun-Xia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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24
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Davies T, Louie JCY, Ndanuko R, Barbieri S, Perez-Concha O, Wu JHY. A Machine Learning Approach to Predict the Added-Sugar Content of Packaged Foods. J Nutr 2022; 152:343-349. [PMID: 34550390 DOI: 10.1093/jn/nxab341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/29/2021] [Revised: 08/17/2021] [Accepted: 09/16/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Dietary guidelines recommend limiting the intake of added sugars. However, despite the public health importance, most countries have not mandated the labeling of added-sugar content on packaged foods and beverages, making it difficult for consumers to avoid products with added sugar, and limiting the ability of policymakers to identify priority products for intervention. OBJECTIVE The aim was to develop a machine learning approach for the prediction of added-sugar content in packaged products using available nutrient, ingredient, and food category information. METHODS The added-sugar prediction algorithm was developed using k-nearest neighbors (KNN) and packaged food information from the US Label Insight dataset (n = 70,522). A synthetic dataset of Australian packaged products (n = 500) was used to assess validity and generalization. Performance metrics included the coefficient of determination (R2), mean absolute error (MAE), and Spearman rank correlation (ρ). To benchmark the KNN approach, the KNN approach was compared with an existing added-sugar prediction approach that relies on a series of manual steps. RESULTS Compared with the existing added-sugar prediction approach, the KNN approach was similarly apt at explaining variation in added-sugar content (R2 = 0.96 vs. 0.97, respectively) and ranking products from highest to lowest in added-sugar content (ρ = 0.91 vs. 0.93, respectively), while less apt at minimizing absolute deviations between predicted and true values (MAE = 1.68 g vs. 1.26 g per 100 g or 100 mL, respectively). CONCLUSIONS KNN can be used to predict added-sugar content in packaged products with a high degree of validity. Being automated, KNN can easily be applied to large datasets. Such predicted added-sugar levels can be used to monitor the food supply and inform interventions aimed at reducing added-sugar intake.
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Affiliation(s)
- Tazman Davies
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jimmy Chun Yu Louie
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Rhoda Ndanuko
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Oscar Perez-Concha
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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25
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Wang Y, Huang Y, Wu P, Ye Y, Sun F, Yang X, Lu Q, Yuan J, Liu Y, Zeng H, Song X, Yan S, Qi X, Yang CX, Lv C, Wu JHY, Liu G, Pan XF, Chen D, Pan A. Plasma lipidomics in early pregnancy and risk of gestational diabetes mellitus: a prospective nested case-control study in Chinese women. Am J Clin Nutr 2021; 114:1763-1773. [PMID: 34477820 DOI: 10.1093/ajcn/nqab242] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 02/21/2021] [Accepted: 06/28/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Lipid metabolism plays an important role in the pathogenesis of diabetes. There is little evidence regarding the prospective association of the maternal lipidome with gestational diabetes mellitus (GDM), especially in Chinese populations. OBJECTIVES We aimed to identify novel lipid species associated with GDM risk in Chinese women, and assess the incremental predictive capacity of the lipids for GDM. METHODS We conducted a nested case-control study using the Tongji-Shuangliu Birth Cohort with 336 GDM cases and 672 controls, 1:2 matched on age and week of gestation. Maternal blood samples were collected at 6-15 wk, and lipidomes were profiled by targeted ultra-HPLC-tandem MS. GDM was diagnosed by oral-glucose-tolerance test at 24-28 wk. The least absolute shrinkage and selection operator is a regression analysis method that was used to select novel biomarkers. Multivariable conditional logistic regression was used to estimate the associations. RESULTS Of 366 detected lipids, 10 were selected and found to be significantly associated with GDM independently of confounders: there were positive associations with phosphatidylinositol 40:6, alkylphosphatidylcholine 36:1, phosphatidylethanolamine plasmalogen 38:6, diacylglyceride 18:0/18:1, and alkylphosphatidylethanolamine 40:5 (adjusted ORs per 1 log-SD increment range: 1.34-2.86), whereas there were inverse associations with sphingomyelin 34:1, dihexosyl ceramide 24:0, mono hexosyl ceramide 18:0, dihexosyl ceramide 24:1, and phosphatidylcholine 40:7 (adjusted ORs range: 0.48-0.68). Addition of these novel lipids to the classical GDM prediction model resulted in a significant improvement in the C-statistic (discriminatory power of the model) to 0.801 (95% CI: 0.772, 0.829). For every 1-point increase in the lipid risk score of the 10 lipids, the OR of GDM was 1.66 (95% CI: 1.50, 1.85). Mediation analysis suggested the associations between specific lipid species and GDM were partially explained by glycemic and insulin-related indicators. CONCLUSIONS Specific plasma lipid biomarkers in early pregnancy were associated with GDM in Chinese women, and significantly improved the prediction for GDM.
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Affiliation(s)
- Yi Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yichao Huang
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - Ping Wu
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Ye
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fengjiang Sun
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - Xue Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Lu
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiaying Yuan
- Department of Science and Education, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Yan Liu
- Department of Obstetrics and Gynecology, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Huayan Zeng
- Nutrition Department, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Xingyue Song
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Shijiao Yan
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou, Hainan, China.,School of Public Health, Hainan Medical University, Haikou, Hainan, China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, West China Second Hospital, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, China
| | - Chun-Xia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuanzhu Lv
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou, Hainan, China
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiong-Fei Pan
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Da Chen
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - An Pan
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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26
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Coyle DH, Shahid M, Dunford EK, Louie JCY, Trieu K, Marklund M, Neal B, Wu JHY. Estimating the potential impact of the Australian government's reformulation targets on household sugar purchases. Int J Behav Nutr Phys Act 2021; 18:138. [PMID: 34706725 PMCID: PMC8555094 DOI: 10.1186/s12966-021-01208-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/05/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Countries around the world are putting in place sugar reformulation targets for packaged foods to reduce excess sugar consumption. The Australian government released its voluntary sugar reformulation targets for nine food categories in 2020. We estimated the potential impact of these targets on household sugar purchases and examined differences by income. For comparison, we also modelled the potential impact of the UK sugar reduction targets on per capita sugar purchases as the UK has one of the most comprehensive sugar reduction strategies in the world. METHODS Grocery purchase data from a nationally representative consumer panel (n=7,188) in Australia was linked with a large database (FoodSwitch) with product-specific sugar content information for packaged foods (n=25,261); both datasets were collected in 2018. Potential reductions in per capita sugar purchases were calculated overall and by food category. Differences in sugar reduction across income level were assessed by analysis of variance. RESULTS In 2018, the total sugar acquired from packaged food and beverage purchases consumed at-home was 56.1 g/day per capita. Australia's voluntary reformulation targets for sugar covered 2,471/25,261 (9.8%) unique products in the FoodSwitch dataset. Under the scenario that all food companies adhered to the voluntary targets, sugar purchases were estimated to be reduced by 0.9 g/day per capita, which represents a 1.5% reduction in sugar purchased from packaged foods. However, if Australia adopted the UK targets, over twice as many products would be covered (n=4,667), and this would result in a more than four times greater reduction in sugar purchases (4.1 g/day per capita). It was also estimated that if all food companies complied with Australia's voluntary sugar targets, reductions to sugar would be slightly greater in low-income households compared with high-income households by 0.3 g/day (95%CI 0.2 - 0.4 g/day, p<0.001). CONCLUSIONS Sugar-reduction policies have the potential to substantially reduce population sugar consumption and may help to reduce health inequalities related to excess sugar consumption. However, the current reformulation targets in Australia are estimated to achieve only a small reduction to sugar intakes, particularly in comparison to the UK's sugar reduction program.
