Poor diet is the leading cause of cardiovascular disease in the USA and globally. Evidence-based policies are crucial to improve diet and population health. We reviewed the effectiveness for a range ...of policy levers to alter diet and diet-related risk factors. We identified evidence to support benefits of focused mass media campaigns (especially for fruits, vegetables, salt), food pricing strategies (both subsidies and taxation, with stronger effects at lower income levels), school procurement policies (for increasing healthful or reducing unhealthful choices), and worksite wellness programs (especially when comprehensive and multicomponent). Evidence was inconclusive for food and menu labeling (for consumer or industry behavior) and changes in local built environment (e.g., availability or accessibility of supermarkets, fast food outlets). We found little empiric evidence evaluating marketing restrictions, although broad principles and large resources spent on marketing suggest utility. Widespread implementation and evaluation of evidence-based policy strategies, with further research on other strategies with mixed/limited evidence, are essential “population medicine” to reduce health and economic burdens and inequities of diet-related illness worldwide.
Several studies have reported a significant inverse association of light to moderate alcohol consumption with coronary heart disease (CHD). However, studies assessing the relationship between alcohol ...consumption and atherosclerosis have reported inconsistent results. The current study was conducted to determine the relationship between alcohol consumption and aortic calcification.
We addressed the research question using data from the population-based ERA-JUMP Study, comprising of 1006 healthy men aged 40–49 years, without clinical cardiovascular diseases, from four race/ethnicities: 301 Whites, 103 African American, 292 Japanese American, and 310 Japanese in Japan. Aortic calcification was assessed by electron-beam computed tomography and quantified using the Agatston method. Alcohol consumption was categorized into four groups: 0 (non-drinkers), ≤1 (light drinkers), >1 to ≤3 (moderate drinkers) and >3 drinks per day (heavy drinkers) (1 drink = 12.5 g of ethanol). Tobit conditional regression and ordinal logistic regression were used to investigate the association of alcohol consumption with aortic calcification after adjusting for cardiovascular risk factors and potential confounders.
The study participants consisted of 25.6% nondrinkers, 35.3% light drinkers, 23.5% moderate drinkers, and 15.6% heavy drinkers. Heavy drinkers Tobit ratio (95% CI) = 2.34 (1.10, 4.97); odds ratio (95% CI) = 1.67 (1.11, 2.52) had significantly higher expected aortic calcification score compared to nondrinkers, after adjusting for socio-demographic and confounding variables. There was no significant interaction between alcohol consumption and race/ethnicity on aortic calcification.
Our findings suggest that heavy alcohol consumption may be an independent risk factor for atherosclerosis.
•Alcohol consumption has a J-shaped association with CHD.•Studies reported conflicting relationships between alcohol consumption and atherosclerosis.•We cross-sectionally examined the relationship between alcohol consumption and aortic calcification.•The heavy alcohol consumption was positively associated with aortic calcification.•Moderate alcohol consumption may lower CHD risk through mechanisms other than reduced atherosclerotic lesion calcification.
The influence of food and beverage labeling (food labeling) on consumer behaviors, industry responses, and health outcomes is not well established.
PRISMA (Preferred Reporting Items for Systematic ...Reviews and Meta-Analyses) guidelines were followed. Ten databases were searched in 2014 for studies published after 1990 evaluating food labeling and consumer purchases/orders, intakes, metabolic risk factors, and industry responses. Data extractions were performed independently and in duplicate. Studies were pooled using inverse-variance random effects meta-analysis. Heterogeneity was explored with I2, stratified analyses, and meta-regression; and publication bias was assessed with funnel plots, Begg's tests, and Egger's tests. Analyses were completed in 2017.
