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de Araújo JM, Eufrosino de Alencar Rodrigues R, da Costa Pereira de Arruda Neta A, Leite Lima Ferreira FE, Lira Formiga Cavalcanti de Lima R, Pinheiro de Toledo Vianna R, Vasconcelos Leitão Moreira L, Moreira da Silva Neto J, Moreira PVL. The direct and indirect costs of cardiovascular diseases in Brazil. PLoS One 2022; 17:e0278891. [PMID: 36548305 PMCID: PMC9778932 DOI: 10.1371/journal.pone.0278891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the direct and indirect costs of cardiovascular diseases (such as coronary heart disease and stroke) by sex and age group, attributed to the excessive consumption of salt, saturated fat and trans fat in Brazil. MATERIALS AND METHODS The data for estimating the Population Attributable Fraction (PAF) corresponding to the consumption of salt, saturated fat and trans-fat were obtained from the Household Budget Survey 2017-2018. The calculation of direct costs for cardiovascular diseases (CVD) was made from the accounting sum of costs with hospitalizations and outpatient care found in the National Health System (Hospital Information System and Outpatient Information System), from 2017 to 2019, including the costs of treatment, such as medical consultations, medical procedures, and drugs. Regarding the indirect costs, they were measured by the loss of human capital, given the premature death, resulting in loss of productivity. To define the attributable costs, they were multiplied by the PAF. RESULTS Higher burden of CVD attributable to the consumption of salt, saturated fat and trans fat were observed in younger individuals, which progressively decreased with advancing age, but still generated economic costs in the order of US$ 7.18 billion, in addition to 1.53 million productive years of life lost (YLL) to premature death, if considering salt as an inducer. Although attributable burden of CVD is higher among younger individuals, the highest costs are associated with males aged 45 to 74 years old for direct costs and 45 to 64 years old for indirect costs. CONCLUSION The attributable fractions to consumption of salt are the ones that cause the most effects on CVD, followed by saturated fat and trans fat, with direct and indirect costs being higher for males.
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Silva TJ, Barrera‐Arellano D, Badan Ribeiro AP. The impact of fatty acid profile on the physicochemical properties of commercial margarines in Brazil. J AM OIL CHEM SOC 2022. [DOI: 10.1002/aocs.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Thaís Jordânia Silva
- Department of Food Technology, School of Food Engineering, University of Campinas (UNICAMP) Cidade Universitária Zeferino Vaz Campinas Brazil
| | - Daniel Barrera‐Arellano
- Department of Food Technology, School of Food Engineering, University of Campinas (UNICAMP) Cidade Universitária Zeferino Vaz Campinas Brazil
| | - Ana Paula Badan Ribeiro
- Department of Food Technology, School of Food Engineering, University of Campinas (UNICAMP) Cidade Universitária Zeferino Vaz Campinas Brazil
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Enespa, Chandra P, Singh DP. Sources, purification, immobilization and industrial applications of microbial lipases: An overview. Crit Rev Food Sci Nutr 2022; 63:6653-6686. [PMID: 35179093 DOI: 10.1080/10408398.2022.2038076] [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: 01/07/2023]
Abstract
Microbial lipase is looking for better attention with the fast growth of enzyme proficiency and other benefits like easy, cost-effective, and reliable manufacturing. Immobilized enzymes can be used repetitively and are incapable to catalyze the reactions in the system continuously. Hydrophobic supports are utilized to immobilize enzymes when the ionic strength is low. This approach allows for the immobilization, purification, stability, and hyperactivation of lipases in a single step. The diffusion of the substrate is more advantageous on hydrophobic supports than on hydrophilic supports in the carrier. These approaches are critical to the immobilization performance of the enzyme. For enzyme immobilization, synthesis provides a higher pH value as well as greater heat stability. Using a mixture of immobilization methods, the binding force between enzymes and the support rises, reducing enzyme leakage. Lipase adsorption produces interfacial activation when it is immobilized on hydrophobic support. As a result, in the immobilization process, this procedure is primarily used for a variety of industrial applications. Microbial sources, immobilization techniques, and industrial applications in the fields of food, flavor, detergent, paper and pulp, pharmaceuticals, biodiesel, derivatives of esters and amino groups, agrochemicals, biosensor applications, cosmetics, perfumery, and bioremediation are all discussed in this review.