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Affiliation(s)
- Daisy H Coyle
- Faculty of Medicine, The George Institute for Global Health, UNSW Sydney, Level 5, 1 King St, Newtown, Australia.
| | - Maria Shahid
- Faculty of Medicine, The George Institute for Global Health, UNSW Sydney, Level 5, 1 King St, Newtown, Australia
| | - Elizabeth K Dunford
- Faculty of Medicine, The George Institute for Global Health, UNSW Sydney, Level 5, 1 King St, Newtown, Australia
- Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jimmy Chun Yu Louie
- Faculty of Medicine, The George Institute for Global Health, UNSW Sydney, Level 5, 1 King St, Newtown, Australia
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Kathy Trieu
- Faculty of Medicine, The George Institute for Global Health, UNSW Sydney, Level 5, 1 King St, Newtown, Australia
| | - Matti Marklund
- Faculty of Medicine, The George Institute for Global Health, UNSW Sydney, Level 5, 1 King St, Newtown, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce Neal
- Faculty of Medicine, The George Institute for Global Health, UNSW Sydney, Level 5, 1 King St, Newtown, Australia
| | - Jason H Y Wu
- Faculty of Medicine, The George Institute for Global Health, UNSW Sydney, Level 5, 1 King St, Newtown, Australia
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27
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Chio AI, Davies T, Wu JHY, Louie JCY. Prevalence of missing nutrition label and ingredients list information on e‐shops of major chain supermarkets in Hong Kong. NUTR BULL 2021. [DOI: 10.1111/nbu.12530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Amy I. Chio
- School of Biological Sciences The University of Hong Kong Pokfulam, Hong Kong
| | - Tazman Davies
- Food Policy Division The George Institute for Global Health Camperdown NSW Australia
| | - Jason H. Y. Wu
- Food Policy Division The George Institute for Global Health Camperdown NSW Australia
| | - Jimmy Chun Yu Louie
- School of Biological Sciences The University of Hong Kong Pokfulam, Hong Kong
- Food Policy Division The George Institute for Global Health Camperdown NSW Australia
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28
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Trieu K, Coyle DH, Afshin A, Neal B, Marklund M, Wu JHY. The estimated health impact of sodium reduction through food reformulation in Australia: A modeling study. PLoS Med 2021; 18:e1003806. [PMID: 34699528 PMCID: PMC8547659 DOI: 10.1371/journal.pmed.1003806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Australian Government recently established sodium targets for packaged foods to encourage voluntary reformulation to reduce population sodium consumption and related diseases. We modeled the health impact of Australia's sodium reformulation targets and additional likely health gains if more ambitious, yet feasible sodium targets had been adopted instead. METHODS AND FINDINGS Using comparative risk assessment models, we estimated the averted deaths, incidence, and disability-adjusted life years (DALYs) from cardiovascular disease (CVD), chronic kidney disease (CKD) and stomach cancer after implementation of (a) Australia's sodium targets (overall and by individual companies); (b) United Kingdom's targets (that covers more product categories); and (c) an optimistic scenario (sales-weighted 25th percentile sodium content for each food category included in the UK program). We used nationally representative data to estimate pre- and post-intervention sodium intake, and other key data sources from the Global Burden of Disease study. Full compliance with the Australian government's sodium targets could prevent approximately 510 deaths/year (95% UI, 335 to 757), corresponding to about 1% of CVD, CKD, and stomach cancer deaths, and prevent some 1,920 (1,274 to 2,600) new cases and 7,240 (5,138 to 10,008) DALYs/year attributable to these diseases. Over half (59%) of deaths prevented is attributed to reformulation by 5 market-dominant companies. Compliance with the UK and optimistic scenario could avert approximately an additional 660 (207 to 1,227) and 1,070 (511 to 1,856) deaths/year, respectively, compared to Australia's targets. The main limitation of this study (like other modeling studies) is that it does not prove that sodium reformulation programs will prevent deaths and disease events; rather, it provides the best quantitative estimates and the corresponding uncertainty of the potential effect of the different programs to guide the design of policies. CONCLUSIONS There is significant potential to strengthen Australia's sodium reformulation targets to improve its health impact. Promoting compliance by market-dominant food companies will be critical to achieving the potential health gains.
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Affiliation(s)
- Kathy Trieu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Daisy H. Coyle
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ashkan Afshin
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Epidemiology and Biostatistics, Imperial College London, United Kingdom
| | - Matti Marklund
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jason H. Y. Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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29
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Bhat S, Coyle DH, Trieu K, Neal B, Mozaffarian D, Marklund M, Wu JHY. Healthy Food Prescription Programs and their Impact on Dietary Behavior and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12:1944-1956. [PMID: 33999108 PMCID: PMC8483962 DOI: 10.1093/advances/nmab039] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
The enormous burden of diet-related chronic diseases has prompted interest in healthy food prescription programs. Yet, the impact of such programs remains unclear. The aim of this study was to conduct a systematic review of healthy food prescription programs and evaluate their impact on dietary behavior and cardiometabolic parameters by meta-analysis. A systematic search was carried out in Medline, Embase, Scopus, and Cochrane Central Register of Controlled Trials databases since their inception to 3 January, 2020 without language restriction. A systematic search of interventional studies investigating the effect of healthy food prescription on diet quality and/or cardiometabolic risk factors including BMI, systolic (SBP) and diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), or blood lipids was carried out. Thirteen studies were identified for inclusion, most of which were quasi-experimental (pre/post) interventions without a control group (n = 9). Pooled estimates revealed a 22% (95% CI: 12, 32; n = 5 studies, n = 1039 participants; I2 = 97%) increase in fruit and vegetable consumption, corresponding to 0.8 higher daily servings (95% CI: 0.2, 1.4; I2 = 96%). BMI decreased by 0.6 kg/m2 (95% CI: 0.2, 1.1; I2 = 6.4%) and HbA1c by 0.8% (95% CI: 0.1, 1.6; I2 = 92%). No significant change was observed in other cardiometabolic parameters. These findings should be interpreted with caution in light of considerable heterogeneity, methodological limitations of the included studies, and moderate to very low certainty of evidence. Our results support the need for well-designed, large, randomized controlled trials in various settings to further establish the efficacy of healthy food prescription programs on diet quality and cardiometabolic health.
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Affiliation(s)
- Saiuj Bhat
- School of Medicine, The University of Western Australia, Crawley, Australia
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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30
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Chan LY, Coyle DH, Wu JHY, Louie JCY. Total and Free Sugar Levels and Main Types of Sugars Used in 18,784 Local and Imported Pre-Packaged Foods and Beverages Sold in Hong Kong. Nutrients 2021; 13:3404. [PMID: 34684405 PMCID: PMC8540970 DOI: 10.3390/nu13103404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/28/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
There is limited information regarding the free sugar content of pre-packaged foods in Hong Kong. This study aims to assess the free sugar content and identify the most frequently used free sugar ingredients (FSI) in pre-packaged foods in Hong Kong. Data from 18,784 products from the 2019 FoodSwitch Hong Kong database were used in this analysis. Ingredient lists were screened to identify FSI. Total sugar content was derived from nutrition labels on packaging. Free sugar content was estimated based on adaptation of a previously established systematic methodology. Descriptive statistics of the total sugar and free sugar content, as well as the mean ± SD contribution of free sugar to total sugar of the audited products were calculated, stratified by food groups. Almost two-thirds (64.5%) of the pre-packaged foods contained at least one FSI. 'Sugar (sucrose)' was the most popular FSI that was found in more than half (54.7%) of the products. 'Fruit and vegetable juices' (median 10.0; IQR 8.3-11.5 g/100 mL) were found to have a higher median free sugar content than 'Soft drinks' (8.0; 6.0-10.6 g/100 mL). Mean ± SD contribution of free sugar to the total sugar content was 65.8 ± 43.4%, with 8 out of 14 food groups having >70% total sugar as free sugar. To conclude, free sugar, especially sucrose, was extensively used in a wide variety of pre-packaged products sold in Hong Kong. Further studies are needed to assess the population intake of free sugar in Hong Kong to inform public health policy on free sugar reduction.
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Affiliation(s)
- Lok Yin Chan
- Faculty of Science, School of Biological Sciences, The University of Hong Kong, Pokfulam, Hong Kong 999077, China;
| | - Daisy H. Coyle
- Food Policy Division, The George Institute for Global Health, Camperdown, NSW 2050, Australia; (D.H.C.); (J.H.Y.W.)
| | - Jason H. Y. Wu
- Food Policy Division, The George Institute for Global Health, Camperdown, NSW 2050, Australia; (D.H.C.); (J.H.Y.W.)
| | - Jimmy Chun Yu Louie
- Faculty of Science, School of Biological Sciences, The University of Hong Kong, Pokfulam, Hong Kong 999077, China;
- Food Policy Division, The George Institute for Global Health, Camperdown, NSW 2050, Australia; (D.H.C.); (J.H.Y.W.)
