1
|
Arora A, Rahaman KS, Parmar JS, Gupta A, Evans N, Chandio N, Selvaratnam N, Manohar N. Trajectories of Sugar-Sweetened Beverage Intake in Early Life: Evidence from a Birth Cohort Study. Nutrients 2024; 16:2336. [PMID: 39064778 PMCID: PMC11279875 DOI: 10.3390/nu16142336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Infancy and early childhood are periods of dietary transition. Early exposure to specific foods and the establishment of dietary habits during this period can shape long-term food preferences and have lasting effects on health. This study aimed to examine the longitudinal trajectories of sugar-sweetened beverage (SSB) intake in Australian children from birth to age 3 years and identify early-life and socioeconomic factors influencing those trajectories. Mother-infant dyads (n = 934) from the Healthy Smiles Healthy Kids birth cohort study were interviewed on their weekly frequency of SSB intake at 4-month, 8-month, 1-year, 2-year, and 3-year age points. Group-based trajectory modelling analysis was performed to identify trajectories for SSB intake among Australian children. A multivariable logistic regression was performed to identify the maternal and child-related predictors of resulting trajectories. The intake of SSBs showed two distinct quadratic trajectories (high and low) with age. While the two trajectories remained distinctive throughout, the SSB consumption for both groups consistently increased between 4 months and 2 years of age and subsequently stabilised. Compared to low SSB consumers (75%), the high SSB consumers (25%) were significantly more likely to be living in households with three or more children (relative risk (RR): 1.59, 95%CI: 1.02-2.48), had low maternal education (left school < year 12-RR: 1.75, 95%CI: 1.09-2.81; completed year 12-RR: 1.57, 95%CI: 1.02-2.81), and resided in highly/the most socioeconomically disadvantaged areas (highly disadvantaged-RR: 1.89, 95%CI: 1.13-3.18; most disadvantaged-RR: 2.06, 95%CI: 1.25-3.38). Children's SSB intake patterns are established early in life as they transition from infancy to preschool age, and the trajectories of intake established during early childhood are strongly influenced by socioeconomic factors. Hence, interventions targeted to limit SSB intake and improve nutrition amongst children should occur in early life.
Collapse
Affiliation(s)
- Amit Arora
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia; (K.S.R.); (J.S.P.); (N.E.); (N.S.)
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia; (N.C.); (N.M.)
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Kh. Shafiur Rahaman
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia; (K.S.R.); (J.S.P.); (N.E.); (N.S.)
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia; (N.C.); (N.M.)
| | - Jinal Shashin Parmar
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia; (K.S.R.); (J.S.P.); (N.E.); (N.S.)
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia; (N.C.); (N.M.)
| | - Adyya Gupta
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia;
| | - Nicole Evans
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia; (K.S.R.); (J.S.P.); (N.E.); (N.S.)
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia; (N.C.); (N.M.)
| | - Navira Chandio
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia; (N.C.); (N.M.)
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Navodya Selvaratnam
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751, Australia; (K.S.R.); (J.S.P.); (N.E.); (N.S.)
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia; (N.C.); (N.M.)
| | - Narendar Manohar
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia; (N.C.); (N.M.)
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| |
Collapse
|
2
|
Li X, Liu Y, Qi Y, Wu Y, Wang M, Gao J, Su Q, Ma J, Qin L. Maternal Serum Polyols and Its Link to Gestational Diabetes Mellitus: A Population-Based Nested Case-Control Study. J Clin Endocrinol Metab 2024; 109:1858-1865. [PMID: 38189482 PMCID: PMC11180503 DOI: 10.1210/clinem/dgae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
CONTEXT Sugar alcohols (also called polyols) are regarded as a "healthy" sugar substitute. One of the possible reasons for their safe use in pregnant women is their natural origin and the presence of polyols in maternal and fetal samples during normal human gestation. But little is known about the association between circulating sugar alcohols levels and maternal metabolic disorders during pregnancy. OBJECTIVE We aimed to detect the concentration of the polyols in participants with and without gestational diabetes mellitus (GDM), and to investigate the association between maternal serum levels of polyols and GDM, as well as newborn outcomes. METHODS A nested population-based case-control study was conducted in 109 women with and without GDM. Maternal concentrations of serum erythritol, sorbitol, and xylitol in the fasting state were quantified using a time of flight mass spectrometry system. RESULT In women with GDM, serum concentrations of erythritol and sorbitol were higher, but serum concentrations of xylitol were lower than those in women without GDM. Per 1-SD increment of Box-Cox-transformed concentrations of erythritol and sorbitol were associated with the increased odds of GDM by 43% and 155% (95% CI 1.07-1.92 and 95% CI 1.77-3.69), while decreased odds were found for xylitol by 25% (95% CI 0.57-1.00). Additionally, per 1-SD increase of Box-Cox-transformed concentrations of serum sorbitol was associated with a 52% increased odds of large for gestational age newborns controlling for possible confounders (95% CI 1.00-2.30). CONCLUSION Maternal circulating sugar alcohols levels during pregnancy were significantly associated with GDM. These findings provide the potential roles of polyols on maternal metabolic health during pregnancy.
Collapse
Affiliation(s)
- Xiaoyong Li
- Department of Endocrinology and Metabolism, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yu Liu
- Department of Endocrinology and Metabolism, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yicheng Qi
- Department of Endocrinology and Metabolism, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yiming Wu
- Department of Endocrinology, Chongming Hospital Affiliated to Shanghai University of Health & Medicine Sciences (Chongming Branch of Xinhua Hospital), Shanghai 202150, China
| | - Meng Wang
- Department of Endocrinology and Metabolism, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jing Gao
- Department of Traditional Chinese Medicine, Pujiang Community Health Service Center, Minhang District, Shanghai 201112, China
| | - Qing Su
- Department of Endocrinology and Metabolism, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jing Ma
- Department of Endocrinology and Metabolism, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Li Qin
- Department of Endocrinology and Metabolism, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Department of Endocrinology, Chongming Hospital Affiliated to Shanghai University of Health & Medicine Sciences (Chongming Branch of Xinhua Hospital), Shanghai 202150, China
| |
Collapse
|
3
|
Jokirinta J, Päkkilä J, Mourelatos E, Sipola S, Laitala ML, Karki S. Trend in basic oral treatment needs in relation to taxation of sweets, ice cream, and sugar-sweetened beverages in Finland: a registry-based study. Acta Odontol Scand 2024; 83:160-165. [PMID: 38628100 PMCID: PMC11302471 DOI: 10.2340/aos.v83.40335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/14/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE The aims were to explore the trend in basic oral treatment needs and total operating cost of public dental services (PDS) in relation to total excise tax revenue generated from sugary products during 2011-2020 and to evaluate the impact of tax policy in excise tax revenue of sugary products and average sugar consumption. METHODS The study comprised longitudinal data retrieved from Finnish registries during the years 2011-2020. Basic oral treatment needs, and total operating cost of PDS, total excise tax revenue generated from sugary products and average sugar consumed (kg per capita) during the years 2011-2020 were obtained. Simplified panel analyses and sensitivity analyses were used to evaluate the effects of explanatory variables on outcomes. Results: An approximate one EUR 1,000,000 increase in total excise tax revenue generated from sugary products corresponds to a 0.4% increase in total operating cost of PDS. There was a significant positive trend in total operating cost of PDS in Finland over the study period. Similarly, an approximate one EUR 1,000,000 rise in total excise tax revenue corresponds to a 0.2% increase in basic oral treatment needs. Additionally, there was a statistically significant difference in the average excise tax revenue for sugary products between the periods before and after 2017. CONCLUSION No change in average sugar consumption was observed despite implementing the new sugar policy. Therefore, it may be worthwhile to reconsider the excise tax on sweets and ice cream as it will significantly increase the total national revenues.
Collapse
Affiliation(s)
- Jesse Jokirinta
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Jari Päkkilä
- Research Unit of Mathematical Sciences, University of Oulu, Oulu, Finland
| | | | - Sakari Sipola
- Oulu Business School, University of Oulu, Oulu, Finland
| | - Marja-Liisa Laitala
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu and Oulu University Hospital, Oulu, Finland.
| | - Saujanya Karki
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| |
Collapse
|
4
|
Mohd Hanim MFB, Md Sabri BA, Yusof N. Online commentaries of the sugar-sweetened beverages tax in Malaysia: Content analysis. Public Health Nurs 2024; 41:139-150. [PMID: 37953703 DOI: 10.1111/phn.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Implementing taxes on sugary drinks, or SSBs, has been a controversial topic in many countries, including Malaysia. This study aimed to examine how Malaysian Facebook users responded to the announcement and implementation of the SSBs tax through netnography. METHODS This cross-sectional study employed qualitative and quantitative methods and used an inductive approach and thematic content analysis to analyze online commentaries on news articles published on popular online news portals from November 2018 to August 2019. Data was collected by downloading the commentaries onto Microsoft Word and importing them into NVivo. RESULTS Of the commentaries analyzed, 60.9% rejected the SSBs tax, and 39.1% favored it. No association was found between the online news articles and the slants of the commentaries. CONCLUSION The results of this study demonstrate a clear divide in public opinion regarding the SSBs tax in Malaysia, with many online readers expressing opposition to the tax despite evidence of the harmful effects of sugar presented in the articles they are commenting on. These findings have implications for policymakers and public health advocates seeking to implement similar taxes in the future.
