Fiscal interventions are promising strategies to improve diets, reduce cardiovascular disease and diabetes (cardiometabolic diseases; CMD), and address health disparities. The aim of this study is to ...estimate the impact of specific dietary taxes and subsidies on CMD deaths and disparities in the US.
Using nationally representative data, we used a comparative risk assessment to model the potential effects on total CMD deaths and disparities of price subsidies (10%, 30%) on fruits, vegetables, whole grains, and nuts/seeds and taxes (10%, 30%) on processed meat, unprocessed red meats, and sugar-sweetened beverages. We modeled two gradients of price-responsiveness by education, an indicator of socioeconomic status (SES), based on global price elasticities (18% greater price-responsiveness in low vs. high SES) and recent national experiences with taxes on sugar-sweetened beverages (65% greater price-responsiveness in low vs. high SES).
Each price intervention would reduce CMD deaths. Overall, the largest proportional reductions were seen in stroke, followed by diabetes and coronary heart disease. Jointly altering prices of all seven dietary factors (10% each, with 18% greater price-responsiveness by SES) would prevent 23,174 (95% UI 22,024-24,595) CMD deaths/year, corresponding to 3.1% (95% UI 2.9-3.4) of CMD deaths among Americans with a lower than high school education, 3.6% (95% UI 3.3-3.8) among high school graduates/some college, and 2.9% (95% UI 2.7-3.5) among college graduates. Applying a 30% price change and larger price-responsiveness (65%) in low SES, the corresponding reductions were 10.9% (95% UI 9.2-10.8), 9.8% (95% UI 9.1-10.4), and 6.7% (95% UI 6.2-7.6). The latter scenario would reduce disparities in CMD between Americans with lower than high school versus a college education by 3.5 (95% UI 2.3-4.5) percentage points.
Modest taxes and subsidies for key dietary factors could meaningfully reduce CMD and improve US disparities.
Evidence points to adverse effects of trans fatty acids (TFA) on health. The aim of this study was to estimate total TFA intake, evaluate major food contributors and its effect on ...dyslipidemia.BackgroundEvidence points to adverse effects of trans fatty acids (TFA) on health. The aim of this study was to estimate total TFA intake, evaluate major food contributors and its effect on dyslipidemia.A total of 3537 adults (48.3% males) were included. Total TFA intake was assessed using two 24-hour dietary recalls. Foods were categorized into specific food groups. Adjusted Logistic Regression analysis was performed to assess the likelihood of dyslipidemia by tertile of TFA aand Saturated Fatty Acid (SFA) level.MethodsA total of 3537 adults (48.3% males) were included. Total TFA intake was assessed using two 24-hour dietary recalls. Foods were categorized into specific food groups. Adjusted Logistic Regression analysis was performed to assess the likelihood of dyslipidemia by tertile of TFA aand Saturated Fatty Acid (SFA) level.Median TFA intake was 0.53% of energy (from 0.34 to 0.81) ranging from 0.27 (Q1) to 0.95 (Q3) (p < 0.001, for trend), and 16% of individuals consumed TFA above 1% of their total energy. Cheese was the main contributor to TFA intake, with processed/refined grains and fried fish following. The latter was the main contributor in older adults (51+ years). Adjusted logistic regression analysis showed that individuals at the highest tertile of trans consumption were 30% more likely to have dyslipidemia compared to the lowest ( OR ( Q 3 - Q 1 ) : 1.3; 95% CI: 1.02-1.66 and OR ( Q 2 - Q 1 ) : 1.3; 95% CI:1.01-1.66, respectively). This increased by 10% when stratified by SFA intake (OR: 1.4; 95% CI: 1.061-1.942) and remained significant only in individuals at the highest tertile and with higher than recommended SFA intake.ResultsMedian TFA intake was 0.53% of energy (from 0.34 to 0.81) ranging from 0.27 (Q1) to 0.95 (Q3) (p < 0.001, for trend), and 16% of individuals consumed TFA above 1% of their total energy. Cheese was the main contributor to TFA intake, with processed/refined grains and fried fish following. The latter was the main contributor in older adults (51+ years). Adjusted logistic regression analysis showed that individuals at the highest tertile of trans consumption were 30% more likely to have dyslipidemia