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  • 1
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. 1 ( 2016-01-13)
    Abstract: Saturated fat ( SFA ), ω‐6 (n‐6) polyunsaturated fat ( PUFA ), and trans fat ( TFA ) influence risk of coronary heart disease ( CHD ), but attributable CHD mortalities by country, age, sex, and time are unclear. Methods and Results National intakes of SFA , n‐6 PUFA , and TFA were estimated using a Bayesian hierarchical model based on country‐specific dietary surveys; food availability data; and, for TFA , industry reports on fats/oils and packaged foods. Etiologic effects of dietary fats on CHD mortality were derived from meta‐analyses of prospective cohorts and CHD mortality rates from the 2010 Global Burden of Diseases study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework. In 2010, nonoptimal intakes of n‐6 PUFA , SFA , and TFA were estimated to result in 711 800 (95% uncertainty interval [UI] 680 700–745 000), 250 900 (95% UI 236 900–265 800), and 537 200 (95% UI 517 600–557 000) CHD deaths per year worldwide, accounting for 10.3% (95% UI 9.9%–10.6%), 3.6%, (95% UI 3.5%–3.6%) and 7.7% (95% UI 7.6%–7.9%) of global CHD mortality. Tropical oil–consuming countries were estimated to have the highest proportional n‐6 PUFA – and SFA ‐attributable CHD mortality, whereas Egypt, Pakistan, and Canada were estimated to have the highest proportional TFA ‐attributable CHD mortality. From 1990 to 2010 globally, the estimated proportional CHD mortality decreased by 9% for insufficient n‐6 PUFA and by 21% for higher SFA, whereas it increased by 4% for higher TFA , with the latter driven by increases in low‐ and middle‐income countries. Conclusions Nonoptimal intakes of n‐6 PUFA , TFA , and SFA each contribute to significant estimated CHD mortality, with important heterogeneity across countries that informs nation‐specific clinical, public health, and policy priorities.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2653953-6
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  • 2
    Online Resource
    Online Resource
    American Medical Association (AMA) ; 2018
    In:  JAMA Vol. 319, No. 3 ( 2018-01-16), p. 227-
    In: JAMA, American Medical Association (AMA), Vol. 319, No. 3 ( 2018-01-16), p. 227-
    Type of Medium: Online Resource
    ISSN: 0098-7484
    RVK:
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2018
    detail.hit.zdb_id: 2958-0
    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
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  • 3
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 137, No. suppl_1 ( 2018-03-20)
    Abstract: Introduction: Taxes on sugar-sweetened beverage (SSB) purchases have emerged as a policy tool to lower obesity, diabetes and CVD risks. Prior cost-effectiveness analyses included SSB tax administration costs yet ignored tax payments as mere transfers from a societal perspective. Yet, tax payments could count as revenues for the government and as costs for consumers and the SSB industry. Corresponding health and economic impacts for different stakeholders, essential to guide decision-making, are not established. Aim: To estimate the health impact and cost-effectiveness of a national penny-per-ounce SSB tax from the healthcare perspective, societal perspective, and across 9 stakeholder groups: 6 consumer categories classified by insurance status (and reflecting varying SSB intake and risk factors), the government, the beverage industry, and other private sector. Methods: A validated microsimulation model (CVD PREDICT) was used to estimate CVD reductions, quality-adjusted life-years (QALYs) gained, costs, and cost-effectiveness among US adults (35+ years), evaluating both 100% and 50% price pass-through to consumers. Model inputs included dietary and demographic data from NHANES, policy effects on consumer intake and SSB-disease effects from meta-analyses, policy costs for tax administration based on the Berkeley tax, and validated healthcare costs. Findings were evaluated over a lifetime, with costs inflated to constant 2017 US dollars and outcomes discounted annually by 3%. Results: With 100% pass-through, the tax prevented 518,000 CVD events among US adults 35+ years over a lifetime and was cost-saving from a societal perspective. Lifetime discounted healthcare cost savings ($31.5bn) were 24 times as large as tax implementation costs ($1.3bn). Evaluating cost-effectiveness by stakeholder, for the 6 consumer categories, the tax was not cost saving, but incremental cost-effectiveness ratios (ICERs) each