Collapse
Affiliation(s)
- Muhammad Faiz Bin Mohd Hanim
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
- Oral Health Program, Ministry of Health, Federal Government Administrative Centre, Putrajaya, Malaysia
| | - Budi Aslinie Md Sabri
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| |
Collapse
|
5
|
Rogers NT, Conway DI, Mytton O, Roberts CH, Rutter H, Sherriff A, White M, Adams J. Estimated impact of the UK soft drinks industry levy on childhood hospital admissions for carious tooth extractions: interrupted time series analysis. BMJ Nutr Prev Health 2023; 6:243-252. [PMID: 38264366 PMCID: PMC10800259 DOI: 10.1136/bmjnph-2023-000714] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/18/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Tooth extraction due to dental caries is associated with socioeconomic deprivation and is a major reason for elective childhood hospital admissions in England. Consumption of sugar-sweetened beverages is a risk factor for dental caries. We examined whether the soft drinks industry levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in incidence rates of hospital admissions for carious tooth extraction in children, 22 months post-SDIL implementation. Methods Changes in incidence rates of monthly National Health Service hospital admissions for extraction of teeth due to a primary diagnosis of dental caries (International Classification of Diseases; ICD-10 code: K02) in England, between January 2012 and February 2020, were estimated using interrupted time series and compared with a counterfactual scenario where SDIL was not announced or implemented. Periodical changes in admissions, autocorrelation and population structure were accounted for. Estimates were calculated overall, by Index of Multiple Deprivation (IMD) fifths and by age group (0-4 years, 5-9 years, 10-14 years, 15-18 years). Results Compared with the counterfactual scenario, there was a relative reduction of 12.1% (95% CI 17.0% to 7.2%) in hospital admissions for carious tooth extractions in all children (0-18 years). Children aged 0-4 years and 5-9 years had relative reductions of 28.6% (95% CI 35.6% to 21.5%) and 5.5% (95% CI 10.5% to 0.5%), respectively; no change was observed for older children. Reductions were observed in children living in most IMD areas regardless of deprivation. Conclusion The UK SDIL was associated with reductions in incidence rates of childhood hospital admissions for carious tooth extractions, across most areas regardless of deprivation status and especially in younger children. Trial registration number ISRCTN18042742.
Collapse
Affiliation(s)
- Nina Trivedy Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - David I Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Oliver Mytton
- Institute of Child Health, University College London, London, UK
| | - Chrissy H Roberts
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Andrea Sherriff
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| |
Collapse
|
6
|
Nguyen TM, Tonmukayakul U, Khanh‐Dao Le L, Singh A, Lal A, Ananthapavan J, Calache H, Mihalopoulos C. Modeled health economic and equity impact on dental caries and health outcomes from a 20% sugar sweetened beverages tax in Australia. HEALTH ECONOMICS 2023; 32:2568-2582. [PMID: 37477540 PMCID: PMC10946924 DOI: 10.1002/hec.4739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 07/22/2023]
Abstract
Dental caries is the most prevalent oral disease across the life course. This study modeled the population health and economic impact of a 20% sugar sweetened beverages tax (SSB) for preventing dental caries compared to no intervention (societal and healthcare perspective). A cost-effectiveness analysis according to quintiles of area-level socioeconomic disadvantage was performed for the 2020 Australian population (0-100 years old) using a closed cohort Markov model. A qualitative assessment of implementation considerations (e.g., acceptability, equity, sustainability) was undertaken. Health outcomes were modeled as decayed teeth prevented and disability-adjusted life years (DALYs) averted. The 10-year and lifetime scenarios were modeled with probabilistic sensitivity analysis (Monte Carlo simulation, 2000 cycles). The 10-year scenario from a societal perspective yielded cost-savings of AUD$63.5M, healthcare cost-savings of AUD$42.2M, 510,977 decayed teeth averted and 98.1 DALYs averted. The lifetime scenario resulted in societal cost savings of AUD$176.6M, healthcare cost-savings of AUD$122.5M, 1,309,211 decayed teeth averted and 254.9 DALYs averted. Modeling indicated 71.5% and 74.5% cost-effectiveness for the 10-year and lifetime scenarios, respectively. A three-fold health benefit for the least advantaged was found compared to the most advantaged. A 20% SSB tax in Australia is cost-effective and promotes health equity.
Collapse
Affiliation(s)
- Tan Minh Nguyen
- Public Health & Preventive MedicineFaculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Utsana Tonmukayakul
- Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Long Khanh‐Dao Le
- Public Health & Preventive MedicineFaculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Ankur Singh
- Melbourne School of Population and Global Health & Melbourne Dental SchoolFaculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Anita Lal
- Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Jaithri Ananthapavan
- Deakin Health Economics and Global Centre for Preventive Health and NutritionInstitute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Hanny Calache
- Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | - Cathrine Mihalopoulos
- Public Health & Preventive MedicineFaculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| |
Collapse
|
7
|
Shen J, Wang J, Yang F, An R. Impact of soda tax on beverage price, sale, purchase, and consumption in the US: a systematic review and meta-analysis of natural experiments. Front Public Health 2023; 11:1126569. [PMID: 37808982 PMCID: PMC10556476 DOI: 10.3389/fpubh.2023.1126569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background As a primary source of added sugars in the US diet, sugar-sweetened beverage (SSB) consumption is presumed to contribute to obesity prevalence and poor oral health. We systematically synthesized and quantified evidence from US-based natural experiments concerning the impact of SSB taxes on beverage prices, sales, purchases, and consumption. Methods A keyword and reference search was performed in PubMed, Web of Science, Cochrane Library, Scopus, and EconLit from the inception of an electronic bibliographic database to Oct 31, 2022. Meta-analysis was conducted to estimate the pooled effect of soda taxes on SSB consumption, prices, passthrough rate, and purchases. Results Twenty-six natural experiments, all adopting a difference-in-differences approach, were included. Studies assessed soda taxes in Berkeley, Oakland, and San Francisco in California, Philadelphia in Pennsylvania, Boulder in Colorado, Seattle in Washington, and Cook County in Illinois. Tax rates ranged from 1 to 2 ¢/oz. The imposition of the soda tax was associated with a 1.06 ¢/oz. (95% confidence interval [CI] = 0.90, 1.22) increase in SSB prices and a 27.3% (95% CI = 19.3, 35.4%) decrease in SSB purchases. The soda tax passthrough rate was 79.7% (95% CI = 65.8, 93.6%). A 1 ¢/oz. increase in soda tax rate was associated with increased prices of SSBs by 0.84 ¢/oz (95% CI = 0.33, 1.35). Conclusion Soda taxes could be effective policy leverage to nudge people toward purchasing and consuming fewer SSBs. Future research should examine evidence-based classifications of SSBs, targeted use of revenues generated by taxes to reduce health and income disparities, and the feasibility of redesigning the soda tax to improve efficiency.
Collapse
Affiliation(s)
- Jing Shen
- Department of Physical Education, China University of Geosciences (Beijing), Beijing, China
| | - Junjie Wang
- School of Kinesiology and Health Promotion, Dalian University of Technology, Dalian, Liaoning, China
| | - Fan Yang
- School of Public Administration, Dongbei University of Finance and Economics, Dalian, Liaoning, China
| | - Ruopeng An
- Brown School, Washington University, St. Louis, MO, United States
| |
Collapse
|
8
|
Hornung J, Sager F. The non-use of evidence in the adoption of a sugar-sweetened beverage tax in OECD countries. Eur J Public Health 2023:ckad098. [PMID: 37328449 PMCID: PMC10393501 DOI: 10.1093/eurpub/ckad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Studies confirm the positive effect of sugar-sweetened beverage (SSB) taxation on public health. However, only a few countries in Europe adopt SSB taxes. From a public policy perspective, we investigate the conditions under which countries do or do not follow this evidence. METHODS Crisp-set Qualitative Comparative Analysis (QCA) of 26 European Organization of Economic Cooperation and Development countries with and without an SSB tax. We test which configurations of conditions (problem pressure, governmental composition, strategic planning, health care system, public health policies, inclusion of expert advice in policymaking) emerge as relevant in determining adoption and non-adoption between the years 1981 and 2021. Pathways that lead to the presence and absence of SSB taxes are identified separately. RESULTS At least one of the following configurations of conditions is present in countries that introduced taxation: (i) high financial problem pressure, low regulatory impact assessment activity; (ii) high public health problem pressure, a contribution-financed health care system, no holistic strategy for combatting non-communicable diseases (NCDs); (iii) a tax-financed health care system, a holistic NCD strategy, high strategic and executive planning capacity. In countries that did not adopt SSB taxes, we find (i) high regulatory impact assessment activity, high levels of sugar export; (ii) no holistic NCD strategy, high spending on preventive care; (iii and iv) a lack of strategic planning capacity and either a high share of spending on preventive care or inclusion of expert advice. DISCUSSION Evidence inclusion requires clear policy priorities in terms of strategy and resources to promote public health.