compared to the lowest ( OR ( Q 3 - Q 1 ) : 1.3; 95% CI: 1.02-1.66 and OR ( Q 2 - Q 1 ) : 1.3; 95% CI:1.01-1.66, respectively). This increased by 10% when stratified by SFA intake (OR: 1.4; 95% CI: 1.061-1.942) and remained significant only in individuals at the highest tertile and with higher than recommended SFA intake.A high intake of TFA combined with high SFA intakes further increase the likelihood of dyslipidemia and should be accounted for in public health prevention programs. Monitoring and evaluation of the recent EU legislative measures on TFA levels in foods is also necessary.ConclusionsA high intake of TFA combined with high SFA intakes further increase the likelihood of dyslipidemia and should be accounted for in public health prevention programs. Monitoring and evaluation of the recent EU legislative measures on TFA levels in foods is also necessary.
A global database of food and nutrient consumption Khatibzadeh, Shahab; Saheb Kashaf, Michael; Micha, Renata ...
Bulletin of the World Health Organization,
12/2016, Volume:
94, Issue:
12
Journal Article
Peer reviewed
Open access
...we used the comprehensive United Nations Food and Agricultural Organization (FAO) food balance sheets,8 which provide country-level data on per capita food availability for major food groups in ...187 countries and across the entire time period studied. ...we combined systematic survey searches with extensive personal contacts to derive a global database of dietary habits.
Sugar intake has been associated with increased prevalence of childhood overweight/obesity; however, results remain controversial. The aim of this study was to examine the probability of ...overweight/obesity with higher sugar intakes, accounting for other dietary intakes. Data from 1165 children and adolescents aged ≥2–18 years (66.8% males) enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were used; specifically, 781 children aged 2–11 years and 384 adolescents 12–18 years. Total and added sugar intake were assessed using two 24 h recalls (24 hR). Foods were categorized into specific food groups to evaluate the main foods contributing to intakes. A significant proportion of children (18.7%) and adolescents (24.5%) exceeded the recommended cut-off of 10% of total energy intake from added sugars. Sweets (29.8%) and processed/refined grains and cereals (19.1%) were the main sources of added sugars in both age groups, while in adolescents, the third main contributor was sugar-sweetened beverages (20.6%). Being overweight or obese was 2.57 (p = 0.002) and 1.77 (p = 0.047) times more likely for intakes ≥10% of total energy from added sugars compared to less <10%, when accounting for food groups and macronutrient intakes, respectively. The predicted probability of becoming obese was also significant with higher total and added-sugar consumption. We conclude that high consumption of added sugars increased the probability for overweight/obesity among youth, irrespectively of other dietary or macronutrient intakes.
Promising school policies to improve children's diets include providing fresh fruits and vegetables (F&V) and competitive food restrictions on sugar-sweetened beverages (SSBs), yet the impact of ...national implementation of these policies in US schools on cardiometabolic disease (CMD) risk factors and outcomes is not known. Our objective was to estimate the impact of national implementation of F&V provision and SSB restriction in US elementary, middle, and high schools on dietary intake and body mass index (BMI) in children and future CMD mortality.
We used comparative risk assessment (CRA) frameworks to model the impacts of these policies with input parameters from nationally representative surveys, randomized-controlled trials, and systematic reviews and meta-analyses. For children ages 5-18 years, this incorporated national data on current dietary intakes and BMI, impacts of these policies on diet, and estimated effects of dietary changes on BMI. In adults ages 25 and older, we further incorporated the sustainability of dietary changes to adulthood, effects of dietary changes on CMD, and national CMD death statistics, modeling effects if these policies had been in place when current US adults were children. Uncertainty across inputs was incorporated using 1000 Monte Carlo simulations.
