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Health and Economic Consequences of an Impending Global Challenge
Get PDFObesity is a global ticking time-bomb with huge potential negative economic and health impacts, especially for the poor. As of 2016, an estimated 44 percent of adults (more than 2 billion) worldwide are overweight/obese, and over 70 percent of them live in low- or middle-income countries, dispelling the myth that obesity is a problem only in high-income countries. The global obesity epidemic presents a formidable challenge to human capital acquisition, national wealth accumulation, and the goals of ending extreme poverty and boosting shared prosperity. Given the renewed global focus on human capital, its links to the obesity epidemic, and the growing evidence base for double- and triple-duty actions, there is both an urgent need for action and a great opportunity for engagement that will require both a whole-of-government and a whole-of-development partner approach. Countries and global partners need to act urgently to address this ensuing epidemic with emphasis highlighting interventions that require corrective public action rather than one of individual responsibility
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Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis
Get PDFBackground Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. Methods and findings Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. Conclusions This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products
Increased energy intake and a shift towards high-fat, non-staple high-carbohydrate foods amongst China's older adults, 1991-2009
Get PDFObjective: We examined trends from 1991- 2009 in total energy intake and food group intake, and examine whether shifts varied by age or generation. Design: Longitudinal time series (1991, 1993, 1997, 2000, 2004, 2006, 2009) Setting: Nine provinces in China Participants: Older Chinese aged ≥60 years (n=5,068) from the China Health and Nutrition Survey from 1991-2009 Methods: Using three 24-hour recalls and a household food inventory collected over three consecutive days, the top twenty food group contributors to total energy intake from 1991- 2009 were identified, and the mean kilocalorie (kcal) difference between 1991 and 2009 for each food group was ranked. The top twenty food group contributors to total energy intake from 1991- 2009 were identified, and the mean kilocalorie (kcal) difference between 1991 and 2009 for each food group was ranked. Linear regression was used to examine changes in mean calorie intake of food groups between 1991 and 2009, adjusting for age, sex, and region. In addition, we examined changes in the mean kcal per capita intake to examine shifts by age group and generation. Results: Mean total energy intake increased significantly among older Chinese adults from 1379 total kilocalories in 1991 to 1463 kilocalories in 2009 (p< 0.001). Most food groups showed a significant increase in intake from 1991 to 2009, with plant oil, wheat buns, and wheat noodles showing the greatest increase. At the same age, more recent generations had more energy intake than earlier generations. An aging effect was observed, with energy intake decreasing with age, although more recent generations showed a smaller decrease in energy intake with aging. Conclusion: Older Chinese adults in recent generations show an increase in total calorie intake compared to older Chinese of earlier generations, paired with a less significant decrease in calorie intake as they age. Increased consumption of high-fat, non-staple high-carbohydrate foods such as plant oil and wheat buns suggests that diet quality of older Chinese adults is becoming less healthful in recent years.Bachelor of Science in Public Healt
Shifts in the nutritional quality of US young adults based on food sources and socioeconomic status, 1989-2014
Get PDFBackground: A lower nutritional quality observed in fast foods and other away from home food sources have led to speculation they increase risk of weight gain. For young adults, a population at high risk of obesity, little is known about the long-term shifts of their diet quality at home compared to away from home sources and whether these changes have influenced diet disparities that exist in the United States.Objective: Our objective was to investigate trends in diet quality for young adults based on food sources and socioeconomic status. Methods: Young adults ages 18-39 were investigated. Diet quality was measured by using the Healthy Eating Index (HEI) 2015 to score participants based on their 24-hour dietary recall data, which were derived from the Continuing Survey of Food Intakes by Individuals 1989-1991 and the National Health and Nutrition Examination Survey 2011-2012 and 2013-14.Results: Overall, diet quality of the sample population increased across all food sources from 1989-91 to 2011-14. The restaurant category overtook the at-home group for the healthiest food source, while fast food remained the unhealthiest option. Vegetable intake decreased across all sources while overall added sugar content increased. Non-Hispanic Whites and Non-Hispanic Blacks experienced similar increases in HEI-2015 scores across all food sources except restaurants, while Mexican American diet quality did not improve during this time period. Although all income levels experienced an increase in diet quality, the disparity between low and high-income groups increased dramatically.Conclusion: US young adults are consuming healthier foods from all food sources; however, consumers of fast food have significantly lower diet quality for the remainder of the day. Additionally, Mexican Americans and low-income individuals have emerged as high-risk groups for poor diet quality.Bachelor of Science in Public Healt
Longitudinal associations between the retail food environment, diet quality, and chronic disease risk among Black and White young adults in the United States