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Affiliation(s)
- Enespa
- School for Agriculture, Sri Mahesh Prasad Post Graduate College, University of Lucknow, Lucknow, Uttar Pradesh, India
| | - Prem Chandra
- Food Microbiology & Toxicology Laboratory, Department of Microbiology, School for Environmental Sciences, Babasaheb Bhimrao Ambedkar University (A Central) University, Lucknow, Uttar Pradesh, India
| | - Devendra Pratap Singh
- Department of Environmental Science, School for Environmental Sciences, Babasaheb Bhimrao Ambedkar University (A Central) University, Lucknow, Uttar Pradesh, India
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Abstract
Context Policy-specific actions to improve food environments will support healthy population diets. Objective To identify cited barriers and facilitators to food environment policy (FEP) processes reported in the literature, exploring these according to the nature of the policy (voluntary or mandatory) and country development status. Data sources A systematic search was conducted of 10 academic and 7 grey-literature databases, national websites, and manual searches of publication references. Data extraction Data on government-led FEPs, barriers, and facilitators from key informants were collected. Data synthesis The constant-comparison approach generated core themes for barriers and facilitators. The appraisal tool developed by Hawker et al. was adopted to determine the quality of qualitative and quantitative studies. Results A total of 142 eligible studies were identified. Industry resistance or disincentive was the most cited barrier in policy development. Technical challenges were most frequently a barrier for policy implementation. Frequently cited facilitators included resource availability or maximization, strategies in policy process, and stakeholder partnership or support. Conclusions The findings from this study will strategically inform health-reform stakeholders about key elements of public health policy processes. More evidence is required from countries with human development indices ranging from low to high and on voluntary policies. Systematic Review Registration PROSPERO registration no. CRD42018115034.
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Affiliation(s)
- SeeHoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Heather Yeatman
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sreelakshmi Sankaranarayanan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Tilakavati Karupaiah
- T. Karupaiah, School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia. E-mail:
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HADIAN Z, MOUSAVI KHANEGHAH A. Sugar, fat, saturated and trans fatty acid contents in Iranian cereal-based baked products. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.26724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Zahra HADIAN
- Shahid Beheshti University of Medical Sciences, Iran
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6
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Allen LN, Wild CEK, Loffreda G, Kak M, Aghilla M, Emahbes T, Bonyani A, Hatefi A, Herbst C, El Saeh HM. Non-communicable disease policy implementation in Libya: A mixed methods assessment. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000615. [PMID: 36962549 PMCID: PMC10021530 DOI: 10.1371/journal.pgph.0000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/09/2022] [Indexed: 11/12/2022]
Abstract
The Libyan Ministry of Health is keen to understand how it can introduce policies to protect its population from non-communicable diseases (NCDs). We aimed to perform an implementation research assessment of the current situation, including challenges and opportunities. We used an explanatory sequential mixed methods design. We started with a quantitative assessment of NCD policy performance based on review of the WHO NCD Progress Monitor Reports. Once we had identified Libya's NCD policy gaps we performed a systematic review to identify international lessons around barriers and successful strategies for the policies Libya has not yet implemented. Finally, we performed a series of key stakeholder interviews with senior policymakers to explore their perspectives around promising policy actions. We used a realist paradigm, methods triangulation, and a joint display to synthesise the interpretation of our findings and develop recommendations. Libya has not fully implemented any of the recommended policies for diet, physical activity, primary care guidelines & therapeutics, or data collection, targets & surveillance. It does not have robust tobacco policies in place. Evidence from the international literature and policymaker interviews emphasised the centrality of according strong political leadership, governance structures, multisectoral engagement, and adequate financing to policy development activities. Libya's complex political and security situation are major barriers for policy implementation. Whilst some policies will be very challenging to develop and deploy, there are a number of simple policy actions that could be implemented with minimum effort; from inviting WHO to conduct a second STEPS survey, to signing the international code on breast-milk substitutes. Like many other fragile and conflict-affected states, Libya has not accorded NCDs the policy attention they demand. Whilst strong high-level leadership is the ultimate key to providing adequate protections, there are a range of simple measures that can be implemented with relative ease.