Collapse
Affiliation(s)
- Johanna Hornung
- KPM Center for Public Management and Multidisciplinary Center for Infectious Diseases (MCID), University of Bern, Bern, Switzerland
| | - Fritz Sager
- KPM Center for Public Management and Multidisciplinary Center for Infectious Diseases (MCID), University of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Hajishafiee M, Kapellas K, Listl S, Pattamatta M, Gkekas A, Moynihan P. Effect of sugar-sweetened beverage taxation on sugars intake and dental caries: an umbrella review of a global perspective. BMC Public Health 2023; 23:986. [PMID: 37237341 DOI: 10.1186/s12889-023-15884-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND As part of the Global Strategy on Oral health, the World Health Organization (WHO) is exploring cost-effective interventions for oral health, including taxation on sugar-sweetened beverages (SSBs). To inform this process, this umbrella review aimed to identify the best available estimates pertaining to the impact of SSB taxation on the reduction of sugars intake, and the sugars-caries dose-response, such that estimates of the impact of SSB taxation on averting dental caries in both high (HIC) and low and middle (LMIC) countries be available. METHODS The questions addressed were: (1) what are the effects of SSB taxation on consumption of SSBs and (2) sugars? (3) What is the effect on caries of decreasing sugars? and (4) what is the likely impact of a 20% volumetric SSB tax on the number of active caries prevented over 10 years? Data sources included PubMed, Embase, Web of Science, Scopus, CINAHL, Dentistry and Oral Sciences Source, Cochrane Library, Joanna Briggs Institute (JBI) Systematic Review Register, and PROSPERO. The review was conducted with reference to JBI guidelines. The quality of included systematic reviews was assessed using AMSTAR to identify best evidence. RESULTS From 419 systematic reviews identified for questions 1 & 2, and 103 for question 3, 48 (Questions 1 & 2) and 21 (Question 3) underwent full text screening, yielding 14 and five included reviews respectively. Best available data indicated a 10% tax would reduce SSB intake by 10.0% (95% CI: -5.0, 14.7%) in HIC and by 9% (range -6.0 to 12.0%) in LMIC, and that a 20% tax would reduce free sugars intake on average by 4.0 g/d in LMIC and 4.4 g/d in HIC. Based on best available dose response data, this could reduce the number of teeth with caries per adults (HIC and LMIC) by 0.03 and caries occurrence in children by 2.7% (LMIC) and 2.9% (HIC), over a 10-year period. CONCLUSION Best available data suggest a 20% volumetric SSB tax would have a modest impact on prevalence and severity of dental caries in both HIC and LMIC.
Collapse
Affiliation(s)
| | - Kostas Kapellas
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Madhuri Pattamatta
- Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Athanasios Gkekas
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Paula Moynihan
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia.
| |
Collapse
|
10
|
Dötsch-Klerk M, Bruins MJ, Detzel P, Martikainen J, Nergiz-Unal R, Roodenburg AJC, Pekcan AG. Modelling health and economic impact of nutrition interventions: a systematic review. Eur J Clin Nutr 2023; 77:413-426. [PMID: 36195747 PMCID: PMC10115624 DOI: 10.1038/s41430-022-01199-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/17/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022]
Abstract
Diet related non-communicable diseases (NCDs), as well as micronutrient deficiencies, are of widespread and growing importance to public health. Authorities are developing programs to improve nutrient intakes via foods. To estimate the potential health and economic impact of these programs there is a wide variety of models. The aim of this review is to evaluate existing models to estimate the health and/or economic impact of nutrition interventions with a focus on reducing salt and sugar intake and increasing vitamin D, iron, and folate/folic acid intake. The protocol of this systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016050873). The final search was conducted on PubMed and Scopus electronic databases and search strings were developed for salt/sodium, sugar, vitamin D, iron, and folic acid intake. Predefined criteria related to scientific quality, applicability, and funding/interest were used to evaluate the publications. In total 122 publications were included for a critical appraisal: 45 for salt/sodium, 61 for sugar, 4 for vitamin D, 9 for folic acid, and 3 for iron. The complexity of modelling the health and economic impact of nutrition interventions is dependent on the purpose and data availability. Although most of the models have the potential to provide projections of future impact, the methodological challenges are considerable. There is a substantial need for more guidance and standardization for future modelling, to compare results of different studies and draw conclusions about the health and economic impact of nutrition interventions.
Collapse
Affiliation(s)
- Mariska Dötsch-Klerk
- Unilever Foods Innovation Centre, Wageningen, The Netherlands.
- Unilever Foods Innovation Centre, Wageningen, Bronland 14, 6708 WH, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
11
|
The effects of a sugar-sweetened beverage tax: moving beyond dental health outcomes and service utilisation. HEALTH ECONOMICS, POLICY, AND LAW 2023; 18:139-153. [PMID: 35916234 DOI: 10.1017/s1744133122000147] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Despite considerable academic and policy interest in the taxation of sugar-sweetened beverages (SSBs), its extra-health implications remain largely unexplored. We investigated the impact of an SSB tax on school absenteeism due to improved dental health, in a framework that accounted for the distribution of the benefit. We designed a quantitative, decision-analytic model that synthesised existing evidence in the areas of dental epidemiology, public health and economics, and simulated causal mechanisms that lead to changes in school attendance in Australian children and adolescents aged 6-17, in a tax vs no tax scenarios. Introducing a 20% sales tax on SSBs would result in a 0.73% (95% confidence interval: 0.38; 1.10), or 4684 (2412; 7071) days per year nationwide, reduction in school absences attributable to dental health reasons. While positive impacts would be seen across the board, the distribution of benefit was favourable towards boys, older teens and those from lower socio-economic status. Our study highlights the need for, and the viability of, quantifying distributions of direct and indirect consequences of public health policy. Despite modest effect size, the equity profile of SSB tax, the long-lasting benefits of educational gains, and potential synergies with other interventions, make it an attractive option for policymakers to consider.
Collapse
|
12
|
Broomhead T, Baker SR. From micro to macro: Structural determinants and oral health. Community Dent Oral Epidemiol 2023; 51:85-88. [PMID: 36749674 DOI: 10.1111/cdoe.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 02/08/2023]
Abstract
The structural determinants of health include social, economic and political mechanisms which generate social stratification and the socioeconomic positions of individuals within society. Despite their importance, these 'causes of the causes' are still relatively under-studied within oral health research. Yet it is important to assess the effects of these 'upstream' determinants, given that most individuals cannot influence or change them. It is also important to move beyond focusing primarily on downstream determinants and approaches at the individual or household level. This review will offer a brief overview of what is currently known about structural determinants and upstream interventions in relation to oral health. The review starts by briefly summarizing oral health focused studies of structural determinants, including welfare regimes, governance and macroeconomic, social and public policies. Current knowledge on upstream interventions associated with oral health such as community water fluoridation, sugar sweetened beverage taxes and dental payment structures will also be covered. The article will then assess gaps in the research base, including current limitations and barriers-as well as opportunities-in analysing the effects of structural determinants and upstream interventions. The review finishes by suggesting next steps for better understanding and addressing these determinants and interventions-including considerations around theory, data and approaches from other fields such as systems science-with the hope that these can help make contributions to future policy decision making processes.
Collapse
Affiliation(s)
- Tom Broomhead
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Sarah R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| |
Collapse
|
13
|
Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
Collapse
Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | | |
Collapse
|
14
|
Shakiba M, Iranparvar P, Jadidfard MP. The impact of sugar-sweetened beverages tax on oral health-related outcomes: a systematic review of the current evidence. Evid Based Dent 2022:10.1038/s41432-022-0830-1. [PMID: 36477678 DOI: 10.1038/s41432-022-0830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/15/2022] [Indexed: 06/17/2023]
Abstract
Objective To provide a systematic overview of the impact of taxing sugar-sweetened beverages (SSBs) on oral health-related outcomes.Data sources For this PRISMA-compliant review, we searched PubMed, Scopus, Embase, Web of Science and Cochrane Central for relevant studies published from database inception to 27 August 2020.Data selection and extraction Two reviewers assessed the abstracts and then the full text of the studies. Primary studies that evaluated the impact of any kind of SSB tax on oral health-related outcomes (that is, decayed, missing and filled teeth, caries increment and dental treatment costs) were included.Data synthesis Of 503 search results, five studies met the inclusion criteria. All five were modelling studies, from which four studies predicted an SSB tax to have a positive impact on oral health-related outcomes, whereas one study in a developing country did not find an SSB tax to be solely successful. According to three studies, the younger population and men are likely to benefit the most from such a tax. One study demonstrated the benefits of an SSB tax to be potentially more significant among low-income individuals.Conclusion While no empirical studies are available to support the benefits of an SSB tax, the studies covered in this review altogether anticipate a positive impact. Furthermore, this review discusses some of the obstacles and limitations of implementing such a tax predicted by the included studies.