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31
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Yin X, Tian M, Sun L, Webster J, Trieu K, Huffman MD, Miranda JJ, Marklund M, Wu JHY, Cobb LK, Chu H, Pearson SA, Neal B, Liu H. Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study. Nutrients 2021; 13:nu13093225. [PMID: 34579109 PMCID: PMC8471368 DOI: 10.3390/nu13093225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Widespread use of reduced-sodium salts can potentially lower excessive population-level dietary sodium intake. This study aimed to identify key barriers and facilitators to implementing reduced-sodium salt as a population level intervention. Semi-structured interviews were conducted with key informants from academia, the salt manufacturing industry, and government. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to inform our interview guides and data analysis. Eighteen key informants from nine countries across five World Health Organization regions participated in the study from January 2020 to July 2020. Participants were concerned about the lack of robust evidence on safety for specific populations such as those with renal impairment. Taste and price compared to regular salt and an understanding of the potential health benefits of reduced-sodium salt were identified as critical factors influencing the adoption of reduced-sodium salts. Higher production costs, low profit return, and reduced market demand for reduced-sodium salts were key barriers for industry in implementation. Participants provided recommendations as potential strategies to enhance the uptake. There are presently substantial barriers to the widespread use of reduced-sodium salt but there are also clear opportunities to take actions that would increase uptake.
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Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- The George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China;
- School of Public Health, Harbin Medical University, Harbin 150081, China
- Correspondence: ; Tel.: +86-(0)451-8750-2881
| | - Lingli Sun
- The George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China;
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Mark D. Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - J. Jaime Miranda
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Public Health and Caring Sciences, Uppsala University, 75236 Uppsala, Sweden
| | - Jason H. Y. Wu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Laura K. Cobb
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY 10005, USA;
| | - Hongling Chu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100083, China;
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW 2050, Australia
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Trieu K, Bhat S, Dai Z, Leander K, Gigante B, Qian F, Korat AVA, Sun Q, Pan XF, Laguzzi F, Cederholm T, de Faire U, Hellénius ML, Wu JHY, Risérus U, Marklund M. Biomarkers of dairy fat intake, incident cardiovascular disease, and all-cause mortality: A cohort study, systematic review, and meta-analysis. PLoS Med 2021; 18:e1003763. [PMID: 34547017 PMCID: PMC8454979 DOI: 10.1371/journal.pmed.1003763] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We aimed to investigate the association of serum pentadecanoic acid (15:0), a biomarker of dairy fat intake, with incident cardiovascular disease (CVD) and all-cause mortality in a Swedish cohort study. We also systematically reviewed studies of the association of dairy fat biomarkers (circulating or adipose tissue levels of 15:0, heptadecanoic acid [17:0], and trans-palmitoleic acid [t16:1n-7]) with CVD outcomes or all-cause mortality. METHODS AND FINDINGS We measured 15:0 in serum cholesterol esters at baseline in 4,150 Swedish adults (51% female, median age 60.5 years). During a median follow-up of 16.6 years, 578 incident CVD events and 676 deaths were identified using Swedish registers. In multivariable-adjusted models, higher 15:0 was associated with lower incident CVD risk in a linear dose-response manner (hazard ratio 0.75 per interquintile range; 95% confidence interval 0.61, 0.93, P = 0.009) and nonlinearly with all-cause mortality (P for nonlinearity = 0.03), with a nadir of mortality risk around median 15:0. In meta-analyses including our Swedish cohort and 17 cohort, case-cohort, or nested case-control studies, higher 15:0 and 17:0 but not t16:1n-7 were inversely associated with total CVD, with the relative risk of highest versus lowest tertile being 0.88 (0.78, 0.99), 0.86 (0.79, 0.93), and 1.01 (0.91, 1.12), respectively. Dairy fat biomarkers were not associated with all-cause mortality in meta-analyses, although there were ≤3 studies for each biomarker. Study limitations include the inability of the biomarkers to distinguish different types of dairy foods and that most studies in the meta-analyses (including our novel cohort study) only assessed biomarkers at baseline, which may increase the risk of misclassification of exposure levels. CONCLUSIONS In a meta-analysis of 18 observational studies including our new cohort study, higher levels of 15:0 and 17:0 were associated with lower CVD risk. Our findings support the need for clinical and experimental studies to elucidate the causality of these relationships and relevant biological mechanisms.
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Affiliation(s)
- Kathy Trieu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Saiuj Bhat
- School of Medicine, The University of Western Australia, Crawley, Australia
| | - Zhaoli Dai
- Centre for Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Sydney Pharmacy School and the Charles Perkins Centre, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia
| | - Karin Leander
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Frank Qian
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Andres V. Ardisson Korat
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Xiong-Fei Pan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Federica Laguzzi
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ulf de Faire
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mai-Lis Hellénius
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jason H. Y. Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Matti Marklund
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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Peñalvo JL, Sagastume D, Mertens E, Uzhova I, Smith J, Wu JHY, Bishop E, Onopa J, Shi P, Micha R, Mozaffarian D. Effectiveness of workplace wellness programmes for dietary habits, overweight, and cardiometabolic health: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e648-e660. [PMID: 34454642 PMCID: PMC8627548 DOI: 10.1016/s2468-2667(21)00140-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 12/17/2022]
Abstract
Background The workplace offers a unique opportunity for effective health
promotion. We aimed to comprehensively study the effectiveness of
multicomponent worksite wellness programmes for improving diet and
cardiometabolic risk factors. Methods We did a systematic literature review and meta-analysis, following
PRISMA guidelines. We searched PubMed-MEDLINE, Embase, the Cochrane Library,
Web of Science, and Education Resources Information Center, from Jan 1,
1990, to June 30, 2020, for studies with controlled evaluation designs that
assessed multicomponent workplace wellness programmes. Investigators
independently appraised the evidence and extracted the data. Outcomes were
dietary factors, anthropometric measures, and cardiometabolic risk factors.
Pooled effects were calculated by inverse-variance random-effects
meta-analysis. Potential sources of heterogeneity and study biases were
evaluated. Findings From 10 169 abstracts reviewed, 121 studies (82 [68%] randomised
controlled trials and 39 [32%] quasi-experimental interventions) met the
eligibility criteria. Most studies were done in North America (57 [47%]),
and Europe, Australia, or New Zealand (36 [30%]). The median number of
participants was 413·0 (IQR 124·0–904·0), and
median duration of intervention was 9·0 months
(4·5–18·0). Workplace wellness programmes improved
fruit and vegetable consumption (0·27 servings per day [95% CI
0·16 to 0·37]), fruit consumption (0·20 servings per
day [0·11 to 0·28]), body-mass index (−0·22
kg/m2 [−0·28 to −0·17]), waist
circumference (−1·47 cm [−1·96 to
−0·98]), systolic blood pressure (−2·03 mm Hg
[−3·16 to −0·89]), and LDL cholesterol
(−5·18 mg/dL [−7·83 to −2·53]),
and to a lesser extent improved total fat intake (−1·18% of
daily energy intake [−1·78 to −0·58]), saturated
fat intake (−0·70% of daily energy [−1·22 to
−0·18]), bodyweight (−0·92 kg
[−1·11 to −0·72]), diastolic blood pressure
(−1·11 mm Hg [−1·78 to −0·44]),
fasting blood glucose (−1·81 mg/dL [−3·33 to
−0·28]), HDL cholesterol (1·11 mg/dL [0·48 to
1·74]), and triglycerides (−5·38 mg/dL
[−9·18 to −1·59]). No significant benefits were
observed for intake of vegetables (0·03 servings per day [95% CI
−0·04 to 0·10]), fibre (0·26 g per day
[−0·15 to 0·67]), polyunsaturated fat
(−0·23% of daily energy [−0·59 to 0·13]),
or for body fat (−0·80% [−1·80 to 0·21]),
waist-to-hip ratio (−0·00 ratio [−0·01 to
0·00]), or lean mass (1·01 kg [−0·82 to
2·83]). Heterogeneity values ranged from 46·9% to
91·5%. Between-study differences in outcomes were not significantly
explained by study design, location, population, or similar factors in
heterogeneity analyses. Interpretation Workplace wellness programmes are associated with improvements in
specific dietary, anthropometric, and cardiometabolic risk indicators. The
heterogeneity identified in study designs and results should be considered
when using these programmes as strategies to improve cardiometabolic
health.
