Obesity is a major risk factor for adverse outcomes after infection with SARS-CoV-2. We aimed to examine this association, including interactions with demographic and behavioural characteristics, ...type 2 diabetes, and other health conditions.
In this prospective, community-based, cohort study, we used de-identified patient-level data from the QResearch database of general practices in England, UK. We extracted data for patients aged 20 years and older who were registered at a practice eligible for inclusion in the QResearch database between Jan 24, 2020 (date of the first recorded infection in the UK) and April 30, 2020, and with available data on BMI. Data extracted included demographic, clinical, clinical values linked with Public Health England's database of positive SARS-CoV-2 test results, and death certificates from the Office of National Statistics. Outcomes, as a proxy measure of severe COVID-19, were admission to hospital, admission to an intensive care unit (ICU), and death due to COVID-19. We used Cox proportional hazard models to estimate the risk of severe COVID-19, sequentially adjusting for demographic characteristics, behavioural factors, and comorbidities.
Among 6 910 695 eligible individuals (mean BMI 26·78 kg/m2 SD 5·59), 13 503 (0·20%) were admitted to hospital, 1601 (0·02%) to an ICU, and 5479 (0·08%) died after a positive test for SARS-CoV-2. We found J-shaped associations between BMI and admission to hospital due to COVID-19 (adjusted hazard ratio HR per kg/m2 from the nadir at BMI of 23 kg/m2 of 1·05 95% CI 1·05–1·05) and death (1·04 1·04–1·05), and a linear association across the whole BMI range with ICU admission (1·10 1·09–1·10). We found a significant interaction between BMI and age and ethnicity, with higher HR per kg/m2 above BMI 23 kg/m2 for younger people (adjusted HR per kg/m2 above BMI 23 kg/m2 for hospital admission 1·09 95% CI 1·08–1·10 in 20–39 years age group vs 80–100 years group 1·01 1·00–1·02) and Black people than White people (1·07 1·06–1·08 vs 1·04 1·04–1·05). The risk of admission to hospital and ICU due to COVID-19 associated with unit increase in BMI was slightly lower in people with type 2 diabetes, hypertension, and cardiovascular disease than in those without these morbidities.
At a BMI of more than 23 kg/m2, we found a linear increase in risk of severe COVID-19 leading to admission to hospital and death, and a linear increase in admission to an ICU across the whole BMI range, which is not attributable to excess risks of related diseases. The relative risk due to increasing BMI is particularly notable people younger than 40 years and of Black ethnicity.
NIHR Oxford Biomedical Research Centre.
Abstract Weight loss can reduce the health risks associated with being overweight or obese. However, the most effective method of weight loss remains unclear. Some programs emphasize physical ...activity, others diet, but existing evidence is mixed as to whether these are more effective individually or in combination. We aimed to examine the clinical effectiveness of combined behavioral weight management programs (BWMPs) targeting weight loss in comparison to single component programs, using within study comparisons. We included randomized controlled trials of combined BWMPs compared with diet-only or physical activity-only programs with at least 12 months of follow-up, conducted in overweight and obese adults (body mass index ≥25). Systematic searches of nine databases were run and two reviewers extracted data independently. Random effects meta-analyses were conducted for mean difference in weight change at 3 to 6 months and 12 to 18 months using a baseline observation carried forward approach for combined BWMPs vs diet-only BWMPs and combined BWMPs vs physical activity-only BWMPs. In total, eight studies were included, representing 1,022 participants, the majority of whom were women. Six studies met the inclusion criteria for combined BWMP vs diet-only. Pooled results showed no significant difference in weight loss from baseline or at 3 to 6 months between the BWMPs and diet-only arms (–0.62 kg; 95% CI –1.67 to 0.44). However, at 12 months, a significantly greater weight-loss was detected in the combined BWMPs (–1.72 kg; 95% CI –2.80 to –0.64). Five studies met the inclusion criteria for combined BWMP vs physical activity-only. Pooled results showed significantly greater weight loss in the combined BWMPs at 3 to 6 months (–5.33 kg; 95% CI –7.61 to –3.04) and 12 to 18 months (–6.29 kg; 95% CI –7.33 to –5.25). Weight loss is similar in the short-term for diet-only and combined BWMPs but in the longer-term weight loss is increased when diet and physical activity are combined. Programs based on physical activity alone are less effective than combined BWMPs in both the short and long term.