From 6,232 articles, a total of 60 studies were identified, including 2 million observations across 111 intervention arms in 11 countries. Food labeling decreased consumer intakes of energy by 6.6% (95% CI= –8.8%, –4.4%, n=31), total fat by 10.6% (95% CI= –17.7%, –3.5%, n=13), and other unhealthy dietary options by 13.0% (95% CI= –25.7%, –0.2%, n=16), while increasing vegetable consumption by 13.5% (95% CI=2.4%, 24.6%, n=5). Evaluating industry responses, labeling decreased product contents of sodium by 8.9% (95% CI= –17.3%, –0.6%, n=4) and artificial trans fat by 64.3% (95% CI= –91.1%, –37.5%, n=3). No significant heterogeneity was identified by label placement or type, duration, labeled product, region, population, voluntary or legislative approaches, combined intervention components, study design, or quality. Evidence for publication bias was not identified.
From reviewing 60 intervention studies, food labeling reduces consumer dietary intake of selected nutrients and influences industry practices to reduce product contents of sodium and artificial trans fat.
Data presented in this article are supplementary data to our primary article ‘Association of Alcohol Consumption and Aortic Calcification in Healthy Men Aged 40–49 Years for the ERA JUMP Study’ 1. In ...this article, we have presented supplementary tables showing the independent association of alcohol consumption with coronary artery calcification using Tobit conditional regression and ordinal logistic regression.
High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative proposed government-supported voluntary national sugar ...reduction targets. This intervention's potential effects and cost-effectiveness are unclear.
A validated microsimulation model, CVD-PREDICT (Cardiovascular Disease Policy Model for Risk, Events, Detection, Interventions, Costs, and Trends), coded in C++, was used to estimate incremental changes in type 2 diabetes, cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs, and cost-effectiveness of the US National Salt and Sugar Reduction Initiative policy. The model was run at the individual level, incorporating the annual probability of each person's transition between health statuses on the basis of risk factors. The model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across 3 cycles (2011 through 2016), added sugar-related diseases from meta-analyses, and policy costs and health-related costs from established sources. A simulated nationally representative US population was created and followed until age 100 years or death, with 2019 as the year of intervention start. Findings were evaluated over 10 years and a lifetime from health care and societal perspectives. Uncertainty was evaluated in a 1-way analysis by assuming 50% industry compliance and probabilistic sensitivity analyses through a second-order Monte Carlo approach. Model outputs included averted diabetes cases, CVD events and CVD deaths, QALYs gained, and formal health care cost savings, stratified by age, race, income, and education.
Achieving the US National Salt and Sugar Reduction Initiative sugar reduction targets could prevent 2.48 million CVD events, 0.49 million CVD deaths, and 0.75 million diabetes cases; gain 6.67 million QALYs; and save $160.88 billion net costs from a societal perspective over a lifetime. The policy became cost-effective (<150 000/QALYs) at 6 years, highly cost-effective (<50 000/QALYs) at 7 years, and cost-saving at 9 years. Results were robust from a health care perspective, with lower (50%) industry compliance, and in probabilistic sensitivity analyses. The policy could also reduce disparities, with greatest estimated health gains per million adults among Black or Hispanic individuals, lower income, and less educated Americans.
Implementing and achieving the US National Salt and Sugar Reduction Initiative sugar reformation targets could generate substantial health gains, equity gains, and cost savings.