Collapse
Affiliation(s)
- Maryam Shakiba
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Cochrane Iran Associate Centre, National Institute for Medical Research Development, Tehran, Iran
| | - Pouria Iranparvar
- Cochrane Iran Associate Centre, National Institute for Medical Research Development, Tehran, Iran
| | - Mohammad-Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
15
|
Dry T, Baker P. Generating Political Commitment for Regulatory Interventions Targeting Dietary Harms and Poor Nutrition: A Case Study on Sugar-Sweetened Beverage Taxation in Australia. Int J Health Policy Manag 2022; 11:2489-2501. [PMID: 35065543 PMCID: PMC9818088 DOI: 10.34172/ijhpm.2021.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/20/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) taxes are an effective public health policy intervention for improving nutrition and public health. Although implemented in over 50 jurisdictions worldwide, this intervention remains vastly underutilised, and in Australia political commitment for such a tax is low. The aim of this study is to understand the politics of SSB taxation in Australia, what factors have constrained political commitment for a tax, and what might enable such commitment in future. METHODS We adopted a case study design, guided by a theoretical framework developed from the political economy of nutrition literature. Data were collected from 16 interviews with informants from multiple sectors, supported by media articles, journal articles, and grey literature. Data were coded and organized by thematic analysis, and synthesised into the final results. RESULTS Nutrition actors have made significant progress in generating commitment for a SSB tax by producing relevant evidence, raising awareness, advocating for action, employing resonating frames, collaborating with civil society organisations, and forming coalitions increasing their overall cohesion. Nevertheless, political commitment for a SSB tax is low and was found to be impeded by the powerful influence of the food, beverage, and sugar industries, opposition from both major Australian political parties, ideological resistance to regulation, a low quality monitoring and surveillance system for food and nutrition, and limited public advocacy. The influence of nutrition actors was also impeded by weak connections to key policy-makers and missed collaborative opportunities with pro-SSB tax organisations. CONCLUSION The identification of several impediments provides an explanation for why political commitment for a SSB tax is low in Australia and reveals several opportunities for how it might be generated in the future. Political commitment may come about through, for example, actions to limit the influence of industry in policy decision-making, and by strengthening the existing pro-SSB tax coalition.
Collapse
Affiliation(s)
- Tristan Dry
- Public Health, School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, VIC, Geelong, Australia
| |
Collapse
|
16
|
Zhang G, Zhang L, Ahmad I, Zhang J, Zhang A, Tang W, Ding Y, Lyu F. Recent advance in technological innovations of sugar-reduced products. Crit Rev Food Sci Nutr 2022; 64:5128-5142. [PMID: 36454077 DOI: 10.1080/10408398.2022.2151560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Sugar is crucial as an essential nutrient for humans as well as for providing texture, sweetness and so on to food. But with the rise in people's pursuit of health, it is becoming increasingly clear that excessive consumption of sugar can locate a load on the body. It has been that excessive sugar is associated with many diseases, such as dental caries, obesity, diabetes, and coronary heart disease. Therefore, researchers and industries are trying to reduce or substitute sugar in food without affecting the sensory evaluation. Substituting sugar with sweeteners is alternatively becoming the most traditional way to minimize its use. So far, the sweeteners such as stevia and xylitol have been are commercially applied. Several studies have shown that technological innovation can partially compensate for the loss in sweetness as a result of sugar reduction, such as cross-modal interactions that stimulate sweetness with aroma, nanofiltration that filters disaccharides and above, enzyme-catalyzed sugar hydrolysis, and microbial fermentation that turns sugar into sugar alcohol. This review summarizes these studies to enhance the safety and quality of sugar-reduced products, and will provide some theoretical frameworks for the food industry to reduce sugar in foods, meet consumers' needs, and promote human health.
Collapse
Affiliation(s)
- Gaopeng Zhang
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, P. R. China
- Key Laboratory of Marine Fishery Resources Exploitment & Utilization of Zhejiang Province, Hangzhou, P. R. China
| | - Lyu Zhang
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, P. R. China
- Key Laboratory of Marine Fishery Resources Exploitment & Utilization of Zhejiang Province, Hangzhou, P. R. China
| | - Ishtiaq Ahmad
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, P. R. China
- Key Laboratory of Marine Fishery Resources Exploitment & Utilization of Zhejiang Province, Hangzhou, P. R. China
| | - Jianyou Zhang
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, P. R. China
- Key Laboratory of Marine Fishery Resources Exploitment & Utilization of Zhejiang Province, Hangzhou, P. R. China
| | - Anqiang Zhang
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, P. R. China
- Key Laboratory of Marine Fishery Resources Exploitment & Utilization of Zhejiang Province, Hangzhou, P. R. China
| | - Wei Tang
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, P. R. China
- Key Laboratory of Marine Fishery Resources Exploitment & Utilization of Zhejiang Province, Hangzhou, P. R. China
| | - Yuting Ding
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, P. R. China
- Key Laboratory of Marine Fishery Resources Exploitment & Utilization of Zhejiang Province, Hangzhou, P. R. China
| | - Fei Lyu
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, P. R. China
- Key Laboratory of Marine Fishery Resources Exploitment & Utilization of Zhejiang Province, Hangzhou, P. R. China
| |
Collapse
|
17
|
Moss ME, Luo H, Rosinger AY, Jacobs MM, Kaur R. High sugar intake from sugar-sweetened beverages is associated with prevalence of untreated decay in US adults: NHANES 2013-2016. Community Dent Oral Epidemiol 2022; 50:579-588. [PMID: 34939664 PMCID: PMC9786558 DOI: 10.1111/cdoe.12725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess the association between sugar from sugar-sweetened beverages (SSBs) and untreated decay in permanent teeth and calculate the cost burden of sugar from SSBs on untreated decay in US adults. METHODS Cross-sectional data from the 2013-2014 and 2015-2016 cycles of the National Health and Nutrition Examination Survey (NHANES) were analysed in 2020 (n = 9001 adults aged ≥20). Multivariable analyses assessed sugar intake from SSB consumption with the presence of untreated decay in permanent teeth and number of untreated decayed teeth. Population attributable risk was used to estimate the cost burden arising from SSBs on untreated decay in US adults. RESULTS One fourth (25.1%) of US adults had untreated dental decay, and higher prevalence was observed among those with low income, low education and race/ethnicity of non-Hispanic Black. Overall, 53% of adults reported no intake of SSBs. For the remaining 47%, the median 24-h intake was 46.8 g of sugar from SSBs. The adjusted prevalence ratio (PR) for untreated decay was 1.3 (95% confidence interval [CI] 1.1-1.5) for consumption of 46.8 g or more of sugar from SSBs compared to those reporting no sugar from SSBs. Number of untreated decayed teeth increased with sugar intake from SSBs from lowest to highest tertile: 0.1, (p = .35); 0.4, (p = .006); and 0.6, (p < .001). The cost burden of untreated decay attributable to SSBs in US adults is estimated conservatively at $1.6 billion USD. CONCLUSIONS Community level interventions directed at sugar from SSBs are justified to address disparities in the burden of untreated dental decay.
Collapse
Affiliation(s)
- Mark E. Moss
- ECU School of Dental MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Huabin Luo
- Brody School of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Asher Y. Rosinger
- Department of Biobehavioral HealthPennsylvania State UniversityState CollegePennsylvaniaUSA,Department of AnthropologyPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Molly M. Jacobs
- College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Roopwant Kaur
- ECU School of Dental MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| |
Collapse
|
18
|
Smith NR, Grummon AH, Ng SW, Wright ST, Frerichs L. Simulation models of sugary drink policies: A scoping review. PLoS One 2022; 17:e0275270. [PMID: 36191026 PMCID: PMC9529101 DOI: 10.1371/journal.pone.0275270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Simulation modeling methods are an increasingly common tool for projecting the potential health effects of policies to decrease sugar-sweetened beverage (SSB) intake. However, it remains unknown which SSB policies are understudied and how simulation modeling methods could be improved. To inform next steps, we conducted a scoping review to characterize the (1) policies considered and (2) major characteristics of SSB simulation models. METHODS We systematically searched 7 electronic databases in 2020, updated in 2021. Two investigators independently screened articles to identify peer-reviewed research using simulation modeling to project the impact of SSB policies on health outcomes. One investigator extracted information about policies considered and key characteristics of models from the full text of included articles. Data were analyzed in 2021-22. RESULTS Sixty-one articles were included. Of these, 50 simulated at least one tax policy, most often an ad valorem tax (e.g., 20% tax, n = 25) or volumetric tax (e.g., 1 cent-per-fluid-ounce tax, n = 23). Non-tax policies examined included bans on SSB purchases (n = 5), mandatory reformulation (n = 3), warning labels (n = 2), and portion size policies (n = 2). Policies were typically modeled in populations accounting for age and gender or sex attributes. Most studies focused on weight-related outcomes (n = 54), used cohort, lifetable, or microsimulation modeling methods (n = 34), conducted sensitivity or uncertainty analyses (n = 56), and included supplementary materials (n = 54). Few studies included stakeholders at any point in their process (n = 9) or provided replication code/data (n = 8). DISCUSSION Most simulation modeling of SSB policies has focused on tax policies and has been limited in its exploration of heterogenous impacts across population groups. Future research would benefit from refined policy and implementation scenario specifications, thorough assessments of the equity impacts of policies using established methods, and standardized reporting to improve transparency and consistency.