were 〈 $50,000/QALY. For the government, tax revenues and healthcare savings were positive, netting $73.7bn in savings. For the beverage industry, net costs were $0.63bn (limited to tax compliance costs). With 50% pass-through, the tax would prevent 279,000 CVD events over a lifetime and remained cost-saving from a societal perspective. Government healthcare savings were approximately half as large, while consumer ICERs all remained 〈 $50,000/QALY. For the beverage industry, tax costs were $33.64bn, much larger than with 100% pass-through, reflecting lower producer revenue per unit sold. Findings were robust to a range of sensitivity analyses. Conclusions: A national SSB tax would improve health and be cost-saving nationally, with varying health impacts and costs across major stakeholders. These novel findings are relevant and timely for policy decisions on continuing expansion of SSB taxes.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1466401-X
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  • 4
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 137, No. suppl_1 ( 2018-03-20)
    Abstract: Introduction: The 2018 Farm Bill represents a major opportunity to reduce disparities in diet and health. The largest component is the Supplemental Nutrition Assistance Program (SNAP), feeding 1 in 6 Americans. Potential options include subsidizing fruits & vegetables (F & V), restricting sugar-sweetened beverages (SSBs), or implementing a broader food incentive/disincentive framework that preserves choice. Their comparative health impacts and cost-effectiveness are not established. Methods: Using a validated microsimulation model (CVD PREDICT), we estimated changes in CVD events, quality-adjusted life-years (QALYs), costs, and cost-effectiveness of 3 policy scenarios in SNAP adults: 1) 30% subsidy on F & V; 2) 30% F & V subsidy + SSB restriction; and 3) 30% subsidy on F & V, whole grains, nuts/seeds, seafood, plant-based oils, and 30% disincentive on SSBs, junk food, and processed meats. Model inputs included national data from NHANES (2009-2014), policy effects from SNAP pilots and food pricing meta-analyses, diet-disease effects from meta-analyses, and policy, food subsidy, and healthcare costs. Results: From a societal perspective, all 3 scenarios were cost-savings at 5, 10, 20 y and lifetime ( Table ). At 5 y, a F & V subsidy would prevent 32,218 CVD events, gain 18,072 QALYs, and save $1.04B ($6.05B lifetime). Corresponding values for a F & V subsidy + SSB restriction were 63,898, 45,772, and $4.47B ($38.83B); and for a broader incentive/disincentive framework that preserved choice, 65,078, 26,663, and $3.98B ($29.90B). Government affordability varied by program duration and by whether subsidy costs for SNAP adults or all SNAP participants were included. Scenario 3 was generally most cost-effective or -saving, followed by scenario 2 and then scenario 1; all were cost-effective over a lifetime from a government affordability perspective. Conclusions: Financial incentives/disincentives through SNAP could generate substantial health benefits and be cost-effective or cost savings.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1466401-X
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  • 5
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 129, No. suppl_1 ( 2014-03-25)
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. suppl_1 ( 2014-03-25)
    Abstract: Background: Global quality and trends over time of dietary patterns, a priority for reducing chronic diseases, are unknown. Methods: We evaluated age- and sex-specific energy-adjusted consumption, derived from 325 national surveys covering 88.7% of the global adult population, of 17 key foods and nutrients in 187 countries in 1990 and 2010. Diet patterns were assessed by two distinct scales, one based on higher intakes of healthful items (higher intakes=higher scores), and the other on lower intakes of unhealthful items (lower intakes=higher scores), by country, age, sex, and national income. Results: In 2010, global diet patterns varied substantially ( Figure ). African and South Asian nations had low scores based on more healthful items, but high scores based on fewer unhealthful items. In contrast, Western countries had moderate scores based on healthful items and very poor scores based on unhealthful items. This distinction between more healthful items and fewer unhealthful items was largely masked if we aggregated the two pattern scores, which were weakly correlated ( r =-0.08). By age and sex, women and older adults had higher