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Affiliation(s)
- Luke N Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cervantée E K Wild
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Giulia Loffreda
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - Mohini Kak
- World Bank Middle East and North Africa, Tunisia
| | | | | | | | - Arian Hatefi
- World Bank Middle East and North Africa, Washington, DC, United States of America
| | | | - Haider M El Saeh
- Libya National Centre for Disease Control, Tajoura, Libya
- University of Tripoli, Tripoli, Libya
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Al-Jawaldeh A, Taktouk M, Chatila A, Naalbandian S, Abdollahi Z, Ajlan B, Al Hamad N, Alkhalaf MM, Almamary S, Alobaid R, Alyafei SA, Azizi MH, Baqadir NM, Barham R, Binsunaid FF, El Ammari L, El Ati J, Hoteit M, Massad H, Nejad MS, Nasreddine L. A Systematic Review of Trans Fat Reduction Initiatives in the Eastern Mediterranean Region. Front Nutr 2021; 8:771492. [PMID: 34901118 PMCID: PMC8662545 DOI: 10.3389/fnut.2021.771492] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/27/2021] [Indexed: 12/04/2022] Open
Abstract
High intakes of trans fatty acids (TFA), particularly industrially-produced TFA, are implicated in the etiology of cardiovascular diseases, which represent the leading cause of mortality in the Eastern Mediterranean Region (EMR). This systematic review aims to document existing national TFA reduction strategies in the EMR, providing an overview of initiatives that are implemented by countries of the region, and tracking progress toward the elimination of industrially-produced TFA. A systematic review of published and gray literature was conducted using a predefined search strategy. A total of 136 peer-reviewed articles, gray literature documents, websites and references from country contacts were obtained, up until 2 August 2021. Randomized-control trials, case-control studies, and studies targeting unhealthy population groups were excluded. Only articles published after 1995, in English, Arabic or French, were included. Key characteristics of strategies were extracted and classified according to a pre-developed framework, which includes TFA intake assessment; determination of TFA levels in foods; strategic approach; implementation strategies (TFA bans/limits; consumer education, labeling, interventions in public institution settings, taxation), as well as monitoring and evaluation of program impact. Thirteen out of the 22 countries of the EMR (59%) have estimated TFA intake levels, 9 have determined TFA levels in foods (41%), and 14 (63.6%) have national TFA reduction initiatives. These initiatives were mainly led by governments, or by national multi-sectoral committees. The most common TFA reduction initiatives were based on TFA limits or bans (14/14 countries), with a mandatory approach being adopted by 8 countries (Bahrain, Iran, Jordan, KSA, Kuwait, Morocco, Oman and Palestine). Complementary approaches were implemented in several countries, including consumer education (10/14), food labeling (9/14) and interventions in specific settings (7/14). Monitoring activities were conducted by few countries (5/14), and impact evaluations were identified in only Iran and the UAE. The robustness of the studies, in terms of methodology and quality of assessment, as well as the lack of sufficient data in the EMR, remain a limitation that needs to be highlighted. Further action is needed to initiate TFA reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluation of ongoing programs.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo, Egypt
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Aya Chatila
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Sally Naalbandian
- Science and Agriculture Library, American University of Beirut, Beirut, Lebanon
| | - Zahra Abdollahi
- Nutrition Department, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Nawal Al Hamad
- The Public Authority for Food and Nutrition, Kuwait City, Kuwait
| | - Majid M. Alkhalaf
- National Nutrition Committee, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | | | - Rawan Alobaid
- Senior Regulations and Standards, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Salah Abdulla Alyafei
- Health Promotion and Non Communicable Disease (NCD) Division, Public Health Department, Ministry of Public Health, Doha, Qatar
| | - Mohammad Hosein Azizi
- Food and Beverage Office, Iran Food and Drug Administration (IFDA), Ministry of Health and Education, Tehran, Iran
| | - Nimah M. Baqadir
- National Nutrition Committee, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | | | - Faisal F. Binsunaid
- Healthy Food Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | | | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, Tunis, Tunisia