National F&V provision would increase daily fruit intake in children by as much as 25.0% (95% uncertainty interval (UI): 15.4, 37.7%), and would have small effects on vegetable intake. SSB restriction would decrease daily SSB intake by as much as 26.5% (95% UI: 6.4, 46.4%), and reduce BMI by as much as 0.7% (95% UI: 0.2, 1.2%). If F&V provision and SSB restriction were nationally implemented, an estimated 22,383 CMD deaths/year (95% UI: 18735, 25930) would be averted.
National school F&V provision and SSB restriction policies implemented in elementary, middle, and high schools could improve diet and BMI in children and reduce CMD mortality later in life.
The aim of the Hellenic National Nutrition and Health Survey was to assess nutritional intake, health status and various behaviors in a representative sample of the Greek population.
Data collection ...took place from 01.09.2013 to 31.05.2015. Random stratified sampling was performed by (a) geographical density criteria of Greece (7 regions), (b) age group of the reference population (< 19, 20-64 and > 65 years) and (c) gender distribution. The final population enrolled included (throughout Greece), 4574 individuals (42.5% men; 57.5% women of who 47.2% were from Athens metropolitan area, 18.5% from Central Macedonia, and the remaining 34% almost equally scattered throughout the country (p for the comparisons with official statistics by region, age group and sex > 0.7). Questionnaires developed were based on extensive review of the literature, following a validation procedure when necessary.
Preliminary analyses revealed that 32% of the adult population were overweight and 15.5% were obese, with significant gender differences in total and per age group (p < 0.001, for all). The majority of the adult population reported being active smokers (50.4%) or regular alcohol consumers (72.4%); with significant gender differences (p < 0.001, for all). Prevalence of hyperlipidemia was 16.7%, cardiovascular disease 13.9%, hypertension 13.3%, thyroid disease 13.8%, and Diabetes Mellitus 3.6%. Significant gender and age group differences were found in various diseases.
Study's preliminary results provide valuable information about the Hellenic population's health. Findings from this survey could be used to detect disease risk factors for public health prevention policies and programs.
Hypertension is a major risk of cardiovascular diseases. This study's aim was to examine associations between hypertension and a priori known lifestyle risk factors, including weight status and ...Mediterranean diet adherence. The study included a representative sample of the adult population (N = 3775 (40.8% males)), from the Hellenic National Nutrition and Health Survey (HNNHS), which took place from September 2013 to May 2015. Demographic and anthropometric data were collected using validated questionnaires, and blood pressure (BP) measurements were performed for the two main metropolitan areas (N = 1040; 41.1%). Hypertension diagnosis was according to the International Classification of Diseases (ICD-10) guidelines. Weighted proportions, extended Mantel-Haenszel (M-H) analyses, and multiple logistic regressions (for the survey data) were performed. Mean systolic BP (SBP) and diastolic BP (DBP) were 118.6 mmHg and 72.2 mmHg respectively, with both values being higher in males compared to females in all age groups (
< 0.001). Study participants with hyperlipidemia or diabetes, and those overweight, were almost twice as likely to be hypertensives, with the odds increasing to 4 for those obese (
for all, < 0.05). Stricter Mediterranean diet adherence significantly decreased the likelihood of hypertension by 36% (OR: 0.64; 95% CI: 0.439, 0.943), and a significant interaction was found between Mediterranean diet adherence and weight status on hypertension. The presence of hypertension is clustered with comorbidities, but is significantly associated with modifiable risk factors, including Mediterranean diet and weight status, underlining the need for personalized medical nutritional treatment.
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.
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.
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.
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.
National Heart, Lung, and Blood Institute.