Collapse
Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah Towner Wright
- Health Sciences Library, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| |
Collapse
|
19
|
Emmert-Fees KMF, Karl FM, von Philipsborn P, Rehfuess EA, Laxy M. Simulation Modeling for the Economic Evaluation of Population-Based Dietary Policies: A Systematic Scoping Review. Adv Nutr 2021; 12:1957-1995. [PMID: 33873201 PMCID: PMC8483966 DOI: 10.1093/advances/nmab028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/24/2020] [Accepted: 02/24/2021] [Indexed: 01/02/2023] Open
Abstract
Simulation modeling can be useful to estimate the long-term health and economic impacts of population-based dietary policies. We conducted a systematic scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guideline to map and critically appraise economic evaluations of population-based dietary policies using simulation models. We searched Medline, Embase, and EconLit for studies published in English after 2005. Modeling studies were mapped based on model type, dietary policy, and nutritional target, and modeled risk factor-outcome pathways were analyzed. We included 56 studies comprising 136 model applications evaluating dietary policies in 21 countries. The policies most often assessed were reformulation (34/136), taxation (27/136), and labeling (20/136); the most common targets were salt/sodium (60/136), sugar-sweetened beverages (31/136), and fruit and vegetables (15/136). Model types included Markov-type (35/56), microsimulation (11/56), and comparative risk assessment (7/56) models. Overall, the key diet-related risk factors and health outcomes were modeled, but only 1 study included overall diet quality as a risk factor. Information about validation was only reported in 19 of 56 studies and few studies (14/56) analyzed the equity impacts of policies. Commonly included cost components were health sector (52/56) and public sector implementation costs (35/56), as opposed to private sector (18/56), lost productivity (11/56), and informal care costs (3/56). Most dietary policies (103/136) were evaluated as cost-saving independent of the applied costing perspective. An analysis of the main limitations reported by authors revealed that model validity, uncertainty of dietary effect estimates, and long-term intervention assumptions necessitate a careful interpretation of results. In conclusion, simulation modeling is widely applied in the economic evaluation of population-based dietary policies but rarely takes dietary complexity and the equity dimensions of policies into account. To increase relevance for policymakers and support diet-related disease prevention, economic effects beyond the health sector should be considered, and transparent conduct and reporting of model validation should be improved.
Collapse
Affiliation(s)
- Karl M F Emmert-Fees
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Florian M Karl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Peter von Philipsborn
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| |
Collapse
|
20
|
Feldman L. The American Dental Association should support sweetened beverage taxation. J Am Dent Assoc 2021; 152:883-885. [PMID: 34482946 DOI: 10.1016/j.adaj.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 11/17/2022]
|
21
|
Lou Arnal LM, Vercet Tormo A, Caverní Muñoz A, Medrano Villarroya C, Lou Calvo E, Munguía Navarro P, Sanz París A. Association between ultrapocessed food and chronic kidney disease. Nefrologia 2021; 41:489-501. [PMID: 36165132 DOI: 10.1016/j.nefroe.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 11/19/2020] [Indexed: 06/16/2023] Open
Abstract
The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25%-35% of phosphorus, 12%-18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies.
Collapse
Affiliation(s)
| | - Antonio Vercet Tormo
- Departamento de tecnología de los alimentos, Facultad de las Ciencias de la Salud y el Deporte, Universidad de Zaragoza, Zaragoza, Spain
| | - Alberto Caverní Muñoz
- Grupo de Nutrición de la SEN, España; Servicio de Dietética, Asociación de Enfermos Renales Alcer Ebro, Zaragoza, Spain
| | | | - Elena Lou Calvo
- Medicina Familiar y Comunitaria, Centro de Salud Torrero-La Paz, Zaragoza, Spain
| | | | - Alejandro Sanz París
- Servicio de Endocrinología y Nutrición, Hospital Universitario Miguel Servet, Zaragoza, Spain
| |
Collapse
|
22
|
Mohd Hanim MF, Md Sabri BA, Yusof N. Online News Coverage of the Sugar-Sweetened Beverages Tax in Malaysia: Content Analysis. JMIR Public Health Surveill 2021; 7:e24523. [PMID: 34406125 PMCID: PMC8411323 DOI: 10.2196/24523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/01/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Malaysia, the Sugar-Sweetened Beverages (SSBs) tax was announced during the parliament's 2019 Budget Speech. The tax was slated to be enforced by April 2019 but was later postponed to July 2019. The announcement has since generated significant media coverage and public feedback. OBJECTIVE This study presents a qualitative and quantitative cross-sectional study using netnography to examine how Malaysian online news articles responded to the SSBs tax after the announcement and postimplementation. METHODS Online news articles published on popular online news platforms from November 2018 to August 2019 were downloaded using NCapture and imported into NVivo for analysis using the inductive approach and thematic content analysis following the initial SSBs implementation announcement. RESULTS A total of 62 news articles were analyzed. Most of the articles positively portrayed the SSBs tax (46.8%) and highlighted its health impacts (76%). There were 7 key framing arguments identified in the articles. The positive arguments revolved around incentivizing manufacturers to introduce healthier products voluntarily, positive health consequences, the tax's impact on government revenue, and the use of the generated revenue toward beneficial social programs. The opposing arguments included increased operating costs to the manufacturer, the increased retail price of drinks, and how the SSBs tax is not a robust solution to obesity. The top priority sector considered in introducing the tax was the health perspective, followed by economic purposes and creating policies such as regulating the food and drinks industry. CONCLUSIONS The majority of online news articles positively reported the implementation of the SSBs tax in Malaysia. This suggests media played a role in garnering support for the health policy. As such, relevant bodies can use negative findings to anticipate and reframe counteracting arguments opposing the SSBs tax.
Collapse
Affiliation(s)
- Muhammad Faiz Mohd Hanim
- Centre of Population Oral Health and Clinical Prevention Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - Budi Aslinie Md Sabri
- Centre of Population Oral Health and Clinical Prevention Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| |
Collapse
|
23
|
Eykelenboom M, Djojosoeparto SK, van Stralen MM, Olthof MR, Renders CM, Poelman MP, Kamphuis CBM, Steenhuis IHM. Stakeholder views on taxation of sugar-sweetened beverages and its adoption in the Netherlands. Health Promot Int 2021; 37:6333509. [PMID: 34333638 PMCID: PMC9053456 DOI: 10.1093/heapro/daab114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An increasing number of governments worldwide have introduced a tax on sugar-sweetened beverages (SSB) for public health. However, the adoption of such a policy is still debated in many other countries, such as in the Netherlands. We investigated Dutch stakeholder views on taxation of SSB and perceived barriers and facilitators to its adoption in the Netherlands. Semi-structured interviews were conducted in 2019 with 27 stakeholders from health and consumer organizations, health professional associations, trade associations, academia, advisory bodies, ministries and parliamentary parties. Data were analysed using a thematic content approach. The findings reveal that, between and within sectors, stakeholders expressed contradictory views on the effectiveness, appropriateness and (socio)economic effects of an SSB tax. Perceived barriers to the adoption of an SSB tax in the Netherlands included an unfavourable political context, limited advocacy for an SSB tax, a strong lobby against an SSB tax, perceived public opposition, administrative load and difficulties in defining SSB. Perceived facilitators to its adoption included an increasing prevalence of overweight, disappointing results from voluntary industry actions, a change of government, state budget deficits, a shift in public opinion, international recommendations and a solid legal basis. In conclusion, this study shows that several challenges remain to be overcome for the adoption of an SSB tax in the Netherlands. Similar research on stakeholder views in other countries may further inform SSB tax policy processes.