| | - Maha Hoteit
- PHENOL Research Group (Public Health Nutrition Program-Lebanon), Faculty of Public Health, Lebanon University, Beirut, Lebanon
| | - Hanan Massad
- Nutrition Department, Ministry of Health, Amman, Jordan
| | | | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
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Silva TJ, Barrera-Arellano D, Ribeiro APB. Margarines: Historical approach, technological aspects, nutritional profile, and global trends. Food Res Int 2021; 147:110486. [PMID: 34399482 DOI: 10.1016/j.foodres.2021.110486] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
Margarines are an expanding market worldwide due to large-scale commercial, lower cost, growth of bakery and confectionery markets, and seasonal independence. The fatty acid composition, solid fat content, consistency, and melting point of the fats used in margarine determine their functional properties. Due to its proven association with increased risk of cardiovascular diseases, the recommendations of the World Health Organization and the enactment of laws in several countries to eliminate industrially produced trans fatty acids (TFA) have resulted in the prohibition or progressive reduction in the use of partially hydrogenated fat. However, issues related to high levels of TFA and saturated fatty acids still constitute a challenge in the formulation of this product category. Current trends on margarine production addition of phytosterols, non-lipid components, organogels, and new interesterified fat bases are reviewed. This review aims to present a historical view and the technological evolution of margarines, including their production processes, formulations, and physical and nutritional characteristics, as well as legislation, and main trends.
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Affiliation(s)
- Thaís Jordânia Silva
- Fats and Oils Laboratory, Department of Food Technology, School of Food Engineering, University of Campinas (Unicamp), Campinas, SP, Brazil.
| | - Daniel Barrera-Arellano
- Fats and Oils Laboratory, Department of Food Technology, School of Food Engineering, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Ana Paula Badan Ribeiro
- Fats and Oils Laboratory, Department of Food Technology, School of Food Engineering, University of Campinas (Unicamp), Campinas, SP, Brazil
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Flannagan K, Gahagan S, Das A, Burrows R, Lozoff B, Villamor E. Serum polyunsaturated fatty acids in infancy are associated with body composition in adolescence. Pediatr Obes 2020; 15:e12656. [PMID: 32426929 DOI: 10.1111/ijpo.12656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/07/2020] [Accepted: 04/23/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Polyunsaturated fatty acids (PUFA) have been related to the development of adiposity. N-3 PUFA appears to be protective against obesity risk, while n-6 PUFA may be associated with greater adiposity. However, most studies have been conducted among adults. The role of PUFA in infancy is unknown. OBJECTIVE To examine associations of serum PUFA at age 1 year with age- and sex-adjusted body mass index Z score (BMIZ) change through age 16 years and body composition at 16 years. METHODS We quantified serum PUFA in 636 Chilean infants aged 1 year. We measured BMIZ at ages 1, 5, 10 and 16 years, and body composition by dual energy X-ray absorptiometry at 16 years. We estimated differences in 1- to 16-years BMIZ change between PUFA quartiles from multivariable linear mixed models with restricted cubic splines. At 16 years, we estimated differences in total fat mass (ToFM), truncal fat mass (TrFM), total lean mass (TLM), percent total fat mass (%ToFM) and percent truncal fat mass (%TrFM) between PUFA quartiles using linear regression. RESULTS PUFA were not associated with BMIZ change. Alpha-linolenic acid (ALA) was positively associated with TrFM (P = .03) and %TrFM (P < .0001) at 16 years while eicosapentaenoic acid (EPA) was inversely associated with %TrFM (P = .001). Docosapentaenoic acid (DPA) was positively associated with ToFM (P = .01), TrFM (P = .009), %ToFM (P = .02) and %TrFM (P = .02). Gamma-linolenic acid (GLA) and the Δ6-desaturase (D6D) activity index were each positively, linearly associated with ToFM, TrFM and %ToFM. The Δ5-desaturase (D5D) activity index was inversely associated with %TrFM (P = .04). CONCLUSIONS ALA, DPA, GLA and the D6D index at 1 year of age were positively associated with adiposity at age 16 years, while EPA and the D5D index were inversely associated with central adiposity. Our results related to EPA and desaturase indices are in agreement with limited prior studies.