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Affiliation(s)
- José L Peñalvo
- Non-Communicable Diseases Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Diana Sagastume
- Non-Communicable Diseases Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Elly Mertens
- Non-Communicable Diseases Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irina Uzhova
- Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Jessica Smith
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; Bell Institute of Health and Nutrition, General Mills, Minneapolis, MN, USA
| | - Jason H Y Wu
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Eve Bishop
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jennifer Onopa
- 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
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; Department of Food Science and Human Nutrition, University of Thessaly, Thessaly, Greece
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Coyle DH, Shahid M, Dunford EK, Ni Mhurchu C, Scapin T, Trieu K, Marklund M, Chun Yu Louie J, Neal B, Wu JHY. The Contribution of Major Food Categories and Companies to Household Purchases of Added Sugar in Australia. J Acad Nutr Diet 2021; 122:345-353.e3. [PMID: 34446399 DOI: 10.1016/j.jand.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/13/2021] [Accepted: 06/12/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Australian Government will soon be releasing a series of sugar reformulation targets for packaged foods. OBJECTIVE To estimate the amount of added sugar purchased from packaged food and beverages and the relative contribution that food categories and food companies made to these purchases in 2018. The secondary objective was to examine differences in purchases of added sugar across income levels. DESIGN Cross-sectional study. PARTICIPANTS/SETTING We used 1 year of grocery purchase data from a nationally representative panel of Australian households (the NielsenIQ Homescan panel), combined with a packaged food and beverage database (FoodSwitch). MAIN OUTCOME MEASURES Added sugar purchases (grams per day per capita), purchase-weighted added sugar content (grams per 100 g) and total weight of products (with added sugar) purchased (grams per day per capita). STATISTICAL ANALYSES PERFORMED Food categories and food companies were ranked according to their contribution to added sugar purchases. Differences in added sugar purchases by income levels were assessed by 1-factor analysis of variance. RESULTS Added sugar information was available from 7188 households and across 26,291 unique foods and beverages. On average, the amount of added sugar acquired from packaged foods and beverages was (mean ± SE) 35.9 ± 0.01 g/d per capita. Low-income households purchased 11.0 g/d (95% CI: 10.9-11.0 g/d, P < .001) more added sugar from packaged products than high-income households per capita. The top 10 food categories accounted for 82.2% of added sugar purchased, largely due to purchases of chocolate and sweets, soft drinks, and ice cream and edible ices. Out of 994 food companies, the top 10 companies contributed to 62.1% of added sugar purchases. CONCLUSIONS The Australian Government can strengthen their proposed sugar reduction program by adding further category-specific targets, prioritizing engagement with key food companies and considering a broader range of policies to reduce added sugar intakes across the Australian population.
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Yin X, Liu H, Webster J, Trieu K, Huffman MD, Miranda JJ, Marklund M, Wu JHY, Cobb LK, Li KC, Pearson SA, Neal B, Tian M. Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan. JMIR Public Health Surveill 2021; 7:e27423. [PMID: 33985938 PMCID: PMC8319774 DOI: 10.2196/27423] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 01/25/2021] [Revised: 04/19/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background Regular salt is about 100% sodium chloride. Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride. Low-sodium salts have a potential role in reducing the population's sodium intake levels and blood pressure, but their availability in the global market is unknown. Objective The aim of this study is to assess the availability, formulation, labeling, and price of low-sodium salts currently available to consumers worldwide. Methods Low-sodium salts were identified through a systematic literature review, Google search, online shopping site searches, and inquiry of key informants. The keywords “salt substitute,” “low-sodium salt,” “potassium salt,” “mineral salt,” and “sodium reduced salt” in six official languages of the United Nations were used for the search. Information about the brand, formula, labeling, and price was extracted and analyzed. Results A total of 87 low-sodium salts were available in 47 out of 195 (24%) countries worldwide, including 28 high-income countries, 13 upper-middle-income countries, and 6 lower-middle-income countries. The proportion of sodium chloride varied from 0% (sodium-free) to 88% (as percent of weight; regular salt is 100% sodium chloride). Potassium chloride was the most frequent component with levels ranging from 0% to 100% (potassium chloride salt). A total of 43 (49%) low-sodium salts had labels with the potential health risks, and 33 (38%) had labels with the potential health benefits. The median price of low-sodium salts in high-income, upper-middle-income, and lower-middle-income countries was US $15.00/kg (IQR 6.4-22.5), US $2.70/kg (IQR 1.7-5.5), and US $2.90/kg (IQR 0.50-22.2), respectively. The price of low-sodium salts was between 1.1 and 14.6 times that of regular salts. Conclusions Low-sodium salts are not widely available and are commonly more expensive than regular salts. Policies that promote the availability, affordability, and labeling of low-sodium salts should increase uptake, helping populations reduce blood pressure and prevent cardiovascular diseases. International Registered Report Identifier (IRRID) RR2-10.1111/jch.14054
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Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - J Jaime Miranda
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - 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, Baltimore, MD, United States.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Laura K Cobb
- Resolve to Save Lives, Initiative of Vital Strategies, New York City, NY, United States
| | - Ka Chun Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,School of Public Health, Imperial College London, London, United Kingdom
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China
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36
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Zheng M, Hesketh KD, Wu JHY, Heitmann BL, Downing K, Campbell KJ. Nighttime sleep duration trajectories were associated with body mass index trajectories in early childhood. Pediatr Obes 2021; 16:e12766. [PMID: 33369282 DOI: 10.1111/ijpo.12766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The respective contribution of total, daytime and nighttime sleep duration in childhood obesity remains unclear. OBJECTIVES To assess the longitudinal association between developmental trajectories of sleep duration and BMI z-score in early childhood. METHODS Data were from the Melbourne INFANT program, a prospective cohort with 4-month-old infants being followed-up until age 60 months (n = 528). Sleep duration (total, daytime, nighttime) and BMI z-score were measured using questionnaire at ages 4, 9, 18, 43 and 60 months. Group-based trajectory modelling was used to describe longitudinal trajectories from ages 4 to 60 months. Multivariable logistic regression was conducted to assess the association between sleep duration and BMI z-score trajectories. RESULTS Three nighttime sleep duration trajectory groups were identified: "Long stable" (10.5 to 11.0 hours, 61%), "catchup long" (8.0 to 11.5 hours, 23%) and "short stable" (8.7 to 9.8 hours, 16%) nighttime sleepers. BMI z-score trajectory groups were classified as "low-BMIz" (-1.5 to -0.5 unit, 21%), "mid-BMIz" (-0.5 to 0.5 unit, 58%) and "high-BMIz" (0.8 to 1.4 unit, 21%). With adjustment for child and maternal covariates, both "catchup long" (OR 3.69 95%CI 1.74, 7.92) and "long stable" nighttime sleepers (OR 4.27 95%CI 2.21, 8.25) revealed higher odds of being in the "mid-BMIz" than the "high-BMIz" group. By contrast, total or daytime sleep duration trajectories were not associated with BMI z-score trajectories. CONCLUSIONS Longer nighttime, but not total or daytime, sleep duration was associated with lower BMI z-score trajectories in early childhood. Our findings reinforce the importance of nighttime sleep for healthy body-weight development in early childhood.
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Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jason H Y Wu
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Berit L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
| | - Katherine Downing
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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37
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Yu J, Thout SR, Li Q, Tian M, Marklund M, Arnott C, Huffman MD, Praveen D, Johnson C, Huang L, Pettigrew S, Neal B, Wu JHY. Effects of a reduced-sodium added-potassium salt substitute on blood pressure in rural Indian hypertensive patients: a randomized, double-blind, controlled trial. Am J Clin Nutr 2021; 114:185-193. [PMID: 33782684 DOI: 10.1093/ajcn/nqab054] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High salt intake is a major modifiable risk factor of hypertension which is prevalent in India. It is not yet clear if salt substitutes reduce blood pressure (BP) among Indian hypertensive patients. OBJECTIVES Examine the acceptability, usage, and BP effects of a reduced-sodium and added-potassium salt substitute among hypertensive patients. METHODS We enrolled 502 participants with hypertension (aged 61.6 ± 12.0 y, 58.8% women) from 7 villages in rural India. Participants were randomly assigned to receive either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride blend), and advised to replace all home salt use. The primary outcome was the change in systolic BP (SBP) from baseline to 3 mo comparing the salt substitute and regular salt groups. Secondary outcomes included the change in diastolic BP (DBP), 24-h urinary biomarkers, and self-reported use and satisfaction with the study salt provided. RESULTS A total of 494 (98%) participants completed 1 mo and 476 (95%) participants completed the 3-mo follow-up. At 3 mo, the salt substitute intervention significantly decreased the average SBP by 4.6 mmHg (95% CI: 3.0, 6.2, P < 0.001) and DBP by 1.1 mmHg (95% CI: 0.2, 2.1 mmHg, P = 0.02). There was a significant increase in 24-h urinary potassium excretion in the salt substitute group by 0.24 g/d (95% CI: 0.12, 0.35 g/d, P < 0.001) and a decrease in the urinary sodium to potassium ratio by 0.71 (95% CI: 0.55, 0.87, P < 0.0001) compared with the control group. Participants reported that they used the study salt nearly every day of the week (mean ± SD, 6.3 ± 1.8 d) and rated the taste of the study salts similarly. CONCLUSION The reduced-sodium added-potassium salt led to a substantial reduction in SBP in hypertensive patients, supporting salt substitution as an effective, low-cost intervention for BP lowering in rural India. This trial was registered at clinicaltrials.gov as NCT03909659.