Get PDFThe recognition of the public health and economic consequences of nutrition-related chronic diseases has led to policies focused on improving the diets of the population subgroups at highest risk: low-income people and African Americans. Sometimes, however, the evidence base for these policies is weak. For example, in response to research suggesting that low-income areas have less access to affordable and nutritious foods, policy interventions have been proposed to address this access disparity; however, this association is far from well established. Similarly, the Dietary Guidelines for Americans (DGA) are widely promoted in public health campaigns, yet there is surprisingly little evidence that following them is effective at reducing risk of chronic disease in the general population, in part because most past studies have been cross-sectional, demographically homogeneous, or conceptually flawed (e.g., potential for reverse causality). Our research fills important substantive gaps in the understanding of these relationships using data from a geographically diverse cohort of Black and White young adults (followed from 1985 to 2005) and analytic methods that exploit the longitudinal structure of the data. First, we examined the longitudinal association between neighborhood socio-demographics and the availability of foods stores. We found that poor and high minority areas had higher availability of supermarkets and grocery stores. This suggests that, contrary to common assumption, stores where healthy foods can typically be purchased are available to the subgroups at highest risk. Second, we examined the prospective association between adherence to the 2005 DGA and risk of major weight gain, diabetes, and progression of other cardio-metabolic risk factors. Overall, we found little evidence that a higher diet quality led to better long-term health (except for blood pressure and HDL cholesterol outcomes). In Whites, higher diet quality was associated with less 20-year weight gain, but unrelated to diabetes incidence or insulin resistance. However, in Blacks, higher diet quality was associated with greater 20-year weight gain, and with slightly higher incidence of diabetes and increase in insulin resistance. Results of this research highlight the urgent need for effectiveness trials of the DGA
Sugar-Sweetened Beverage (SSB) Consumption is Associated with Lower Quality of the Non-SSB Diet in U.S. Adolescents and Young Adults
No full textBackground. Since 2003-4, the US has seen large declines in sugar-sweetened beverage (SSB) intake overall and especially among non-Hispanic white subpopulations. Obesity prevalence has not shown comparable declines in the two highest SSB groups, adolescents and young adults. Little is understood about the quality of the diet excluding SSBs (non-SSB diet).Objective. The objective of this study is to evaluate differences in non-SSB diet quality among SSB consumers and non-consumers in adolescents and young adults and among the three major ace/ethnic subgroups.Design. This study utilized data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally representative survey of the US population for both days of the survey, when possible.Participants. This study included 6,426 adolescents, ages 12-18, and young adults, ages 19-29, in NHANES (2009-2014).Main outcome measures. Quality of the non-SSB diet was measured using the 2015 Healthy Eating Index (HEI).Statistical analyses performed. Multivariate linear regressions controlled for sociodemographic characteristics and stratified by race/ethnicity (non-Hispanic whites, non-Hispanic blacks, and Hispanics). Subpopulations were stratified by non-SSB consumption, low consumption, and high consumption based on the World Health Organization’s added sugar recommendations. Results. Adolescents and young adults had significantly different non-SSB HEI scores among different SSB consumer groups (p < 0.001), with higher non-SSB HEI scores among non-consumers. However, non-SSB HEI scores were universally low and require improvement. Among non-Hispanic Blacks, significant differences in non-SSB HEI were only found between non- and low SSB consumers. Among Hispanics, associations varied by age group, with significant differences found for young adults but no association found for adolescents. Conclusions. Universally low non-SSB HEI scores among SSB consumers indicate that reducing SSB consumption alone will not be a sufficient strategy for improving dietary quality among adolescents and young adults. Future interventions need to consider ways to increase the quality of the non-SSB diet.Bachelor of Science in Public Healt
Diet quality and socio-demographic characteristics of self-perceived vegetarians in the United States, 1977-2010
Get PDFIncreasing knowledge of how the diet composition and socio-demographics of vegetarians have
changed over time can help us to understand changes in the health and nutrition status of
vegetarians. The objective of this study is to examine the shift in diet composition of self-perceived
vegetarians over the past forty years, as well as the demographic and socioeconomic
characteristics of being a self-perceived vegetarian in 1977 and in 2010. Using OLS regression,
the probability of being a vegetarian by key demographic characteristics was examined for 1977-
78 and 2007-2010. Consumption of key nutrients, including total daily kilocalories, ounces of
meat, added sugars, whole grains, servings of fruits and vegetables were compared by vegetarian
status in 1977-78 and 2007-2010. In doing so, the final goal is to compare the overarching
picture of the diet of vegetarians over the past forty years in the United States.Bachelor of Science in Public Healt
Analysis of Trends in Dietary Energy, Carbohydrate, Fat, Protein, Sodium, and Potassium Intake in Chinese Adolescents from 1991 to 2011
Get PDFObjective: To examine temporal trends in dietary energy, carbohydrate, fat, and protein intake,
and sodium and potassium intake of Chinese adolescents aged 12 – 17 years by sex and
urbanicity, using data from the China Health and Nutrition Survey (CHNS).