Abstract only Background: School procurement policies - e.g., free/reduced price provision of healthful foods/beverages, quality standards for competitive foods/beverages, or quality standards for ...school meals - are increasingly being used to promote healthy diets in kids. However, their effectiveness has not been systematically evaluated. Methods: We used MOOSE and PRISMA guidelines to systematically search multiple online databases for original interventions (randomized, quasi-experimental) assessing influence of school procurement policies, alone or as part of multi-component strategies, on dietary intakes in children. Data were extracted independently and in duplicate. Inverse variance-weighted meta-analysis was used to pool estimates. Pre-specified sources of heterogeneity (study design, location; intervention duration, coverage, components; outcome type, ascertainment) were analyzed using meta-regression and subgroup analysis. Funnel plots, Begg’s, and Egger’s tests evaluated potential publication bias. Results: From 6,193 abstracts, 76 interventional studies met inclusion criteria. Many were multicomponent. Thirty-two assessed free/reduced price provision of healthful foods/beverages, mostly in cafeterias or classrooms, with average duration 18 mo. In pooled analysis, free/reduced price provision of fruits and vegetables increased fruit intake by 0.22 servings/d (n=14 studies; 95% CI: 0.10, 0.34) and total fruit and vegetable intake by 0.28 servings/d (n=12; 0.07, 0.49), but not vegetable intake alone (n=8; 0.01 servings/d -0.03, 0.05). Twenty-seven interventions evaluated policies on competitive foods/beverages (most often sugar-sweetened beverages), with average duration 23 mo. Strategies included restrictions/bans, quality standards, or both. These interventions reduced sugar-sweetened beverage intake by 0.11 (12-oz) servings/d (n=7; -0.16, -0.05). Thirty-two interventions assessed quality standards for school meals (lunch and/or breakfast), with average follow-up 28 mo. Standards were typically based on types of foods, nutrient content, and/or portion size. Dietary targets varied appreciably, and results were generally inconsistent across studies, with no significant overall pooled effect. Findings for secondary outcomes of food content, food availability, and adiposity will be presented. Statistical heterogeneity in these analyses was variable; meta-regression did not identify significant sources. Little evidence for publication bias was seen. Conclusions: These findings support efficacy of school procurement policies that provide free/reduced price healthful choices or target competitive foods/beverages. Efficacy of quality standards for school meals appears heterogeneous with less consistent benefits. These findings inform policy priorities for improving diets in children.
Few studies have examined the association of long-chain n-3 polyunsaturated fatty acids (LCn-3PUFAs) with the measures of atherosclerosis in the general population. This study aimed to examine the ...relationship of total LCn-3PUFAs, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) with aortic calcification.
In a multiethnic population-based cross-sectional study of 998 asymptomatic men aged 40–49 years (300 US-White, 101 US-Black, 287 Japanese American, and 310 Japanese in Japan), we examined the relationship of serum LCn-3PUFAs to aortic calcification (measured by electron-beam computed tomography and quantified using the Agatston method) using Tobit regression and ordinal logistic regression after adjusting for potential confounders. Overall 56.5% participants had an aortic calcification score (AoCaS) > 0. The means (SD) of total LCn-3PUFAs, EPA, and DHA were 5.8% (3.3%), 1.4% (1.3%), and 3.7% (2.1%), respectively. In multivariable-adjusted Tobit regression, a 1-SD increase in total LCn-3PUFAs, EPA, and DHA was associated with 29% (95% CI = 0.51, 1.00), 9% (95% CI = 0.68, 1.23), and 35% (95% CI = 0.46, 0.91) lower AoCaS, respectively. Results were similar in ordinal logistic regression analysis. There was no significant interaction between race/ethnicity and total LCn–3PUFAs, EPA or DHA on aortic calcification.
This study showed the significant inverse association of LCn-3PUFAs with aortic calcification independent of conventional cardiovascular risk factors among men in the general population. This association appeared to be driven by DHA but not EPA.
•Evidence concerning LCn-3PUFAs and atherosclerosis is limited in the general population.•Cross-sectionally examined the relationship of LCn-3 PUFAs to aortic calcification in asymptomatic middle aged men.•Overall, LCn-3PUFAs especially DHA was inversely and significantly associated with aortic calcification.•No significant interaction between race/ethnicity and total LCn-3 PUFAs, EPA or DHA on aortic calcification.•In the general middle-aged male population, DHA may be more anti-atherogenic than EPA.