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Affiliation(s)
- Kerry Flannagan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Sheila Gahagan
- Division of Child Development and Community Health, University of California, San Diego, California, USA
| | - Arun Das
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Raquel Burrows
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Betsy Lozoff
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Reformulation of Packaged Foods and Beverages in the Colombian Food Supply. Nutrients 2020; 12:nu12113260. [PMID: 33114419 PMCID: PMC7692620 DOI: 10.3390/nu12113260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 01/21/2023] Open
Abstract
Public discussion, advocacy, and legislative consideration of policies aimed at reducing consumption of processed foods, such as sugar-sweetened beverage (SSB) taxes and mandatory front-of-package (FOP) warning labels, may stimulate product reformulation as a strategy to prevent regulation. In Colombia, there have been major legislative pushes for SSB taxes and FOP labels, although neither has passed to date. In light of the ongoing policy debate and successful implementation of similar policies in Peru and Chile, we explored manufacturer reformulation in the Colombian food supply. We compared the quantities of nutrients of concern (including sugar, sodium, and saturated fat) from the nutrition facts panels of the same 102 packaged foods and 36 beverages from the top-selling brands in Colombia between 2016 and 2018. Our analyses showed a substantial decrease in median sugar content of beverages, from 9.2 g per 100 mL to 5.2 g per 100 mL, and an increase in the percentage of beverages containing non-nutritive sweeteners (NNS), from 33% to 64% (p = 0.003). No meaningful changes in the quantities of nutrients of concern among foods were observed. Our findings suggest little reformulation has occurred in Colombia in the absence of mandatory policies, except for the substitution of sugar with NNS among beverages.
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Passi-Solar Á, Margozzini P, Mindell JS, Ruiz M, Valencia-Hernandez CA, Scholes S. Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017. BMC Public Health 2020; 20:1397. [PMID: 32928176 PMCID: PMC7490861 DOI: 10.1186/s12889-020-09483-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background Trend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003–2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17 years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators. Methods We used data from 2003, 2010, and 2017 Chilean national health surveys. Each year we assessed levels of (1) mean systolic (SBP) and diastolic (DBP) blood pressure, (2) hypertension prevalence (BP ≥ 140/90 mmHg or use of antihypertensive treatment), and (3) awareness, treatment, and control. Logistic regression on pooled data was used to assess trends in binary outcomes; linear regression was used to assess trends in continuous SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain antihypertensive treatment (self-reported versus medicine inventory). The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to re-define hypertension using lower thresholds (BP ≥ 130/80 mmHg). Results Hypertension prevalence was 34.0, 32.0 and 30.8% in 2003, 2010 and 2017, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% versus 41% for treatment, P < 0.001; 34% versus 14% for control, P < 0.001), while levels of awareness were stable (66% versus 59%, P = 0.130). Awareness, treatment, and control levels were higher among females in 2003, 2010, and 2017 (P < 0.001). Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17 and 55% in absolute and relative terms, respectively. Conclusions Chile has experienced a positive population-wide lowering in blood pressure distribution which may be explained partly by a significant rise in levels of treated- and controlled-hypertension since 2003. Lowering the thresholds used to define elevated BP would substantially increase the financial public health challenge of further improving attainment levels at each step of the care cascade. Innovative and collaborative strategies are needed to improve hypertension management, especially among males.
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Affiliation(s)
- Álvaro Passi-Solar
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.,Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, CP 88330077, Santiago, Chile
| | - Paula Margozzini
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, CP 88330077, Santiago, Chile.