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Affiliation(s)
- Jie Yu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Sudhir Raj Thout
- The George Institute for Global Health India, Punjagutta, Hyderabad, India
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Devarsetty Praveen
- The George Institute for Global Health India, Punjagutta, Hyderabad, India
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Imperial College London, London, United Kingdom
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Pan XF, Huang Y, Li X, Wang Y, Ye Y, Chen H, Marklund M, Wen Y, Liu Y, Zeng H, Qi X, Yang X, Yang CX, Liu G, Gibson RA, Xu S, Yu D, Chen D, Li Y, Mei Z, Pan A, Wu JHY. Circulating fatty acids and risk of gestational diabetes mellitus: prospective analyses in China. Eur J Endocrinol 2021; 185:87-97. [PMID: 33914701 DOI: 10.1530/eje-21-0118] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to examine prospective associations between circulating fatty acids in early pregnancy and incident gestational diabetes mellitus (GDM) among Chinese pregnant women. METHODS Analyses were based on two prospective nested case-control studies conducted in western China (336 GDM cases and 672 matched controls) and central China (305 cases and 305 matched controls). Fasting plasma fatty acids in early pregnancy (gestational age at enrollment: 10.4 weeks(s.d., 2.0)) and 13.2 weeks (1.0), respectively) were determined by gas chromatography-mass spectrometry, and GDM was diagnosed based on the International Association of Diabetes in Pregnancy Study Groups criteria during 24-28 weeks of gestation. Multiple metabolic biomarkers (HOMA-IR (homeostatic model assessment for insulin resistance), HbA1c, c-peptide, high-sensitivity C-reactive protein, adiponectin, leptin, and blood lipids) were additionally measured among 672 non-GDM controls at enrollment. RESULTS Higher levels of saturated fatty acids (SFAs) 14:0 (pooled odds ratio, 1.41 for each 1-s.d. increase; 95% CI: 1.25, 1.59) and 16:0 (1.19; 1.05, 1.35) were associated with higher odds of GDM. Higher levels of n-6 polyunsaturated fatty acid (PUFA) 18:2n-6 were strongly associated with lower odds of GDM (0.69; 0.60, 0.80). In non-GDM pregnant women, higher SFAs 14:0 and 16:0 but lower n-6 PUFA 18:2n-6 were generally correlated with unfavorable metabolic profiles. CONCLUSIONS We documented adverse associations of 14:0 and 16:0 but a protective association of 18:2n-6 with GDM among Chinese pregnant women. Our findings highlight the distinct roles of specific fatty acids in the onset of GDM.
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Affiliation(s)
- Xiong-Fei Pan
- Department of Epidemiology & Biostatistics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Ministry of Education & Ministry of Environmental Protection Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yichao Huang
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - Xinping Li
- Ministry of Education & Ministry of Environmental Protection Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yi Wang
- Department of Epidemiology & Biostatistics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Ministry of Education & Ministry of Environmental Protection Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Ye
- Department of Epidemiology & Biostatistics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Ministry of Education & Ministry of Environmental Protection Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huan Chen
- China Academy of Chinese Medical Sciences, Guang'anmen Hospital, Xicheng District, Beijing, China
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ying Wen
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Yan Liu
- Department of Obstetrics and Gynecology, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Huayan Zeng
- Department of Nutrition, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, West China Second Hospital, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Xue Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chun-Xia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ge Liu
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert A Gibson
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Shunqing Xu
- Ministry of Education & Ministry of Environmental Protection Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Da Chen
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - Yuanyuan Li
- Ministry of Education & Ministry of Environmental Protection Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhixiong Mei
- Obstetrics Department, The Third Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - An Pan
- Department of Epidemiology & Biostatistics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Ministry of Education & Ministry of Environmental Protection Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Qian F, Ardisson Korat AV, Imamura F, Marklund M, Tintle N, Virtanen JK, Zhou X, Bassett JK, Lai H, Hirakawa Y, Chien KL, Wood AC, Lankinen M, Murphy RA, Samieri C, Pertiwi K, de Mello VD, Guan W, Forouhi NG, Wareham N, Hu ICFB, Riserus U, Lind L, Harris WS, Shadyab AH, Robinson JG, Steffen LM, Hodge A, Giles GG, Ninomiya T, Uusitupa M, Tuomilehto J, Lindström J, Laakso M, Siscovick DS, Helmer C, Geleijnse JM, Wu JHY, Fretts A, Lemaitre RN, Micha R, Mozaffarian D, Sun Q. n-3 Fatty Acid Biomarkers and Incident Type 2 Diabetes: An Individual Participant-Level Pooling Project of 20 Prospective Cohort Studies. Diabetes Care 2021; 44:1133-1142. [PMID: 33658295 PMCID: PMC8132316 DOI: 10.2337/dc20-2426] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Prospective associations between n-3 fatty acid biomarkers and type 2 diabetes (T2D) risk are not consistent in individual studies. We aimed to summarize the prospective associations of biomarkers of α-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with T2D risk through an individual participant-level pooled analysis. RESEARCH DESIGN AND METHODS For our analysis we incorporated data from a global consortium of 20 prospective studies from 14 countries. We included 65,147 participants who had blood measurements of ALA, EPA, DPA, or DHA and were free of diabetes at baseline. De novo harmonized analyses were performed in each cohort following a prespecified protocol, and cohort-specific associations were pooled using inverse variance-weighted meta-analysis. RESULTS A total of 16,693 incident T2D cases were identified during follow-up (median follow-up ranging from 2.5 to 21.2 years). In pooled multivariable analysis, per interquintile range (difference between the 90th and 10th percentiles for each fatty acid), EPA, DPA, DHA, and their sum were associated with lower T2D incidence, with hazard ratios (HRs) and 95% CIs of 0.92 (0.87, 0.96), 0.79 (0.73, 0.85), 0.82 (0.76, 0.89), and 0.81 (0.75, 0.88), respectively (all P < 0.001). ALA was not associated with T2D (HR 0.97 [95% CI 0.92, 1.02]) per interquintile range. Associations were robust across prespecified subgroups as well as in sensitivity analyses. CONCLUSIONS Higher circulating biomarkers of seafood-derived n-3 fatty acids, including EPA, DPA, DHA, and their sum, were associated with lower risk of T2D in a global consortium of prospective studies. The biomarker of plant-derived ALA was not significantly associated with T2D risk.
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Affiliation(s)
- Frank Qian
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andres V Ardisson Korat
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, U.K
| | - Matti Marklund
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nathan Tintle
- Department of Mathematics and Statistics, Dordt University, Sioux Center, IA.,Fatty Acid Research Institute, Sioux Falls, SD
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Xia Zhou
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - Heidi Lai
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.,Imperial College London, London, U.K
| | - Yoichiro Hirakawa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Alexis C Wood
- Children's Nutrition Research Center, U.S. Department of Agriculture/Agricultural Research Service, Houston, TX
| | - Maria Lankinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Rachel A Murphy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Cecilia Samieri
- INSERM, UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Kamalita Pertiwi
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Vanessa D de Mello
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Weihua Guan
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, U.K
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, U.K
| | - InterAct Consortium Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Ulf Riserus
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - William S Harris
- Fatty Acid Research Institute, Sioux Falls, SD.,Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA
| | | | - Lyn M Steffen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Allison Hodge
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Graham G Giles
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jaana Lindström
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markku Laakso
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Catherine Helmer
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Johanna M Geleijnse
- INSERM, UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Amanda Fretts
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.,Division of Cardiology, Tufts Medical Center, Boston, MA
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40
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Ndanuko R, Maganja D, Kibet A, Coyle DH, Kimiywe J, Raubenheimer D, Marklund M, Wu JHY. Sodium Content and Labelling Completeness of Packaged Foods and Beverages in Kenya. Nutrients 2021; 13:1385. [PMID: 33924065 PMCID: PMC8074286 DOI: 10.3390/nu13041385] [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: 03/31/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 11/19/2022] Open
Abstract
Increased consumption of unhealthy processed foods, particularly those high in sodium, is a major risk factor for cardiovascular diseases. Nutrition information on packaged foods can help guide consumers toward products with less sodium, however the availability of nutrition information on foods sold in Kenya is currently unknown. The aims of this study were to estimate the proportion of packaged foods and beverages displaying nutrition information for sodium and determine the amount of sodium in packaged foods available for sale in Kenya. Data was collected in 2019 from five retail supermarkets in Nairobi. The availability of sodium information provided on packaged products and the sodium content were recorded. As secondary analyses, we compared sodium content labelling of products in Kenya by manufacturing location and the sodium content of products available in Kenya and South Africa. A total of 6003 packaged products in 56 food categories were identified. Overall, 39% of products displayed sodium content, though the availability of labelling varied widely between food categories, with coverage in main categories ranging from 0% (yoghurts and yoghurt drinks) to 86% (breakfast cereals). Food categories with the highest median sodium content were herbs and spices (9120 mg/100 g), sauces (1200 mg/100 g) and meat alternatives (766 mg/100 g) although wide variabilities were often observed within categories. Imported products were more likely to provide information on sodium than locally produced products (81% compared to 26%) and reported higher median sodium levels (172 mg/100 g compared to 96 mg/100 g). Kenyan products reported a higher median sodium content than South African products in six categories while South African products had higher median sodium in 20 categories, with considerable variation in median sodium content between countries in some categories. These findings highlight considerable potential to improve the availability of sodium information on packaged products in Kenya and to introduce reformulation policies to reduce the amount of sodium in the Kenyan food supply.