Collapse
Affiliation(s)
- Michelle Eykelenboom
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Sanne K Djojosoeparto
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Princetonlaan 8a, 3584 CB Utrecht, the Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Maartje P Poelman
- Chairgroup Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, 6706 KN Wageningen, the Netherlands
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands
| | - Ingrid H M Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| |
Collapse
|
24
|
Hagenaars LL, Jeurissen PPT, Klazinga NS, Listl S, Jevdjevic M. Effectiveness and Policy Determinants of Sugar-Sweetened Beverage Taxes. J Dent Res 2021; 100:1444-1451. [PMID: 34034538 DOI: 10.1177/00220345211014463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Sugar consumption is on the rise globally with detrimental (oral) health effects. There is ample evidence that sugar-sweetened beverage (SSB) taxes can efficiently reduce sugar consumption. However, evidence alone is seldom enough to implement a policy. In this article, we present a narrative synthesis of evidence, based on real-world SSB tax evaluations, and we combine this with lessons from policy development case studies. This article is structured according to the Health Policy Analysis Triangle, which identifies a policy's content and process and important contextual factors. SSB tax policy content needs to be coupled to existing problems and public sentiment, which depend on more aspects than aspects related to (oral) health alone. Whether or not to include artificially sweetened beverages, therefore, is not solely a matter of showing the evidence of their oral health impact but also dependent on the stated aim of a tax and public sentiment toward tax policies in general. SSB taxes also need to be in line with existing tax and decision-making rules. Earmarking revenue for specific (health promotion) purposes may therefore be less straightforward as it might appear. The policy process of creating context-sensitive SSB tax policy content is not easy either. Advocacy coalitions need to be formed early in the process, and stamina, expertise, and flexibility are required to get a SSB tax adopted in a specific community. This requires a meticulously considered SSB tax structure implementation process. Oral health professionals who want to lead the way in advocating for SSB taxes should realize that evidence-based arguments on potential effectiveness alone will not be enough to realize change. The oral health community can learn important lessons from other "doctor-activists" such as pulmonologists, who have successfully advocated for higher tobacco taxes by being visible in the public debate with clear messaging and robust policy proposals.
Collapse
Affiliation(s)
- L L Hagenaars
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - P P T Jeurissen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - N S Klazinga
- Department of Social Medicine, Amsterdam UMC-University of Amsterdam, Amsterdam, the Netherlands
| | - S Listl
- Department of Dentistry-Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Department of Conservative Dentistry, Translational Health Economics Group, Heidelberg University, Heidelberg, Germany
| | - M Jevdjevic
- Department of Dentistry-Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| |
Collapse
|
25
|
Alhareky M. Taxation of Sugar-Sweetened Beverages and its Impact on Dental Caries: A Narrative Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:113-117. [PMID: 34084101 PMCID: PMC8152378 DOI: 10.4103/sjmms.sjmms_54_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/04/2022]
Abstract
Dental caries is one of the largest health concerns worldwide, and a key causative factor is excess sugar intake. Sugar-sweetened beverages (SSBs) are one of the largest sources of added sugars, which significantly contribute to adverse oral and general health. To reduce SSB consumption and its consequent impact on health, including dental caries, several interventional measures have been implemented; sugar taxation is one such measure. This review aimed at understanding the current knowledge available regarding the effect of sugar taxation on dental caries. Accordingly, PubMed, the Cochrane Library, Web of Science, and Scopus were searched with relevant keywords and findings from the identified studies are discussed in this review article.
Collapse
Affiliation(s)
- Muhanad Alhareky
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
26
|
Hernández-F M, Cantoral A, Colchero MA. Taxes to Unhealthy Food and Beverages and Oral Health in Mexico: An Observational Study. Caries Res 2021; 55:183-192. [PMID: 33853058 DOI: 10.1159/000515223] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/14/2021] [Indexed: 11/19/2022] Open
Abstract
In January 2014, taxes on sugar-sweetened beverages and nonessential energy-dense food were implemented in Mexico to discourage the consumption of these products. Published evaluations have shown reductions in purchases of taxed food and beverages associated with the implementation of this fiscal policy. Although there are some studies on the impact on health based on simulation studies, no evaluations with empirical data on changes in oral health have been published. We used administrative records and data from an epidemiological surveillance system to estimate changes in (1) outpatient visits related to dental caries; (2) having experienced dental caries: Decayed, Missing and Filled Teeth (DMFT) >0 for permanent dentition or dmft >0 for primary dentition (dmft); (3) number of teeth with caries experience (DMFT and dmft), (4) cases with DMFT >0 or dmft >0, and (5) the series of mean DMFT or dmft, associated with the taxes. We estimated probit and negative binomial models for outcomes at individual level, and interrupted time series analysis for population-level outcomes. The implementation of the taxes was associated with negative changes in the trends of outpatient visits, as well as for cases with DMFT >0, dmft >0 and mean DMFT. Taxes were also associated with a lower probability of having experienced dental caries and with a lower number of teeth with caries experience in the samples studied. Our results suggest positive impacts of the implementation of taxes on unhealthy food and beverages in the oral health of Mexicans, which are the first health benefits observed, and add to the health benefits predicted by modeling studies.
Collapse
Affiliation(s)
- Mauricio Hernández-F
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Alejandra Cantoral
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - M Arantxa Colchero
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| |
Collapse
|
27
|
Lou Arnal LM, Vercet Tormo A, Caverní Muñoz A, Medrano Villarroya C, Lou Calvo E, Munguía Navarro P, Sanz París A. Association between ultrapocessed food and chronic kidney disease. Nefrologia 2021. [PMID: 33714628 DOI: 10.1016/j.nefro.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25-35% of phosphorus, 12-18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies.
Collapse
Affiliation(s)
| | - Antonio Vercet Tormo
- Departamento de tecnología de los alimentos, Facultad de las Ciencias de la Salud y el Deporte, Universidad de Zaragoza, Zaragoza, España
| | - Alberto Caverní Muñoz
- Grupo de Nutrición de la SEN, España; Servicio de Dietética, Asociación de Enfermos Renales Alcer Ebro, Zaragoza, España
| | | | - Elena Lou Calvo
- Medicina Familiar y Comunitaria, Centro de Salud Torrero-La Paz, Zaragoza, España
| | | | - Alejandro Sanz París
- Servicio de Endocrinología y Nutrición, Hospital Universitario Miguel Servet, Zaragoza, España
| |
Collapse
|
28
|
Jevdjevic M, Wijn SRW, Trescher AL, Nair R, Rovers M, Listl S. Front-of-Package Food Labeling to Reduce Caries: Economic Evaluation. J Dent Res 2020; 100:472-478. [PMID: 33331232 PMCID: PMC8058828 DOI: 10.1177/0022034520979147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Front-of-package food labeling (FoPFL) is increasingly advocated as an effective intervention to facilitate behavior changes toward healthier food purchasing and consumption, particularly in relation to products with added sugar. The present study assessed the potential caries-related impacts of FoPFL, using Germany as an example. The outcomes of interest were caries lesions prevented, dental treatment costs avoided, productivity loss reductions, and disability-adjusted life years (DALYs) averted. The baseline consumption of added sugar was derived from the German National Nutrition Survey. The reduction in sugar intake due to FoPFL was modeled according to estimates from a recent meta-analysis. Microsimulations were performed for 500,000 individuals and over a time horizon of 10 y. Deterministic and probabilistic sensitivity analyses were performed to check the robustness of results. For the period from 2017 to 2027, FoPFL was identified to prevent 2,370,715 (95% confidence interval [CI], 2,062,730-2,678,700) caries lesions and avert 677.62 (95% CI, 589.59-765.65) DALYs. Treatment cost savings amounted to €175.67 million (95% CI, €152.85-€198.49), and productivity losses reduced by €27.33 million (95% CI, €23.78-€30.88). Sensitivity analyses showed that the magnitude of the effects is highly dependent on consumers' response to FoPFL. Our findings suggest that FoPFL has the potential to substantially reduce caries increment, caries-related morbidity, and economic burden. In addition, our study allows for the inclusion of oral health estimates in overall health estimates for sugar-related food labeling. Before prioritizing a strategy to tackle sugar consumption, decision makers should carefully consider all relevant context-specific factors and implementation costs.
Collapse
Affiliation(s)
- M Jevdjevic
- Department of Dentistry-Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - S R W Wijn
- Department of Operating Rooms, Radboud UMC, Nijmegen, The Netherlands
| | - A L Trescher
- Department of Conservative Dentistry, Translational Health Economics Group, Heidelberg University, Heidelberg, Germany
| | - R Nair
- Department of Dentistry-Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - M Rovers
- Department of Operating Rooms, Radboud UMC, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud UMC, Nijmegen, The Netherlands
| | - S Listl
- Department of Dentistry-Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Conservative Dentistry, Translational Health Economics Group, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
29
|
Ha DH, Crocombe LA, Khan S, Do LG. The impact of different determinants on the dental caries experience of children living in Australia rural and urban areas. Community Dent Oral Epidemiol 2020; 49:337-345. [PMID: 33289154 DOI: 10.1111/cdoe.12606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/14/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
AIMS Evidence suggests there are geographical variations in child oral health and this has prompted research into determinants of that variation. This study aimed to investigate factors attributable to the difference in child oral health between urban and rural areas in Australia. METHOD Data were from the National Child Oral Health Study 2012-14, a population-based study of 5- to 14-year-old children, who underwent oral epidemiological examinations by trained examiners. Caries prevalence (dmfs/DMFS > 0) and experience (dmfs/DMFS count) in the primary dentition (5- to 8-year-old) and permanent dentition (9- to 14-year-old) were calculated. Children were grouped by residential location (urban or rural areas). A parental questionnaire collected information on family socio-economic factors, and individual health behaviours (dental access, sugar consumption and toothbrushing). Residential history was used to calculate lifetime exposure to water fluoridation (WF). Analyses were weighted to produce population-representative estimates. The primary outcomes were assessed separately for the two groups in regression models with robust standard error estimation to estimate prevalence ratios and mean ratios and their 95% confidence intervals. Population Attributable Fractions were calculated using the population distribution of the exposures and their adjusted estimates. RESULTS 10 581 5- to 8-year-old and 14 041 9- to 14-year-old children were included. Caries prevalence was higher in rural than in urban areas. In multivariable models, exposure to fluoridation, reason for dental visit and consumption of sugary beverages were consistently associated with caries prevalence and experience. WF coverage attributed to differences in caries prevalence (10% vs 21%) and experience (14% vs 35%) in the permanent dentition. High consumption of sugary beverages attributed to a higher primary and permanent dental caries experience in rural than in urban areas. Dental access was also attributed to the differences between the two areas. CONCLUSION Factors at both community and individual levels attributed to the observed differences in child caries prevalence and experience between urban and rural areas.