| | - Jennifer S Mindell
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Milagros Ruiz
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Carlos A Valencia-Hernandez
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Shaun Scholes
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
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Impact of diet on CVD and diabetes mortality in Latin America and the Caribbean: a comparative risk assessment analysis. Public Health Nutr 2020; 24:2577-2591. [PMID: 32489172 DOI: 10.1017/s1368980020000646] [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] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To quantify diet-related burdens of cardiometabolic diseases (CMD) by country, age and sex in Latin America and the Caribbean (LAC). DESIGN Intakes of eleven key dietary factors were obtained from the Global Dietary Database Consortium. Aetiologic effects of dietary factors on CMD outcomes were obtained from meta-analyses. We combined these inputs with cause-specific mortality data to compute country-, age- and sex-specific absolute and proportional CMD mortality of eleven dietary factors in 1990 and 2010. SETTING Thirty-two countries in LAC. PARTICIPANTS Adults aged 25 years and older. RESULTS In 2010, an estimated 513 371 (95 % uncertainty interval (UI) 423 286-547 841; 53·8 %) cardiometabolic deaths were related to suboptimal diet. Largest diet-related CMD burdens were related to low intake of nuts/seeds (109 831 deaths (95 % UI 71 920-121 079); 11·5 %), low fruit intake (106 285 deaths (95 % UI 94 904-112 320); 11·1 %) and high processed meat consumption (89 381 deaths (95 % UI 82 984-97 196); 9·4 %). Among countries, highest CMD burdens (deaths per million adults) attributable to diet were in Trinidad and Tobago (1779) and Guyana (1700) and the lowest were in Peru (492) and The Bahamas (504). Between 1990 and 2010, greatest decline (35 %) in diet-attributable CMD mortality was related to greater consumption of fruit, while greatest increase (7·2 %) was related to increased intakes of sugar-sweetened beverages. CONCLUSIONS Suboptimal intakes of commonly consumed foods were associated with substantial CMD mortality in LAC with significant heterogeneity across countries. Improved access to healthful foods, such as nuts and fruits, and limits in availability of unhealthful factors, such as processed foods, would reduce diet-related burdens of CMD in LAC.
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Progress towards eliminating industrially produced trans-fatty acids in the Canadian marketplace, 2013-2017. Public Health Nutr 2020; 23:2257-2267. [PMID: 32482203 DOI: 10.1017/s1368980019004816] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the prevalence of partially hydrogenated oils (PHO), hydrogenated oils (HO) and/or both in Canadian packaged foods in 2013 and 2017 and to determine the mean trans-fatty acid (TFA) content of products declaring such oils. DESIGN Repeated cross-sectional study of the Food Label Information Program. SETTING Food labels (n 32 875) were collected from top Canadian grocery retailers in 2013 and 2017. Proportions of products declaring PHO, HO and/or both in the Ingredients List were calculated by year and food category. The percentage contribution of TFA (g) to total fat (g) was calculated and compared against the voluntary TFA limits, defined as <2 % of total fat content for fats and oils, and <5 % for all other foods. Foods exceeding limits were identified. The mean TFA content (in g/serving and per 100 g) was calculated for products with these oils. RESULTS The use of PHO, HO and/or both significantly decreased in Canadian foods from 2013 to 2017 (0·8 to 0·2 %, 5 to 2·4 % and 5·7 to 2·6 %, respectively, for PHO, HO and/or both). The mean TFA content of products containing PHO increased (0·34 to 0·57 g TFA/serving); although it was not statistically significant, it is still concerning that TFA content increased. The TFA content significantly decreased in foods with HO (0·24 to 0·16 g TFA/serving, P < 0·05) during 2013-2017. CONCLUSIONS Products with PHO continue to be present in the Canadian marketplace, despite voluntary efforts to eliminate them. Products with HO should also be monitored, as they can also contribute to TFA content in foods.
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Ricardo CZ, Peroseni IM, Mais LA, Martins APB, Duran AC. Trans Fat Labeling Information on Brazilian Packaged Foods. Nutrients 2019; 11:E2130. [PMID: 31500088 PMCID: PMC6770177 DOI: 10.3390/nu11092130] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
Although the adverse effects of trans fat consumption are well documented, industrially-produced trans fats are still used in a variety of food products. Our objective was to investigate the presence of trans fat information on the nutrition facts panel, in the list of ingredients, and the use of trans fat claims in packaged food and beverages marketed in Brazil. This was a cross-sectional study that used data from packaged food and beverages available in the five supermarket chains with the largest market share in Brazil. Of the 11,434 products that were analyzed, 81.3% did not present a source of trans fats in the list of ingredients. The percentages of products with specific (hydrogenated fats or oils) and unspecific trans fat terms (margarine, vegetable fat, and vegetable cream) in the list of ingredients were 4.1% and 14.6%, respectively. Bakery products, cookies and crackers, candies and desserts, snacks, and convenience foods had the highest percentages of trans fat claims. We also found claims in products with ingredients that are sources of trans fats. In conclusion, trans fat ingredients were found in almost one-fifth of the Brazilian packaged foods. The current Brazilian legislation is not sufficient to inform consumers about the content of trans fats in packaged foods. Along with measures to restrict the use of industrially-produced trans fats, improvements in nutritional labeling are also needed.