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Affiliation(s)
- Rhoda Ndanuko
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia; (D.H.C.); (M.M.); (J.H.Y.W.)
| | - Damian Maganja
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia; (D.H.C.); (M.M.); (J.H.Y.W.)
| | - Alex Kibet
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi 00100, Kenya; (A.K.); (J.K.)
| | - Daisy H. Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia; (D.H.C.); (M.M.); (J.H.Y.W.)
| | - Judith Kimiywe
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi 00100, Kenya; (A.K.); (J.K.)
| | - David Raubenheimer
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia; (D.H.C.); (M.M.); (J.H.Y.W.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Public Health and Caring Sciences, Uppsala University, 751 22 Uppsala, Sweden
| | - Jason H. Y. Wu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia; (D.H.C.); (M.M.); (J.H.Y.W.)
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41
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Affiliation(s)
- Alexandra Jones
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Kent Buse
- The George Institute for Global Health, Imperial College, London, UK
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42
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Liu Y, Li N, Yan N, Pan XF, Li Q, Micha R, Mozaffarian D, Huffman MD, Wang Y, Neal B, Tian M, Zhao Y, Wu JHY. Protocol for a randomized controlled trial to test the acceptability and adherence to 6-months of walnut supplementation in Chinese adults at high risk of cardiovascular disease. Nutr J 2021; 20:3. [PMID: 33407490 PMCID: PMC7789667 DOI: 10.1186/s12937-020-00660-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/11/2020] [Accepted: 12/15/2020] [Indexed: 12/30/2022] Open
Abstract
Background Consumption of nuts improves cardio-metabolic risk factors in clinical trials and relates to lower risk of cardiovascular disease (CVD) in prospective observational studies. However, there has not been an adequately powered randomized controlled trial to test if nuts supplementation actually reduces incident CVD. In order to establish the feasibility of such a trial, the current study aimed to assess the acceptability and adherence to long-term nut supplementation amongst individuals at high CVD risk in China. Methods This protocol described a 6-month trial performed in Ningxia Province in China among participants with a history of CVD or older age (female ≥65 years, male ≥60 years) with multiple CVD risk factors. Participants were randomized to control (received non-edible gift), low dose walnut (30 g/d), or high dose walnut (60 g/d) groups in a 1:1:1 ratio. Walnuts were provided at no cost to participants and could be consumed according to personal preferences. Follow-up visits were scheduled at 2 weeks, 3 months and 6 months. The primary outcome was fasting plasma alpha linolenic acid (ALA) levels used as an indicator of walnut consumption. Secondary outcomes included self-reported walnut intake from the 24 h dietary recalls. The target sample size of 210 provided 90% statistical power with two-sided alpha of 0.05 to detect a mean difference of 0.12% (as percent of total fatty acid) in plasma ALA between randomized groups. Results Two hundred and ten participants were recruited and randomized during October 2019. Mean age of participants was 65 years (SD = 7.3), 47% were females, and 94% had a history of CVD at baseline. Across the three study groups, participants had similar baseline demographic and clinical characteristics. Discussion This trial will quantify acceptability and adherence to long-term walnut supplementation in a Chinese population at high risk of CVD. The findings will support the design of a future large trial to test the effect of walnut supplementation for CVD prevention. Trial registration NCT04037943 Protocol version: v3.0 August 14 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s12937-020-00660-7.
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Affiliation(s)
- Yishu Liu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Nan Li
- Ningxia Medical University, Yinchuan, China
| | - Ni Yan
- Ningxia Medical University, Yinchuan, China
| | - Xiong-Fei Pan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Qiang Li
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - 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
| | - Mark D Huffman
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yanfang Wang
- Peking University Clinical Research Institute, Beijing, China
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,School of Public Health, Imperial College London, London, UK.,Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Yi Zhao
- Ningxia Medical University, Yinchuan, China.
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
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43
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Coyle DH, Shahid M, Dunford EK, Mhurchu CN, Mckee S, Santos M, Popkin BM, Trieu K, Marklund M, Taylor F, Neal B, Wu JHY. Correction to: Contribution of major food companies and their products to household dietary sodium purchases in Australia. Int J Behav Nutr Phys Act 2020; 17:159. [PMID: 33276790 PMCID: PMC7716491 DOI: 10.1186/s12966-020-01064-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daisy H Coyle
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.
| | - Maria Shahid
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Elizabeth K Dunford
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.,Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.,National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | | | | | - Barry M Popkin
- Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kathy Trieu
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Matti Marklund
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Fraser Taylor
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
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Marklund M, Zheng M, Veerman JL, Wu JHY. Estimated health benefits, costs, and cost-effectiveness of eliminating industrial trans-fatty acids in Australia: A modelling study. PLoS Med 2020; 17:e1003407. [PMID: 33137090 PMCID: PMC7605626 DOI: 10.1371/journal.pmed.1003407] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 09/29/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND trans-fatty acids (TFAs) are a well-known risk factor of ischemic heart disease (IHD). In Australia, the highest TFA intake is concentrated to the most socioeconomically disadvantaged groups. Elimination of industrial TFA (iTFA) from the Australian food supply could result in reduced IHD mortality and morbidity while improving health equity. However, such legislation could lead to additional costs for both government and food industry. Thus, we assessed the potential cost-effectiveness, health gains, and effects on health equality of an iTFA ban from the Australian food supply. METHODS AND FINDINGS Markov cohort models were used to estimate the impact on IHD burden and health equity, as well as the cost-effectiveness of a national ban of iTFA in Australia. Intake of TFA was assessed using the 2011-2012 Australian National Nutrition and Physical Activity Survey. The IHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting where consumption was lowered to a theoretical minimum distribution with a mean of 0.5% energy per day (corresponding to TFA intake only from nonindustrial sources, e.g., dairy foods). Policy costs, avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and changes in IHD-related healthcare costs saved were estimated over 10 years and lifetime of the adult Australian population. Cost-effectiveness was assessed by calculation of incremental cost-effectiveness ratios (ICERs) using net policy cost and HALYs gained. Health benefits and healthcare cost changes were also assessed in subgroups based on socioeconomic status, defined by Socio-Economic Indexes for Areas (SEIFA) quintile, and remoteness. Compared to a base case of no ban and current TFA intakes, elimination of iTFA was estimated to prevent 2,294 (95% uncertainty interval [UI]: 1,765; 2,851) IHD deaths and 9,931 (95% UI: 8,429; 11,532) IHD events over the first 10 years. The greatest health benefits were accrued to the most socioeconomically disadvantaged quintiles and among Australians living outside of major cities. The intervention was estimated to be cost saving (net cost <0 AUD) or cost-effective (i.e., ICER < AUD 169,361/HALY) regardless of the time horizon, with ICERs of 1,073 (95% UI: dominant; 3,503) and 1,956 (95% UI: 1,010; 2,750) AUD/HALY over 10 years and lifetime, respectively. Findings were robust across several sensitivity analyses. Key limitations of the study include the lack of recent data of TFA intake and the small sample sizes used to estimate intakes in subgroups. As with all simulation models, our study does not prove that a ban of iTFA will prevent IHD, rather, it provides the best quantitative estimates and corresponding uncertainty of a potential effect in the absence of stronger direct evidence. CONCLUSIONS Our model estimates that a ban of iTFAs could avert substantial numbers of IHD events and deaths in Australia and would likely be a highly cost-effective strategy to reduce social-economic and urban-rural inequalities in health. These findings suggest that elimination of iTFA can cost-effectively improve health and health equality even in countries with low iTFA intake.