Collapse
Affiliation(s)
- Diep H Ha
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA, Australia
| | - Leonard A Crocombe
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA, Australia
- Centre for Rural Health, University of Tasmania, Hobart, Tas., Australia
| | - Shahrukh Khan
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA, Australia
- School of Medicine, University of Tasmania, Hobart, Tas., Australia
| | - Loc G Do
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
30
|
Bridge G, Lomazzi M, Bedi R. A cross-country exploratory study to investigate the labelling, energy, carbohydrate and sugar content of formula milk products marketed for infants. Br Dent J 2020; 228:198-212. [PMID: 32060463 DOI: 10.1038/s41415-020-1252-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aims The first aim was to describe the energy, carbohydrate and sugar contents of formula milk products in eleven countries. The second was to assess the labelling methods used. Based on the findings, approaches to facilitate the selection of infant-appropriate formula milk products were proposed.Background Consumption of excess sugar during infancy can increase the risk of non-communicable diseases (NCDs) including obesity, diabetes and dental caries. Reduction of sugar consumption has been high on the global public health agenda. Although most infants are fed formula milk products in addition to, or instead of, breastmilk (with only 38% exclusively breastfed), the sugar content of these products is often not included in sugar reduction strategies.Methods An exploratory study was conducted to describe the labelling and nutritional composition of a sample of infant formula products available in 11 countries. The sample, which was collected between May and August 2019, included commercially available formula products (n = 257) targeted at infants aged <3 years of age. The products were sold in supermarkets and by other major retailers across the sample countries. Primary data were obtained from labels on the packaging of the formula products.Results Findings suggest that the majority of products sampled were higher in total carbohydrate and carbohydrates of which sugar and lactose, than breastmilk, supporting previous research. The nutrition information presented on the products was often unclear and was inconsistent across the 11 counties sampled. None of the products had front-of-pack (FOP) nutritional information.Conclusion Findings suggest that globally, infant formula products are higher in carbohydrates, sugar and lactose than breastmilk. Labelling is unclear and inconsistent across brands and between countries. Based on the findings of this study, mandatory regulation of sugar content in formula products is needed with clear FOP nutrition information to help consumers choose the healthy option for their infants.
Collapse
Affiliation(s)
- Gemma Bridge
- Leeds Business School, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - Marta Lomazzi
- Institute of Global Health, University of Geneva, Geneva, 1202, Switzerland; Executive Manger of the World Federation of Public Health Associations, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Raman Bedi
- Centre for International Child Oral Health, Emeritus Professor, King's College London, London, WC2B 5RL, UK
| |
Collapse
|
31
|
Jain V, Crosby L, Baker P, Chalkidou K. Distributional equity as a consideration in economic and modelling evaluations of health taxes: A systematic review. Health Policy 2020; 124:919-931. [PMID: 32718790 DOI: 10.1016/j.healthpol.2020.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE/SETTING The extent to which distributional equity is incorporated into evaluations of the (potential or observed) impact of health taxes is unclear. This systematic review of economic and modelling evaluations investigating taxation on tobacco, sugar-sweetened-beverages (SSBs), or alcohol aims to assess the proportion that have considered distributional impact by income or socioeconomic group. Secondary aims included summarising the reported distributional impacts, for both costs and health benefits. FINDINGS Of 4656 search results, 69 studies were included. The majority were economic analyses with epidemiological modelling, with studies on SSB taxes being of the highest quality. Tobacco was most commonly investigated tax, with 37 evaluations. Of these, 12 (32 %) considered distributional equity, with six (27 %) of 22 included SSB evaluations doing the same, and none for alcohol. A tobacco tax favoured lowerincome groups in the distribution of costs in all identified evaluations and for health benefits in nine out of 12 evaluations (75 %). For SSBs, four evaluations (67 %) found costs to favour low-income groups, with three (50 %) for health benefits. CONCLUSIONS Despite recommendations, evaluations of health taxes do not routinely consider the distributional impact of both costs and health benefits. Evaluations for alcohol taxation are particularly weak in this regard. Where investigated, the majority of evidence found tobacco taxation to favour low-income groups, whereas the limited evidence for SSBs is mixed.
Collapse
Affiliation(s)
- Vageesh Jain
- Institute for Global Health (IGH), University College London, UK; Public Health England, London, UK.
| | - Liam Crosby
- Institute for Epidemiology and Healthcare, University College London, London, UK; Tower Hamlets Council, London, UK
| | - Peter Baker
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
| | - Kalipso Chalkidou
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
| |
Collapse
|
32
|
Moynihan P, Miller C. Beyond the Chair: Public Health and Governmental Measures to Tackle Sugar. J Dent Res 2020; 99:871-876. [DOI: 10.1177/0022034520919333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Limiting free sugars to <5% of energy intake is a World Health Organization evidence-based recommendation to protect oral health throughout the life course. Achieving this requires a concerted approach with upstream interventions, including legislation underpinning community interventions and health promotion. Global production and trade are the main drivers of sugars consumption, which can be addressed only through prioritization of health impacts in agricultural and trade agreements, including pricing and subsidies. Increasing evidence demonstrates the benefit, including dental benefits, of taxes on sugar-sweetened beverages, a major source of sugars—with taxes based on sugars content being favored due to the dual impact in incentivizing consumers to buy less and encouraging producers to use less through product reformulation. A benefit of product reformulation is that the potential impact on sugars intake occurs independent of consumer behavior change, making the benefits more equitable across social groups. Evidence from meta-analysis indicates that sugars reformulation and portion size reduction could lower energy intake by more than 10% and 16%, respectively. Sophisticated and targeted digital marketing of products high in sugars is another key driver of sugars intake. With the exception of children’s television broadcasting, marketing of products high in sugars is largely unregulated, and increased awareness of modern marketing strategies and more stringent regulation are urgently needed. To ensure a commercial level playing field, mandatory approaches are required. Midstream actions include creating healthier food environments in neighborhoods, community settings (schools, sports centers, hospitals), and workplaces. Only through coalition among authorities responsible for planning and health will “obesogenic and cariogenic” environments be replaced with those that make healthy choices the easiest choice. It is recognized that providing nutrition health education alone is insufficient to achieve necessary sugars reduction; however, education has a key role to play in changing social norms and creating drive for change.
Collapse
Affiliation(s)
- P. Moynihan
- Adelaide Dental School and Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - C. Miller
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| |
Collapse
|
33
|
Urwannachotima N, Hanvoravongchai P, Ansah JP, Prasertsom P, Koh VRY. Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis. BMC Oral Health 2020; 20:76. [PMID: 32183817 PMCID: PMC7079374 DOI: 10.1186/s12903-020-1061-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 03/03/2020] [Indexed: 12/20/2022] Open
Abstract
Background The tiered sugar-sweetened beverage (SSB) tax was implemented in Thailand to encourage industries to reduce sugar content in beverages, and consequently reduce sugar consumption in the population. The aim of the study is to explore the expected impact of the new SSB tax policy in Thailand, a middle-income country in Asia, and other alternative policies on oral health outcomes as measured by the prevalence and severity of dental caries among the Thai population. Methods A qualitative system dynamics model that captures the complex interrelationships among SSB tax, sugar consumption and dental caries, was elicited through participatory stakeholder engagement. Based on the qualitative model, a quantitative system dynamics model was developed to simulate the SSB tax policy and other alternative scenarios in order to evaluate their impact on dental caries among Thai adults from 2010 to 2040. Results Under the base-case scenario, the dental caries prevalence among the Thai population 15 years and older, is projected to increase from 61.3% in 2010 to 74.9% by 2040. Implementation of SSB tax policy is expected to decrease the prevalence of dental caries by only 1% by 2040, whereas the aggressive policy is projected to decrease prevalence of dental caries by 21% by 2040. Conclusions In countries where a majority of the sugar consumed is from non-tax sugary food and beverages, especially Asian countries where street food culture is ubiquitous and contributes disproportionately to sugar intake, SSB tax alone is unlikely to have meaningful impact on oral health unless it is accompanied with a comprehensive public health policy that aims to reduce total sugar intake from non-SSB sources.