Objectives The Novel approaches for preventing or limiting events (NAPLIES) and The Atorvastatin for Reduction of Myocardial Damage during Angioplasty (ARMYDA) studies demonstrated a beneficial ...effect of statin loading in preventing major adverse cardiac events (MACE) after elective percutaneous coronary intervention (PCI) for stable angina, unstable angina, non-ST-segment-elevation myocardial infarction (NSTEMI). The so called ‘pleiotropic effects’ of statins include modulation of endothelial function, inhibition of inflammation, and attenuation of thrombosis, all of which could provide clinical benefits in the setting of elective PCI by reducing postprocedural incidence of myocardial and MACE. So far, the efficacy of atorvastatin loading in patients with acute ST-segment-elevation myocardial infarction (STEMI) undergoing primary PCI has not been confirmed. Also, whether the ‘pleiotropic effects’ of statins could explain the possible mechanism(s) needs to be discussed. This study sought to explore potential protective effects of statin loading before primary PCI on coronary endothelial function, inflammation, and MACE. Methods A total 60 patients with STEMI were randomised into loading dose group (80 mg atorvastatin before PCI, n=20), regular dose group (20 mg atorvastatin before PCI, n=20), and control group (without atorvastatin before PCI, n=20). All patients received primary PCI and routine treatment. The plasma samples were collected before, immediately after, 6 h after and 24 h after PCI in all the patients. Plasma concentrations of endothelial nitric oxide synthase (eNOS), Nitric Oxide (NO), interleukin-6 (IL-6), tumour necrosis factor (TNF-а), intercellular adhesion molecule-1 (ICAM-1) were tested by ELISA. The results of coronarography, electrocardiogram, myocardial enzyme, high-sensitivity C-reactive protein (hs-CRP), amino terminal-pro brain natriuretic peptide (NT-proBNP), echocardiography, MACE, and the safety of statin loading were also collected. Results Plasma eNOS immediately and 24 h after PCI were higher in the regular dose group (p<0.05). Plasma eNOS before and 24 h after PCI, along with plasma NO at any time point did not show significant differences among the 3 groups. Plasma IL-6 before PCI were lower in the loading dose group (90.773±7.646 pg/ml vs 95.592±4.269 pg/ml vs 94.324±3.692 pg/ml, p=0.023). Plasma IL-6 after PCI, plasma TNF-a and ICAM-1 at any time point did not show significant differences among the 3 groups. MACE occurred in 2 (10.0%) patients in the loading dose group, 2 (10.0%) patients in the regular dose group, 3 (15.0%) patients in the control group, respectively (p=0.855). Conclusions Atorvastatin loading in patients with STEMI undergoing primary PCI may not have protective effects on coronary endothelial function, inflammation, and MACE.
Abstract only Background: Cardiometabolic diseases such as CVD and diabetes are rising rapidly in many regions, especially the Middle East. Governments could reduce these burdens by targeting ...suboptimal diets, but little is known about national dietary policies in this region. Objective: To systematically investigate, summarize, and identify gaps in national dietary policies in 22 Middle Eastern nations. Methods: Using PRISMA and MOOSE guidelines, we systematically searched PubMed, Econ Lit, PAIS, Cochrane library, AGRIS, Web of Science, CABI, and CINAHL for original studies, reviews, and organizational reports on national dietary policies adopted in these countries; Google searches are ongoing. We searched for dietary policies in 6 categories: media/education, labeling/consumer info, taxes/subsidies, school programs, workplace approaches, and direct bans/mandates. We evaluated 13 dietary targets of interest (Figure). Studies were excluded if published prior to 1980, described only local (subnational) policies, or only provided data on policies for food safety, micronutrient deficiency, hunger, or other issues without at least one focus on cardiometabolic risk. Results: From 3866 identified studies, 17 met inclusion criteria. We found 4 types of dietary policies (media/education, labeling/consumer information, taxation/subsidies, direct bans/mandates) in 9 countries of the region (Bahrain, Djibouti, Egypt, Iran, Jordan, Kuwait, Pakistan, Sudan, United Arab Emirates) that targeted 7 dietary factors (fruits, vegetables, whole grains, unprocessed red meat, trans fats, sodium, dietary fiber) . Details of these policies will be presented, as well as current gaps (Figure). Conclusions: Our findings highlight existing national dietary policies that have been adopted to reduce cardiometabolic diseases in the Middle East, as well as remaining major policy gaps, thereby identifying current progress and opportunities for policy innovation.
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