scores based on either healthful or unhealthful items ( p 〈 0.05). Compared to low-income countries, high-income countries had higher scores based on more healthful items (+4.4 [95% uncertainty interval: 3.8, 5.0]), but substantially lower scores based on fewer unhealthful items (-28.1 [-27.3, -28.9] ). From 1990 to 2010, most regions improved their diets based on more healthful items (global average=+2.2 [2.0, 2.4]), except for poorest nations; conversely, nearly all regions worsened their diets based on fewer unhealthful items (-2.5 [-2.8, -2.2] ), with marked heterogeneity across global regions. Conclusions: Diet quality varies substantially worldwide, with important differences by higher intakes of healthier foods vs. lower intakes of unhealthy foods. The findings emphasize distinct, nation-specific policy priorities for increasing healthful and decreasing unhealthful foods.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1466401-X
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  • 6
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 125, No. suppl_10 ( 2012-03-13)
    Abstract: Background: Food-based research and policy recommendations are highly relevant in the modern era to understand and reduce the pandemics of chronic disease occurring in nearly all nations. Unfortunately, reliable and systematically assessed individual consumption data (as opposed to disappearance data) on food habits and trends have not been available on a global scale. Objective: To produce comprehensive data on consumption of major foods and their uncertainties by country, region, age, and sex in 1990 and 2005. Methods. We developed methods to identify, assess, and obtain exposure data (mean, SD) by age and sex from nationally representative diet surveys worldwide on fruits, vegetables, legumes, nuts/seeds, whole grains, seafood, red meats, processed meats, milk, and sugar-sweetened beverages. To address missing data and estimate mean intake, we developed and applied a multi-level hierarchical imputation Bayesian model that accounted for country- and region-level data, measurement comparability, study representativeness, and diet assessment method. Time-varying country-level covariates were used to inform estimates, including FAO food availability data, population, GDP, latitude, metabolic risks, and other diet covariates. Uncertainty of the estimates accounted for uncertainty from sampling and statistical modeling. Results: We obtained relevant data (85% by direct author contact) from 165 nationally and 40 non-nationally representative surveys from 109 countries in 20 regions, covering 79% of the global population. Data were most frequently available for fruits and vegetables (Figure). Findings for other foods will be presented at the meeting. Conclusions: Our systematic analysis of representative country-specific nutrition surveys on a global scale has produced estimates of the exposure distribution of major foods by age, sex, country, region, and time period. Such global assessment is crucial to estimate the impact of diet on chronic diseases worldwide.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1466401-X
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  • 7
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 135, No. suppl_1 ( 2017-03-07)
    Abstract: Introduction: The neighborhood food environment - locations and density of different types of stores and restaurants - is of great interest to reduce obesity. However, prior meta-analyses have focused on cross-sectional studies, for which reverse causation is a major limitation. Meta-analyses restricted to longitudinal study designs evaluating the food environment and change in BMI have yet to be conducted. Hypothesis: We hypothesized that increased exposure to fast food restaurants would be associated with increased change in BMI. Methods: Eleven databases were searched for longitudinal studies evaluating convenience stores, fast food restaurants, grocery stores, or supermarkets and change in BMI. Inclusion criteria consisted of: (1) interventional, quasi-experimental, or cohort studies; (2) adult or children populations; (3) any country; (4) geographic density or distance of food outlets; (5) a multivariable-adjusted change in BMI over time and corresponding uncertainty. Data were extracted independently and in duplicate, and studies pooled using fixed and random-effects models. Heterogeneity was quantified using Cochrane’s Q, and publication bias using funnel plots, Egger’s test, and Begg’s test. Results: 13 studies including 98,268 subjects