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Affiliation(s)
- Matti Marklund
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | | | - Jason H. Y. Wu
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
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Pan XF, Magliano DJ, Zheng M, Shahid M, Taylor F, Julia C, Ni Mhurchu C, Pan A, Shaw JE, Neal B, Wu JHY. Seventeen-Year Associations between Diet Quality Defined by the Health Star Rating and Mortality in Australians: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Curr Dev Nutr 2020; 4:nzaa157. [PMID: 33204933 PMCID: PMC7649117 DOI: 10.1093/cdn/nzaa157] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Health Star Rating (HSR) is the government-endorsed front-of-pack labeling system in Australia and New Zealand. OBJECTIVES We aimed to examine prospective associations of a dietary index (DI) based on the HSR, as an indicator of overall diet quality, with all-cause and cardiovascular disease (CVD) mortality. METHODS We utilized data from the national population-based Australian Diabetes, Obesity and Lifestyle Study. The HSR-DI at baseline (1999-2000) was constructed by 1) calculation of the HSR points for individual foods in the baseline FFQ, and 2) calculation of the HSR-DI for each participant based on pooled HSR points across foods, weighted by the proportion of energy contributed by each food. Vital status was ascertained by linkage to the Australian National Death Index. Associations of HSR-DI with mortality risk were assessed by Cox proportional hazards regression. RESULTS Among 10,025 eligible participants [baseline age: 51.6 ± 14.3 y (mean ± standard deviation)] at entry, higher HSR-DI (healthier) was associated with higher consumption of healthy foods such as fruits, vegetables, and nuts, and lower consumption of discretionary foods such as processed meats and confectionery (P-trend < 0.001 for each). During a median follow-up of 16.9 y, 1682 deaths occurred with 507 CVD deaths. In multivariable models adjusted for demographic characteristics, lifestyle factors, and medical conditions, higher HSR-DI was associated with lower risk of all-cause mortality, with a hazard ratio (95% confidence interval) of 0.80 (0.69, 0.94; P-trend < 0.001) comparing the fifth with the first HSR-DI quintile. A corresponding inverse association was observed for CVD mortality (0.71; 0.54, 0.94; P-trend = 0.008). CONCLUSIONS Better diet quality as defined by the HSR-DI was associated with lower risk of all-cause and CVD mortality among Australian adults. Our findings support the use of the HSR nutrient profiling algorithm as a valid tool for guiding consumer food choices.
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Affiliation(s)
- Xiong-Fei Pan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dianna J Magliano
- Diabetes and Population Health Unit, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Maria Shahid
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Fraser Taylor
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Chantal Julia
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre – University of Paris (CRESS), Bobigny, France
- Department of Public Health, Avicenne Hospital (AP-HP), Bobigny, France
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jonathan E Shaw
- Diabetes and Population Health Unit, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Wu J, Zheng H, Liu X, Chen P, Zhang Y, Luo J, Kuang J, Li J, Yang Y, Ma T, Yang Y, Huang X, Liang G, Liang D, Hu Y, Wu JHY, Arnott C, Mai W, Huang Y. Prognostic Value of Secreted Frizzled-Related Protein 5 in Heart Failure Patients With and Without Type 2 Diabetes Mellitus. Circ Heart Fail 2020; 13:e007054. [PMID: 32842761 DOI: 10.1161/circheartfailure.120.007054] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with heart failure (HF) with diabetes mellitus have distinct biomarker profiles compared with those without diabetes mellitus. SFRP5 (secreted frizzled-related protein 5) is an anti-inflammatory adipokine with an important suppressing role on the development of type 2 diabetes mellitus (T2DM). This study aimed to evaluate the prognostic value of SFRP5 in patients with HF with and without T2DM. METHODS The study included 833 consecutive patients with HF, 312 (37.5%) of whom had T2DM. Blood samples were collected at presentation, and SFRP5 levels were measured. The primary outcome was the composite end points of first occurrence of HF rehospitalization or all-cause mortality during follow-up. RESULTS During median follow-up of 2.1 years, 335 (40.2%) patients in the cohort experienced the composite primary outcome. After adjustment for multiple risk factors, each doubling of SFRP5 level was associated with a 21% decreased risk of primary outcomes in the overall study population (P<0.001). Subgroup analyses showed that the association between level of SFPR5 and primary outcomes may be stronger in patients with T2DM (hazard ratio, 0.69 [95% CI, 0.61-0.79]) than in patients without T2DM (hazard ratio, 0.89 [95% CI, 0.79-1.01]; interaction P=0.006). Similar associations were observed when taking SFRP5 as a categorical variable. Addition of SFRP5 significantly improved discrimination and reclassification of the incident primary outcomes beyond clinical risk factors and N-terminal pro-B-type natriuretic peptide in all patients with HF and those with T2DM (all P<0.01). CONCLUSIONS SFRP5 is an independent novel biomarker for risk stratification in HF, especially in HF with T2DM.
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Affiliation(s)
- Jiandi Wu
- Department of Cardiology, Affiliated Foshan Hospital (J.W., D.L.), Southern Medical University, Foshan, China
| | - Haoxiao Zheng
- Department of Cardiology, Shunde Hospital (H.Z., X.L., J. Luo, X.H., Y. Hu, Y. Huang), Southern Medical University, Foshan, China
| | - Xinyue Liu
- Department of Cardiology, Shunde Hospital (H.Z., X.L., J. Luo, X.H., Y. Hu, Y. Huang), Southern Medical University, Foshan, China
| | - Peisong Chen
- Department of Laboratory medicine (P.C.), the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunlong Zhang
- Key Laboratory of Neuroscience, School of Basic Medical Sciences, Guangzhou Medical University, China (Y.Z.)
| | - Jianjin Luo
- Department of Cardiology, Shunde Hospital (H.Z., X.L., J. Luo, X.H., Y. Hu, Y. Huang), Southern Medical University, Foshan, China.,Department of Cardiology, the Second Hospital of Zhaoqing, Guangdong, China (J. Luo, G.L.)
| | - Jian Kuang
- Department of Cardiology (J.K., W.M.), the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), China (J.K., W.M.)
| | - Jingwei Li
- Department of Cardiology, People's Liberation Army General Hospital, Beijing, China (J. Li)
| | - Yu Yang
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (Yu Yang)
| | - Tianyi Ma
- Department of Cardiology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Changsha, China (T.M.)
| | - Yanhua Yang
- Department of Cardiology, Dongguan people's Hospital (Yanhua Yang), Southern Medical University, Foshan, China
| | - Xiaohui Huang
- Department of Cardiology, Shunde Hospital (H.Z., X.L., J. Luo, X.H., Y. Hu, Y. Huang), Southern Medical University, Foshan, China
| | - Guoquan Liang
- Department of Cardiology, the Second Hospital of Zhaoqing, Guangdong, China (J. Luo, G.L.)
| | - Donglian Liang
- Department of Cardiology, Affiliated Foshan Hospital (J.W., D.L.), Southern Medical University, Foshan, China
| | - Yunzhao Hu
- Department of Cardiology, Shunde Hospital (H.Z., X.L., J. Luo, X.H., Y. Hu, Y. Huang), Southern Medical University, Foshan, China
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (J.H.Y.W., C.A., Y. Huang)
| | - Clare Arnott
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (J.H.Y.W., C.A., Y. Huang).,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.).,Charles Perkins Centre, University of Sydney, NSW, Australia (C.A.)
| | - Weiyi Mai
- Department of Cardiology (J.K., W.M.), the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), China (J.K., W.M.)