BackgroundWe aimed to systematically identify, standardise and disseminate individual-level dietary intake surveys from up to 207 countries for 54 foods, beverages and nutrients, including ...subnational intakes by age, sex, education and urban/rural residence, from 1980 to 2015.MethodsBetween 2008–2011 and 2014–2020, the Global Dietary Database (GDD) project systematically searched for surveys assessing individual-level intake worldwide. We prioritised nationally or subnationally representative surveys using 24-hour recalls, Food-Frequency Questionnaires or short standardised questionnaires. Data were retrieved from websites or corresponding members as individual-level food group microdata or aggregate stratum-level data. Standardisation included quality assessment; data cleaning; categorising of foods and nutrients and their units; aggregation by demographic strata and energy adjustment.ResultsWe standardised and incorporated 1220 surveys into the final GDD 2017 database, together represented 188 countries and 99.0% of the world’s population in 2015. 72.1% were nationally, 17.0% subnationally, and 10.9% community-level representative. 41.2% used Food-Frequency Questionnaires; 23.4%, 24-hour recalls; 15.8%, Demographic Health Survey questionnaires; 13.1%, biomarkers and 6.4%, household surveys. 73.9% of surveys included data on children; 52.2%, by urban and rural residence; and 30.2%, by education. Most surveys were in high-income countries, followed by sub-Saharan Africa and Asia. Most commonly ascertained foods were fruits (N=803 surveys), non-starchy vegetables (N=787) and sugar-sweetened beverages (N=440); and nutrients, sodium (N=343), energy (N=256), calcium (N=224) and fibre (N=200). Least available data were on iodine, vitamin A, plant protein, selenium, added sugar and animal protein.ConclusionsThis systematic search, retrieval and standardised effort provides the most comprehensive empirical evidence on dietary intakes across and within countries worldwide.
BACKGROUND: The overall consumption of trans fatty acids (TFAs) increases the risk of coronary artery disease. However, multiple TFA isomers exist, each with potentially different health effects. ...Different food sources of these specific TFA isomers are not well established. OBJECTIVE: Our objective was to determine the major independent food sources of specific TFA isomers. DESIGN: We investigated relations of major potential food sources of TFAs, as assessed by serial food-frequency questionnaires, with 10 plasma phospholipid TFA isomers 5 trans (t-) 18:1, 3 t-18:2, and 2 t-16:1 in 3330 older adults in the Cardiovascular Health Study, a community-based multicenter cohort. Stepwise regression was used to identify independent major food sources of individual plasma phospholipid TFA isomers, which were adjusted for demographic, lifestyle, and dietary factors. RESULTS: All 5 t-18:1 isomers were similarly associated with foods commonly made with partially hydrogenated vegetable oils (PHVOs), including biscuits (0.51 higher SD of total 18:1 fatty acid concentrations per serving/d, P < 0.01), chips and/or popcorn (0.33 higher SD per serving/d, P = 0.02), margarine (0.32 higher SD per serving/d, P < 0.001), fried foods (0.32 higher SD per serving/d, P = 0.04), and bakery foods (0.23 higher SD per serving/d, P = 0.02). Each of the t-18:2 isomers were associated only with bakery foods (0.50 higher SD of total 18:2 fatty acid concentrations per serving/d, P < 0.001). Ruminant foods were major correlates of t-16:1n-7, including red meats (0.72 higher SD per serving/d, P < 0.001), butter (0.43 higher SD per serving/d, P < 0.001), and higher-fat dairy (0.37 higher SD per serving/d, P < 0.001). In contrast, t-16:1n-9 were derived mainly from margarine (0.31 higher SD per serving/d, P < 0.001). CONCLUSIONS: t-18:1 Isomers are similarly derived from multiple PHVO-containing foods. In contrast, t-18:2 and t-16:1n-9 isomers are derived from more-specific types of PHVO-containing foods. Ruminant foods are major sources of t-16:1n-7. Different TFA isomers and dietary sources should be considered when investigating health effects and interventions to lower TFAs.
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