were identified. In random effects models, no significant association was seen between food environments and change in BMI ( Figure ). A nonsignificant trend was seen toward lower BMI with increasing density of supermarkets; however, a similar nonsignificant trend was also observed between increasing density of fast food restaurants and lower BMI. Evidence for publication bias was not identified. Conclusion: In available longitudinal studies,no significant relationships were identified between food environments and change in BMI. Our novel findings support the need for further longitudinal and especially interventional studies of how the built food environment, including new measures related to cost and accessibility, may influence health and weight.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1466401-X
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  • 8
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 135, No. suppl_1 ( 2017-03-07)
    Abstract: Introduction: Worksites are promising venues for promoting health, given considerable time spent at work and opportunities for environmental change. Yet, the impact of worksite wellness programs (WWPs) on diet and adiposity, as well as the most relevant WWP components, are not established. Methods: Following MOOSE and PRISMA guidelines, we conducted a systematic review and meta-analysis of the impact of multi-component WWP trials (RCT or quasi-experimental) on diet and adiposity. Data were extracted in duplicate and pooled using inverse variance random effects meta-analysis. Pre-specified sources of heterogeneity (study design, world region, worksite type, duration, WWP components) were analyzed by meta-regression and subgroup analysis. Funnel plots, Begg’s, and Egger’s tests evaluated potential publication bias. Results: From 6612 abstracts, we identified 48 studies assessing WWPs and diet or adiposity. Most were in the US (54%) or Europe (23%), with diet (64%) and exercise/weight loss (20%) as main targets. Intervention components were variable (Figure). Most common outcomes were intakes of fruits and vegetables (F & V) (19 studies), total fat or fat subtypes (18), and dietary fiber (4); and BMI (35) and waist circumference (WC) (10). Median duration was 12 months (range: 1-48 mo). In pooled analyses, WWP increased intake of F & V, especially fruits (Figure). Significant effects were not identified for dietary fiber, total fat, or fat subtypes. WWP also reduced BMI (Figure) and WC (-2.03 cm, 95% CI:-3.88,-0.20). Trial duration significantly modified effects on BMI ( 〈 12 mo duration: -0.64 kg/m 2 ; 12+ mo: -0.16 kg/m 2 ; P-interaction=0.046); but not WC or F & V intake. Additional findings for heterogeneity, including WWP components, and publication bias will be presented. Conclusions: These novel findings support effectiveness of WWP for increasing F & V and reducing BMI and WC.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1466401-X
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  • 9
    In: Proceedings of the Nutrition Society, Cambridge University Press (CUP), Vol. 79, No. OCE2 ( 2020)
    Abstract: There is a pressing need for validated methods to assess healthfulness of grain foods to promote consumer awareness and policy change. We investigated how one pragmatic metric, the presence per 10 g of carbohydrate of at least 1 g of fiber (≤ 10:1-ratio), related to other constituents of grain foods as well as cardiometabolic risk factors in Brazil. Data were from the population-based study 2015 Health Survey of São Paulo, including a probabilistic sample of urban residents in São Paulo, Brazil. A total of 1,188 participants age 20 + years completed a 24-h dietary recall, and a subsample of 603 participants also had blood sample, anthropometric and blood pressure measurements collected, and answered a second 24-h recall. The National Cancer Institute method was used to estimate the usual intake of nutrients and foods. Energy and nutrient contents of grain foods meeting or not meeting the ≤ 10:1 ratio were evaluated using univariate linear regressions with robust variance. The association between the percent of energy (%E) from grain foods meeting the criterion and cardiometabolic risk factors was investigated in the subsample with complete data using multivariable linear regression models. Models were adjusted for age, sex, education, income, ethnicity, smoking status, alcohol intake, physical activity, prevalent clinical diseases, and total energy intake. Mean intake of grain foods meeting the ≤ 10:1 ratio was 1.7%E (95%CI 1.6%, 