Both the global average per capita consumption of meat and the total amount of meat consumed are rising, driven by increasing average individual incomes and by population growth. The consumption of ...different types of meat and meat products has substantial effects on people's health, and livestock production can have major negative effects on the environment. Here, we explore the evidence base for these assertions and the options policy-makers have should they wish to intervene to affect population meat consumption. We highlight where more research is required and the great importance of integrating insights from the natural and social sciences.
Public health strategies place increasing emphasis on opportunities to promote healthy behaviours within the workplace setting. Previous research has suggested worksite health promotion programmes ...have positive effects on physical activity and weight loss, yet little is known regarding their effects on dietary behaviour. The aim of this review was to assess the effects of worksite interventions on employee diets.
Electronic databases (MEDLINE, The Cochrane Library, PsycINFO, EMBASE, LexisNexis) were searched for relevant articles published between 1995 and April 2009. Studies were eligible for inclusion if they were peer-reviewed English language publications describing a worksite-based health promotion intervention with minimum study duration of eight weeks. All study designs were eligible. Studies had to report one or more diet-related outcome (energy, fat, fruit, or vegetable intakes). Methodological quality was assessed using a checklist that included randomisation methods, use of a control group, and study attrition rates.
Sixteen studies were included in the review. Eight programmes focussed on employee education, and the remainder targeted change to the worksite environment, either alone or in combination with education. Study methodological quality was moderate. In general, worksite interventions led to positive changes in fruit, vegetable and total fat intake. However, reliance on self-reported methods of dietary assessment means there is a significant risk of bias. No study measured more robust outcomes such as absenteeism, productivity, or healthcare utilisation.
The findings of this review suggest that worksite health promotion programmes are associated with moderate improvement in dietary intake. The quality of studies to date has been frequently sub-optimal and further, well designed studies are needed in order to reliably determine effectiveness and cost-effectiveness. Future programmes to improve employee dietary habits should move beyond individual education and aim to intervene at multiple levels of the worksite environment.
Reducing meat consumption can help prevent non-communicable diseases and protect the environment. Interventions targeting conscious determinants of human behaviour are generally acceptable approaches ...to promote dietary change, but little is known about their effectiveness to reduce the demand for meat.
To evaluate the effectiveness of interventions targeting conscious determinants of human behaviour to reduce the demand for meat.
We searched six electronic databases on the 31st of August 2017 with a predefined algorithm, screened publicly accessible resources, contacted authors, and conducted forward and backward reference searches. Eligible studies employed experimental designs to evaluate interventions targeting conscious determinants of human behaviour to reduce the consumption, purchase, or selection of meat in comparison to a control condition, a baseline period, or relative to other eligible interventions. We synthesised results narratively and conducted an exploratory crisp-set Qualitative Comparative Analysis to identify combinations of intervention characteristics associated with significant reductions in the demand for meat.
We included 24 papers reporting on 59 interventions and 25,477 observations. Self-monitoring interventions and individual lifestyle counselling led to, or were associated with reduced meat consumption. Providing information about the health or environmental consequences of eating meat was associated with reduced intentions to consume and select meat in virtual environments, but there was no evidence to suggest this approach influenced actual behaviour. Education about the animal welfare consequences of eating meat was associated with reduced intentions to consume meat, while interventions implicitly highlighting animal suffering were not. Education on multiple consequences of eating meat led to mixed results. Tailored education was not found to reduce actual or intended meat consumption, though few studies assessed this approach.
Some interventions targeting conscious determinants of human behaviour have the potential to reduce the demand for meat. In particular, self-monitoring interventions and individual lifestyle counselling can help to reduce meat consumption. There was evidence of effectiveness of some educational messages in reducing intended consumption and selection of meat in virtual environments.
CRD42017076720 .