Collapse
Affiliation(s)
- Nipaporn Urwannachotima
- Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand. .,Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Piya Hanvoravongchai
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - John Pastor Ansah
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Piyada Prasertsom
- Bureau of Dental Health, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Victoria Rui Ying Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Lower Kent Ridge Road, Singapore, Singapore
| |
Collapse
|
34
|
A narrative review of the effects of sugar-sweetened beverages on human health: A key global health issue. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e76-e103. [PMID: 32170920 DOI: 10.15586/jptcp.v27i1.666] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 01/09/2023]
Abstract
The provision of healthy and safe food is vital for human health, and the addition of unnecessary sugars in foodstuffs is an important global issue, leading to multiple long- and short-term health issues and spiraling costs for individuals and governments alike. The negative effect of excess sugar consumption contributes to adverse health conditions, including obesity, type 2 diabetes, and poor oral health in both high and low resource settings. A key plank of governmental and health promotion bodies' nutritional guidance is to raise public awareness of "hidden" sugars, salt, and fats, such as found in processed foods and sugar-sweetened beverages (SSBs), and guide individuals to reduce their consumption. This rapid narrative review brings together some of the key issues identified in the literature around the consumption of SSBs, including patterns of consumption, the general impact on human health and nutrition, specific effects on oral health and the oral microbiome, and strategies to address over-consumption. The range of long-term adverse effects on health is often misunderstood or unknown by the public. However, some strategies have succeeded in reducing the consumption of SSBs, including public health strategies and interventions and the imposition of taxes or levies, and this article makes recommendations for action.
Collapse
|
35
|
A call to action: advocating for the integration of oral health promotion and public health via sugar sweetened beverage taxation. Br Dent J 2019; 227:663-664. [PMID: 31653997 DOI: 10.1038/s41415-019-0841-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We call on dental health professionals to advocate for the integration of oral health promotion into public health, and argue that a campaign for revenue from SSB taxation to be used for oral health promotion is a good place to start. The impact of sugar on health centres on obesity, diabetes and dental caries; these also have a disproportionate impact upon low income communities. Sugar sweetened beverages (SSB) are recognised as a universal major source of sugar, and it has been recommended that the amount and frequency of intake of SSBs should be limited. SSB taxes are a possible way of reducing sugar intake, as well as an effective method of integrating oral health (OH) into general health promotion. There is widespread support for these taxes from PH professionals as they have the potential to improve diet and nutrition, and by OH professionals since nutrition is an integral component of OH, and sugar reduction can reduce the incidence of caries. SSB taxes can also generate revenues which can be reinvested in healthcare to further health improvement. Despite the self-evident benefits for integration, few countries have made a concentrated effort to integrate. We argue that revenues must also be invested to promote OH through an integrated public health and dental public health approach.
Collapse
|
36
|
Stormon N, Lalloo R. Monitoring the extent of water fluoridation coverage in Australia. Health Promot J Austr 2019; 31:169-171. [PMID: 31420902 DOI: 10.1002/hpja.288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/04/2019] [Accepted: 08/13/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Nicole Stormon
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Herston, Brisbane, QLD, Australia
| | - Ratilal Lalloo
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Herston, Brisbane, QLD, Australia
| |
Collapse
|
37
|
Jevdjevic M, Trescher AL, Rovers M, Listl S. The caries-related cost and effects of a tax on sugar-sweetened beverages. Public Health 2019; 169:125-132. [PMID: 30884363 DOI: 10.1016/j.puhe.2019.02.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/17/2019] [Accepted: 02/02/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES While taxes on sugar-sweetened beverages (SSBs) have frequently been proposed to reduce non-communicable diseases like obesity and type 2 diabetes, relatively little is known about the caries-related impacts of SSB taxation. We assessed the effect of a 20% ad valorem tax on SSBs on dental caries and related treatment costs, specifically taking into account that consumers may switch from SSBs to other (non-taxed) sugar-containing drinks. STUDY DESIGN Cost-effectiveness analysis. METHODS A tooth-level Markov model was developed to evaluate the cost and effects of SSB taxation. Tax-related changes in sugar consumption were calculated using available evidence on SSBs price and cross-price elasticities, thereby taking changes in drinks consumption behaviors into account. The model was used to establish lifetime disease-free tooth years, caries lesions prevented, caries-related treatment costs avoided, tax revenues, and administrative costs (reference case: the Netherlands). Deterministic and probabilistic sensitivity analyses were performed to address uncertainties. RESULTS A 20% SSB taxation would result in an average of 2.13 (95% uncertainty interval [UI] 2.12-2.13) caries-free tooth years per person and, on population level, prevention of 1,030,163 (95% UI 1,027,903-1,032,423) caries lesions. The intervention was found to save an aggregate total of € 159.01 (95% UI 158.67-159.35) million in terms of dental care expenditures. The estimated lifetime tax revenues (€3.49billion) were larger than the administrative costs for taxation (€37.3 million). CONCLUSIONS Our results show that SSB taxation may substantially improve oral health and reduce the caries-related economic burden. Benefits would be the greatest for younger age groups.
Collapse
Affiliation(s)
- M Jevdjevic
- Department of Quality and Safety of Oral Healthcare, Radboud UMC, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands.
| | - A-L Trescher
- Department of Conservative Dentistry, Translational Health Economics Group, Heidelberg University, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - M Rovers
- Department of Operating Rooms, Radboud UMC, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Department of Health Evidence, Radboud UMC, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - S Listl
- Department of Quality and Safety of Oral Healthcare, Radboud UMC, Philips van Leydenlaan 25, 6525 EX Nijmegen, the Netherlands; Department of Conservative Dentistry, Translational Health Economics Group, Heidelberg University, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| |
Collapse
|
38
|
Lalloo R, Tadakamadla SK, Kroon J, Tut O, Kularatna S, Boase R, Kapellas K, Gilchrist D, Cobbledick E, Rogers J, Johnson NW. Salivary characteristics and dental caries experience in remote Indigenous children in Australia: a cross-sectional study. BMC Oral Health 2019; 19:21. [PMID: 30654791 PMCID: PMC6337781 DOI: 10.1186/s12903-018-0692-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/12/2018] [Indexed: 01/15/2023] Open
Abstract
Background While associations between salivary characteristics and dental caries have been well studied, we are not aware of this being assessed in a remote Indigenous child population, where lifestyles may be different from urban children. Our aim was to assess associations between caries experience and putative biomarkers in saliva, accounting for oral hygiene and dietary habits. Methods Children attending schools in an Indigenous community in remote north Queensland, Australia were invited to an oral examination by qualified and calibrated examiners. Salivary flow rate, pH, buffering capacity and loads of mutans streptococci (MS), lactobacilli (LB) and yeasts were determined. Also, data on tooth brushing frequency and soft drinks consumption were obtained via a questionnaire. Caries experience was recorded by the International Caries Detection and Assessment System (ICDAS-II), and quantified as decayed, missing and filled surfaces. Relationships between the salivary variables and the cumulative caries experience (dmfs+DMFS) in the deciduous and permanent dentitions were examined by multivariate analyses to control the effect of confounders. Results The mean cumulative decayed (DS + ds), missing (MS + ms) and filled (FS + fs) surfaces were 3.64 (SD: 4.97), 1.08 (4.38) and 0.79 (1.84) respectively. Higher salivary MS and LB counts, low tooth brushing frequency and daily soft drink consumption were significantly related to greater caries experience. Caries experience was about twice in those with ≥10^5 CFU/ml saliva counts of MS (mean = 6.33, SD: 8.40 vs 3.11, 5.77) and LB (7.03, 7.49 vs 4.41, 8.00). In the fully-adjusted multivariate model, caries experience in those with higher counts of MS and LB were 51 and 52% more than those with lower counts. Conclusions As with studies in other populations, childhood salivary counts of MS and LB were significantly associated with greater caries experience in this remote Indigenous community. To address the serious burden of oral disease, we are researching ways to promote a healthy oral environment by encouraging good dietary habits, and emphasising the importance of daily tooth brushing with a fluoridated toothpaste. Our ongoing longitudinal studies will indicate the success of measures employed to reduce the counts of bacteria closely associated with cariogenesis and their impact on caries increment. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527; date of registration: 3rd July 2015.
Collapse
Affiliation(s)
- R Lalloo
- School of Dentistry, The University of Queensland, Brisbane, Australia
| | - S K Tadakamadla
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Queensland, 4222, Australia
| | - J Kroon
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Queensland, 4222, Australia.,School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - O Tut
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Queensland, 4222, Australia
| | - S Kularatna
- Australian Centre for Health Service Innovation, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia
| | - R Boase
- School of Dentistry, James Cook University, Cairns, Australia
| | - K Kapellas
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, Adelaide, Australia
| | - D Gilchrist
- School of Dentistry, James Cook University, Cairns, Australia
| | - E Cobbledick
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Queensland, 4222, Australia
| | - J Rogers
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Queensland, 4222, Australia
| | - N W Johnson
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Queensland, 4222, Australia. .,School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia. .,King's College London Dental Institute, London, UK.
| |
Collapse
|