1.8%), and 0.2 50 g servings/day. Per 50 g serving, foods meeting the ≤ 10:1 ratio criterion had lower available carbohydrate (-3.0 g/serving, p = 0.045), total sugar (-7.4g/serving, p 〈 0.001), added sugar (-7.2 g/serving, p 〈 0.001) and saturated fatty acids (-0.7 g/serving, p = 0.022), as well as more dietary fiber (+ 3.5g/serving, p 〈 0.001), protein (+ 2.1 g/serving, p 〈 0.001), potassium (+ 100.1 mg/serving, p = 0.002), iron (+ 0.9 mg/serving, p = 0.011), selenium (+ 4.2 mcg/serving, p = 0.007), magnesium (+ 38.7 mg/serving, p 〈 0.001) and zinc (+ 1.1 mg/serving, p = 0.004). After multivariable-adjusted adjustment, each increase in 1%E from grain foods meeting the ≤ 10:1 ratio was associated with lower levels of blood triacylglycerol 12.5% (95%CI -22.4%, -3.8%), the triacylglycerol/HDL-c ratio (-16.9% 95%CI -30.6%, -4.5%), fasting insulin (-15.3% 95%CI -30.7%, -1.5%), and HOMA-IR (15.8% 95%CI -32.8%, -1.0%). The ≤ 10:1 ratio identified grain foods with higher nutritional quality and higher intakes of these foods were associated with fewer cardiometabolic risk factors, in particular risk factors related to atherogenic dyslipidemia and insulin resistance that are influenced by carbohydrate quality. This criterion may represent a useful method for characterizing and promoting healthful grain foods.
    Type of Medium: Online Resource
    ISSN: 0029-6651 , 1475-2719
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2016335-6
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  • 10
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 137, No. suppl_1 ( 2018-03-20)
    Abstract: Introduction: Excess added sugars, particularly from sugar-sweetened beverages (SSBs), are linked to cardiometabolic risk including obesity, type 2 diabetes (T2D) and CVD. Despite recent declines in SSB intake in the US, added sugar intake from SSBs and foods remains high and exceeds dietary recommendations. In May 2016, the US Food and Drug Administration (FDA) announced major revisions to the Nutrition Facts panel, including mandatory labeling of added sugar content, as a strategy to target added sugars from packaged foods and beverages. Yet, potential health effects remain unclear; and the FDA recently announced delays in implementation. Aim: To estimate the cardiometabolic and economic effects of implementing FDA’s added sugar labeling policy over a 20-year horizon. Methods: A validated microsimulation model, the US IMPACT Food Policy Model, was used to estimate the T2D and CVD cases averted and quality-adjusted life-years (QALYs) gained from the FDA policy for US adults age 30+ years. Model inputs included: nationally representative demographics and added sugar intakes from NHANES; policy effects on consumer intake from labeling intervention studies; obesity-mediated effects and direct independent effects of added sugars from SSBs and other foods, considered separately, on T2D and CVD from meta-analyses; policy costs including government administrative costs and industry compliance costs from federal government reports; national health statistics from the CDC; and healthcare costs including medical, productivity, and indirect costs from the AHA and American Diabetes Association. All costs were inflated to constant 2017 US dollars, discounted annually at 3%. We took a societal perspective and assumed a willingness to pay of $100,000 per QALY. Probabilistic sensitivity analysis accounted for model parameter uncertainty and population heterogeneity. Results: Between 2018 and 2037, the FDA added sugar labeling policy could prevent approximately 580,000 (95% UI: 270,000–960,000) T2D cases and 210,000 (96,000–440,000) CVD cases, generating 600,000 (290,000–970,000) discounted QALYs. The policy would produce discounted net cost savings (health savings minus policy costs) of $47.3bn (21.7-78.6), including $25.6bn (11.9-43.1) from direct healthcare cost reductions. Most ( 〉 60%) savings were driven by costs related to T2D. Incorporating modelling and input uncertainty, the FDA added sugar label was estimated with 〉 80% probability to be cost-effective by 2020 and cost-saving by 2022. Potential additional reductions from industry reformulations were not included and could further increase cost-savings. Conclusions: Implementing the FDA added sugar labeling mandate would generate substantial health gains and cost savings for the US population, highlighting the need for timely implementation, monitoring and evaluation.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1466401-X
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