Reducing meat consumption could bring health and environmental benefits, but there is little research to date on effective interventions to achieve this. A non-randomised controlled intervention ...study was used to evaluate whether prominent positioning of meat-free products in the meat aisle was associated with a change in weekly mean sales of meat and meat-free products. Weekly sales data were obtained from 108 stores: 20 intervention stores that moved a selection of 26 meat-free products into a newly created meat-free bay within the meat aisle and 88 matched control stores. The primary outcome analysis used a hierarchical negative binomial model to compare changes in weekly sales (units) of meat products sold in intervention versus control stores during the main intervention period (Phase I: February 2019 to April 2019). Interrupted time series analysis was also used to evaluate the effects of the Phase I intervention. Moreover, 8 of the 20 stores enhanced the intervention from August 2019 onwards (Phase II intervention) by adding a second bay of meat-free products into the meat aisle, which was evaluated following the same analytical methods. Prominent positioning of meat-free products into the meat aisle in a supermarket was not effective in reducing sales of meat products, but successfully increased sales of meat-free alternatives in the longer term.
Governments are increasingly looking for policies to change supermarket environments to support healthier food purchasing. We evaluated 6 interventions within major United Kingdom grocery stores, ...including availability, positioning, promotions, and signage strategies to encourage selection of healthier products.
Nonrandomised controlled study designs were used, except for one intervention that was rolled out nationwide using a pre/post within-store design. Store-level weekly sales (units, weight (g), and value (£)) of products targeted in the interventions were used in primary analyses using multivariable hierarchical models and interrupted time series (ITS) analyses. Stocking low fat chips next to regular chips was associated with decreases in sales of regular chips (units) in intervention versus control stores (-23% versus -4%; P = 0.001) with a significant level change in ITS models (P = 0.001). Increasing availability of lower energy packs of biscuits was associated with increased sales but reduced sales of regular biscuits in intervention versus control stores (lower energy biscuits +18% versus -2%; P = 0.245; regular biscuits -4% versus +7%; P = 0.386), although not significantly, though there was a significant level change in ITS models (P = 0.004 for regular biscuits). There was no evidence that a positioning intervention, placing higher fibre breakfast cereals at eye level was associated with increased sales of healthier cereal or reduced sales of regular cereal. A price promotion on seasonal fruits and vegetables showed no evidence of any greater increases in sales of items on promotion in intervention versus control stores (+10% versus +8%; P = 0.101) but a significant level change in ITS models (P < 0.001). A nationwide promotion using Disney characters was associated with increased sales of nonsugar baked beans (+54%) and selected fruits (+305%), with a significant level change in ITS models (P < 0.001 for both). Shelf labels to highlight lower sugar beverages showed no evidence of changes in purchasing of lower or higher sugar drinks. These were all retailer-led interventions that present limitations regarding the lack of randomisation, residual confounding from unmeasured variables, absolute differences in trends and sales between intervention versus control stores, and no independent measures of intervention fidelity.
Increasing availability and promotions of healthier alternatives in grocery stores may be promising interventions to encourage purchasing of healthier products instead of less healthy ones. There was no evidence that altering positioning within an aisle or adding shelf edge labelling is associated with changes in purchasing behaviours.
https://osf.io/br96f/.
There is uncertainty regarding the association between unprocessed red and processed meat consumption and the risk of ischemic heart disease (IHD), and little is known regarding the association with ...poultry intake. The aim of this systematic review and meta-analysis was to quantitatively assess the associations of unprocessed red, processed meat, and poultry intake and risk of IHD in published prospective studies. We systematically searched CAB Abstract, MEDLINE, EMBASE, Web of Science, bioRxiv and medRxiv, and reference lists of selected studies and previous systematic reviews up to June 4, 2021. All prospective cohort studies that assessed associations between 1(+) meat types and IHD risk (incidence and/or death) were selected. The meta-analysis was conducted using fixed-effects models. Thirteen published articles were included (n
total
= 1,427,989; n
cases
= 32,630). Higher consumption of unprocessed red meat was associated with a 9% (relative risk (RR) per 50 g/day higher intake, 1.09; 95% confidence intervals (CI), 1.06 to 1.12; n
studies
= 12) and processed meat intake with an 18% higher risk of IHD (1.18; 95% CI, 1.12 to 1.25; n
studies
= 10). There was no association with poultry intake (n
studies
= 10). This study provides substantial evidence that unprocessed red and processed meat, though not poultry, might be risk factors for IHD.