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital (H.Z., X.L., J. Luo, X.H., Y. Hu, Y. Huang), Southern Medical University, Foshan, China.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (J.H.Y.W., C.A., Y. Huang)
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47
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Climie RE, Wu JHY, Calkin AC, Chapman N, Inglis SC, Mirabito Colafella KM, Picone DS, Tan JTM, Thomas E, Viola HM, Wise SG, Murphy AJ, Nelson MR, Nicholls SJ, Hool LC, Doyle K, Figtree GA, Marques FZ. Lack of Strategic Funding and Long-Term Job Security Threaten to Have Profound Effects on Cardiovascular Researcher Retention in Australia. Heart Lung Circ 2020; 29:1588-1595. [PMID: 32839116 PMCID: PMC7442027 DOI: 10.1016/j.hlc.2020.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/06/2020] [Revised: 07/08/2020] [Accepted: 07/24/2020] [Indexed: 01/24/2023]
Abstract
Background Cardiovascular disease is the leading cause of death in Australia. Investment in research solutions has been demonstrated to yield health and a 9.8-fold return economic benefit. The sector, however, is severely challenged with success rates of traditional peer-reviewed funding in decline. Here, we aimed to understand the perceived challenges faced by the cardiovascular workforce in Australia prior to the COVID-19 pandemic. Methods We used an online survey distributed across Australian cardiovascular societies/councils, universities and research institutes over a period of 6 months during 2019, with 548 completed responses. Inclusion criteria included being an Australian resident or an Australian citizen who lived overseas, and a current or past student or employee in the field of cardiovascular research. Results The mean age of respondents was 42±13 years, 47% were male, 85% had a full-time position, and 40% were a group leader or laboratory head. Twenty-three per cent (23%) had permanent employment, and 82% of full-time workers regularly worked >40 hours/week. Sixty-eight per cent (68%) said they had previously considered leaving the cardiovascular research sector. If their position could not be funded in the next few years, a staggering 91% of respondents would leave the sector. Compared to PhD- and age-matched men, women were less likely to be a laboratory head and to feel they had a long-term career path as a cardiovascular researcher, while more women were unsure about future employment and had considered leaving the sector (all p<0.05). Greater job security (76%) and government and philanthropic investment in cardiovascular research (72%) were highlighted by responders as the main changes to current practices that would encourage them to stay. Conclusion Strategic solutions, such as diversification of career pathways and funding sources, and moving from a competitive to a collaborative culture, need to be a priority to decrease reliance on government funding and allow cardiovascular researchers to thrive.
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Affiliation(s)
- Rachel E Climie
- Sports Cardiology and Diabetes and Population Health Laboratories, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Anna C Calkin
- Central Clinical School, Monash University, Melbourne, Vic, Australia; Lipid Metabolism and Cardiometabolic Disease, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Niamh Chapman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia
| | - Sally C Inglis
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia
| | - Joanne T M Tan
- Vascular Research Centre, Lifelong Health Theme, South Australian Health & Medical Research Institute, Adelaide, SA, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Emma Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Helena M Viola
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Steven G Wise
- School of Medical Sciences, Department of Physiology, University of Sydney, Sydney, NSW, Australia
| | - Andrew J Murphy
- Haematopoiesis and Leukocyte Biology, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia
| | - Livia C Hool
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Kerry Doyle
- Australian Cardiovascular Alliance, Sydney, NSW, Australia
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Francine Z Marques
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science, Monash University, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.
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Huang L, Federico E, Jones A, Wu JHY. Presence of trans fatty acids containing ingredients in pre-packaged foods in Australia in 2018. Aust N Z J Public Health 2020; 44:419-420. [PMID: 32776668 DOI: 10.1111/1753-6405.13014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The World Health Organization (WHO) has set a goal of prompt, complete and sustained elimination of industrially produced trans fats (iTFA) in the global food supply by 2023. We aimed to assess the number of products in the Australian packaged food supply likely to contain iTFA. METHODS Using a large pre-packaged food monitoring database collected in 2018, we searched the ingredient list using specific and non-specific ingredient terms to identify products likely to contain iTFA. RESULTS In total, 28,349 foods were included for analysis: 131 (0.5%) products contained specific ingredients indicative of iTFA, and 1,626 (5.7%) products contained non-specific ingredients that may indicate the presence of iTFA. Bread and bakery products, cereal and grain products and confectionery were the top three food groups that contained specific ingredients indicative of iTFA. Only 19 (14.5%) products with specific iTFA-indicating ingredients declared the amount of trans fats. Conclusions and implications for public health: Compared to other countries, the use of iTFA-containing ingredients is low in Australia, but repeated exposure to products containing iTFA could still put consumers at risk of excessive consumption. Legislation to eliminate iTFA should be considered to minimise the exposure to these harmful chemicals.
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Affiliation(s)
- Liping Huang
- Sydney School of Public Health, University of Sydney, New South Wales.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales
| | - Emilia Federico
- School of Health Science, Australian Catholic University, North Sydney, New South Wales
| | - Alexandra Jones
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales
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49
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Thout SR, Yu J, Tian M, Huffman MD, Arnott C, Li Q, Devarsetty P, Johnson C, Pettigrew S, Neal B, Wu JHY. Rationale, design, and baseline characteristics of the Salt Substitute in India Study (SSiIS): The protocol for a double-blinded, randomized-controlled trial. J Clin Hypertens (Greenwich) 2020; 22:1504-1512. [PMID: 32710677 DOI: 10.1111/jch.13947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/06/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 02/04/2023]
Abstract
Reduced-sodium, added-potassium salt substitutes have favorable effects on blood pressure, but have not been tested in India. The Salt Substitute in India Study (SSiIS) is a double-blinded, randomized-controlled trial designed to investigate the effects of reduced-sodium, added-potassium salt substitution to replace usual cooking salt use and blood pressure (BP) among hypertensive patients in rural India. The primary objective is to assess effects on systolic blood pressure at 3 months. The secondary objectives are to determine effects on diastolic blood pressure, urinary sodium, and potassium levels, and to determine acceptability of the intervention. Eligible individuals received usual salt (100% sodium chloride) or salt substitute (70% sodium chloride and 30% potassium chloride) to replace all salt required for cooking and seasoning in the household. A total of 502 participants aged ≥18 years with a history of hypertension were successfully recruited and randomized in a 1:1 ratio to intervention or control, between November 2019 and January 2020. Mean blood pressure at baseline was 133.5/83.6 mm Hg and 96% were using one or more blood pressure-lowering medications. The overall mean average 24-hour urinary sodium excretion was 2825 (SD, 1166) mg/L, which corresponds to a urinary salt excretion of 10.4 g/d. Baseline findings suggest sodium intake in this population significantly exceeds World Health Organization recommendations. The SSiIS trial has successfully recruited participants and is well placed to determine whether salt substitution is an effective means of lowering blood pressure for rural Indian patients with hypertension.
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Affiliation(s)
- Sudhir Raj Thout
- The George Institute for Global Health India, Punjagutta, Hyderabad, India
| | - Jie Yu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Praveen Devarsetty
- The George Institute for Global Health India, Punjagutta, Hyderabad, India
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Imperial College London, London, UK
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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50
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Coyle DH, Shahid M, Dunford EK, Mhurchu CN, Mckee S, Santos M, Popkin BM, Trieu K, Marklund M, Taylor F, Neal B, Wu JHY. Contribution of major food companies and their products to household dietary sodium purchases in Australia. Int J Behav Nutr Phys Act 2020; 17:81. [PMID: 32576211 PMCID: PMC7310483 DOI: 10.1186/s12966-020-00982-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/13/2019] [Accepted: 06/08/2020] [Indexed: 12/21/2022] Open
Abstract
Background The Australian federal government will soon release voluntary sodium reduction targets for 30 packaged food categories through the Healthy Food Partnership. Previous assessments of voluntary targets show variable industry engagement, and little is known about the extent that major food companies and their products contribute to dietary sodium purchases among Australian households. Methods The aim of this cross-sectional study was to identify the relative contribution that food companies and their products made to Australian household sodium purchases in 2018, and to examine differences in sodium purchases by household income level. We used 1 year of grocery purchase data from a nationally representative consumer panel of Australian households who reported their grocery purchases (the Nielsen Homescan panel), combined with database that contains product-specific sodium content for packaged foods and beverages (FoodSwitch). The top food companies and food categories were ranked according to their contribution to household sodium purchases. Differences in per capita sodium purchases by income levels were assessed by 1-factor ANOVA. All analyses were modelled to the Australian population in 2018 using sample weights. Results Sodium data were available from 7188 households who purchased 26,728 unique products and purchased just under 7.5 million food product units. Out of 1329 food companies, the top 10 accounted for 35% of unique products and contributed to 58% of all sodium purchased from packaged foods and beverages. The top three companies were grocery food retailers each contributing 12–15% of sodium purchases from sales of their private label products, particularly processed meat, cheese and bread. Out of the 67 food categories, the top 10 accounted for 73% of sodium purchased, particularly driven by purchases of processed meat (14%), bread (12%) and sauces (11%). Low-income Australian households purchased significantly more sodium from packaged products than high-income households per capita (452 mg/d, 95%CI: 363-540 mg/d, P < 0.001). Conclusions A small number of food companies and food categories account for most of the dietary sodium purchased by Australian households. Prioritizing government engagement with these groups could deliver a large reduction in population sodium intake.
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Affiliation(s)
- Daisy H Coyle
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.
| | - Maria Shahid
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Elizabeth K Dunford
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.,Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.,National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | | | | | - Barry M Popkin
- Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kathy Trieu
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Matti Marklund
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Fraser Taylor
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
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