Methods: Individual level, consecutive 3 – day 24 hour recalls were analyzed from survey years
1991 (n=489), 2000 (n=677), and 2011 (n=253) from nine provinces that represent a range of
geography, economic development, public resources, and health indicators in China. Linear
multivariable regression models were conducted to predict the mean intake of energy,
macronutrients, sodium and potassium. Models were adjusted for age, per capita income,
mother’s education, region, and family size.
Results: Intakes of total energy, sodium, and sodium-potassium ratio decreased from 1991 to
2011 (p<0.01) among both sexes and all urbanicity groups; however, the major shift was a
structural change from carbohydrates to fat and protein. Both sexes showed decrease in
carbohydrate-derived energy and increase in fat-derived energy (p<0.05). Increase in protein
intake was only significant in the male and high-urbanicity groups (p<0.01). Changes in
potassium intake were only observed in the high urbanicity group (p<0.01).
Conclusions: This data suggest that Chinese adolescents are undergoing a transition to a high fat
diet, independent of sex or urbanicity. Urbanicity appears to play a role in protein and potassium
intake. Improvements of sodium-potassium ratios seem primarily due to decrease in sodium
intake and require further reduction efforts.Bachelor of Science in Public Healt
Determining Body Mass Index Cutoffs to Identify Increased Risk of Hypertension for Asian Ethnicities
Get PDFAn optimal BMI cutoff is needed in public health and clinical settings as the guidance an optimal body weight. Although body mass index (BMI) cutoffs of 25 and 30 kg/m2 for overweight and obesity, respectively, have been widely used among Westerners and recommended by the World Health Organization as an international criterion for body fatness at the population level, there are still controversial opinions about the optimal BMI cutoffs for Asians. We conducted the study to determine an optimal BMI cutoff for overweight, which represents elevated hypertension and to determine the best anthropometric index in the prediction of hypertension in Asians. We used data from representative surveys conducted in China, Indonesia, and Vietnam in the early 2000s. With the use of ROC curve analyses, both longitudinal and cross-sectional studies suggest an optimal BMI cutoff of < 25 kg/m2. The lower optimal BMI level is beneficial for Asians because it triggers earlier preventions for overweight and non-communicable diseases (NCDs), and thus, reduces economic and health burdens due to overweight and NCDs among Asians worldwide. In addition, our study shows ethnic differences in optimal BMI cutoffs between Chinese, Indonesian, and Vietnamese adults and suggests the use of country specific BMI cutoffs. We contribute to current knowledge by providing a BMI cutoff based on a longitudinal sample in Asians and a sample of Southeast Asians. With the use of the change-in-estimate approach, our findings show that waist circumference does not perform better than BMI or adds meaningfully to the prediction of hypertension outcome by BMI. BMI appears to be sufficient to screen for cardiovascular risk in Asians
China’s Nutrition Transition: The Effects of Rapid Social Change on Adult Activity Patterns and Overweight
Get PDFThe rising prevalence of overweight throughout the world has prompted the recognition of a "global epidemic," with increases being partially attributed to population-level reductions in physical activity and increases in sedentary behaviors. In China, overweight has started to emerge as a significant public health concern. Prospective research on the relationship between physical activity and overweight is relatively uncommon in the developing world, and China offers a unique opportunity for study given the tremendous increases in urbanization and economic development seen in the recent past. Such growth can impact the physical activity patterns of individuals by driving concomitant increases in car ownership, in labor-saving household devices, in the mechanization of the workplace, as well as decreases in the proportion of the workforce employed in more physically-demanding occupations. The purpose of this research was to examine the impact of urbanization on the physical activity patterns of Chinese adults, as well as to investigate the impact of these changes on weight status. Analyses were conducted using data from the China Health and Nutrition Survey, an ongoing longitudinal study of a socioeconomically and demographically diverse sample of the Chinese population. Using multilevel models we showed that community-level urbanization was importantly associated with occupational activity after adjustment for individual-level sociodemographic factors. In subsequent analyses we found both occupational and household activity to be important predictors of weight in men and iv women, while leisure time and transportation activity did not have the same effect. This research helps to fill an important gap in understanding the impact of urbanization on physical activity and on subsequent overweight in an enormous transitioning populace
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