Consumption of free sugars in the UK greatly exceeds dietary recommendations. Public Health England (PHE) has set voluntary targets for industry to reduce the sales-weighted mean sugar content of key ...food categories contributing to sugar intake by 5% by 2018 and 20% by 2020. The aim of this study was to assess changes in the sales-weighted mean sugar content and total volume sales of sugar in selected food categories among UK companies between 2015 and 2018.
We used sales data from Euromonitor, which estimates total annual retail sales of packaged foods, for 5 categories-biscuits and cereal bars, breakfast cereals, chocolate confectionery, sugar confectionery, and yoghurts-for 4 consecutive years (2015-2018). This analysis includes 353 brands (groups of products with the same name) sold by 99 different companies. These data were linked with nutrient composition data collected online from supermarket websites over 2015-2018 by Edge by Ascential. The main outcome measures were sales volume, sales-weighted mean sugar content, and total volume of sugar sold by category and company. Our results show that between 2015 and 2018 the sales-weighted mean sugar content of all included foods fell by 5.2% (95% CI -9.4%, -1.4%), from 28.7 g/100 g (95% CI 27.2, 30.4) to 27.2 g/100 g (95% CI 25.8, 28.4). The greatest change seen was in yoghurts (-17.0% 95% CI -26.8%, -7.1%) and breakfast cereals (-13.3% 95% CI -19.2%, -7.4%), with only small reductions in sugar confectionery (-2.4% 95% CI -4.2%, -0.6%) and chocolate confectionery (-1.0% 95% CI -3.1, 1.2). Our results show that total volume of sugars sold per capita fell from 21.4 g/d (95% CI 20.3, 22.7) to 19.7 g/d (95% CI 18.8, 20.7), a reduction of 7.5% (95% CI -13.1%, -2.8%). Of the 50 companies representing the top 10 companies in each category, 24 met the 5% reduction target set by PHE for 2018. The key limitations of this study are that it does not encompass the whole food market and is limited by its use of brand-level sales data, rather than individual product sales data.
Our findings show there has been a small reduction in total volume sales of sugar in the included categories, primarily due to reductions in the sugar content of yoghurts and breakfast cereals. Additional policy measures may be needed to accelerate progress in categories such as sugar confectionery and chocolate confectionery if the 2020 PHE voluntary sugar reduction targets are to be met.
High meat consumption, particularly red meat and processed meat, negatively affects our health, while meat production is one of the largest contributors to global warming and environmental ...degradation. The aim of our study was to explore trends in meat consumption within the UK and the associated changes in environmental impact. We also aimed to identify any differences in intake associated with gender, ethnicity, socioeconomic status, and year of birth.
Our study aimed to describe consumption of red, white, and processed meat within the UK, using data from the National Diet and Nutrition Survey rolling programme (2008–09 to 2018–19), and the associated changes in environmental impact. Meat consumption was based on disaggregated meat data, from 4 day food diaries that excluded all non-meat components of composite dishes. For each year surveyed, trends for meat intake were reported as mean grams per capita per day and linear-regression models were used to test for trends. We used multivariable linear-regression models to examine differences among consumers, as a percentage of food energy, by gender, ethnicity, equivalised household income, and year of birth.
From 2008 to 2019, average meat consumption per capita per day decreased from 103·7 g (SE 2·3) to 86·3 g (2·9) per day (ptrend<0·0001), including an absolute reduction in red-meat consumption of 13·7 g (ptrend<0·0001), an absolute reduction in processed meat consumption of 7·0 g (ptrend<0·0001), and a 3·2 g increase (ptrend=0·0027) in white-meat consumption. Collectively, these changes were associated with a significant reduction in all six environmental indicators over the whole period. The two middle birth-year groups (people born in 1960–79 and 1980–99) and White individuals were the highest meat consumers. Meat intake increased over time among people born after 1999, was unchanged among Asian and Asian British populations, and decreased in all other population subgroups. We found no difference in intake with gender or household income.
Despite the overall reduction in meat intake, reaching meat-consumption targets that align with sustainable diets will require a substantial acceleration of this trend.
The Wellcome Trust, Our Planet Our Health programme (Livestock, Environment, and People).
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