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Affiliation(s)
- Camila Zancheta Ricardo
- Center for Epidemiological Research in Nutrition and Public Health, University of Sao Paulo, Sao Paulo 01246-904, Brazil.
| | | | - Laís Amaral Mais
- Brazilian Institute for Consumer Defense, Sao Paulo 05002-050, Brazil.
| | - Ana Paula Bortoletto Martins
- Center for Epidemiological Research in Nutrition and Public Health, University of Sao Paulo, Sao Paulo 01246-904, Brazil.
- Brazilian Institute for Consumer Defense, Sao Paulo 05002-050, Brazil.
| | - Ana Clara Duran
- Center for Epidemiological Research in Nutrition and Public Health, University of Sao Paulo, Sao Paulo 01246-904, Brazil.
- Center for Food Studies, University of Campinas, Campinas 13083-970, Brazil.
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Ghebreyesus TA, Frieden TR. REPLACE: a roadmap to make the world trans fat free by 2023. Lancet 2018; 391:1978-1980. [PMID: 29773233 DOI: 10.1016/s0140-6736(18)31083-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/11/2022]
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16
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Kakisu E, Tomchinsky E, Victoria Lipps M, Fuentes J. Analysis of the reduction of trans-fatty-acid levels in the foods of Argentina. Int J Food Sci Nutr 2018; 69:928-937. [DOI: 10.1080/09637486.2018.1428537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Emiliano Kakisu
- Instituto Nacional de Alimentos. Administración Nacional de Alimentos, Medicamentos y Tecnología Médica (ANMAT), Estados Unidos 25, CAA1101A, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, C1425FQB, Ciudad Autónoma de Buenos Aires, Argentina
| | - Eliana Tomchinsky
- Instituto Nacional de Alimentos. Administración Nacional de Alimentos, Medicamentos y Tecnología Médica (ANMAT), Estados Unidos 25, CAA1101A, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Victoria Lipps
- Instituto Nacional de Alimentos. Administración Nacional de Alimentos, Medicamentos y Tecnología Médica (ANMAT), Estados Unidos 25, CAA1101A, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Fuentes
- Instituto Nacional de Alimentos. Administración Nacional de Alimentos, Medicamentos y Tecnología Médica (ANMAT), Estados Unidos 25, CAA1101A, Ciudad Autónoma de Buenos Aires, Argentina
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Avilés-Santa ML, Colón-Ramos U, Lindberg NM, Mattei J, Pasquel FJ, Pérez CM. From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America. Front Endocrinol (Lausanne) 2017; 8:298. [PMID: 29176960 PMCID: PMC5687125 DOI: 10.3389/fendo.2017.00298] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Abstract
The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes-including type 2 DM and gestational diabetes mellitus (GDM)-and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America.
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Affiliation(s)
- M. Larissa Avilés-Santa
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD, United States
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Nangel M. Lindberg
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Francisco J. Pasquel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Cynthia M. Pérez
- University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
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Trans Fat Intake and Its Dietary Sources in General Populations Worldwide: A Systematic Review. Nutrients 2017; 9:nu9080840. [PMID: 28783062 PMCID: PMC5579633 DOI: 10.3390/nu9080840] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 12/25/2022] Open
Abstract
After the discovery that trans fat increases the risk of coronary heart disease, trans fat content of foods have considerably changed. The aim of this study was to systematically review available data on intakes of trans fat and its dietary sources in general populations worldwide. Data from national dietary surveys and population studies published from 1995 onward were searched via Scopus and websites of national public health institutes. Relevant data from 29 countries were identified. The most up to date estimates of total trans fat intake ranged from 0.3 to 4.2 percent of total energy intake (En%) across countries. Seven countries had trans fat intakes higher than the World Health Organization recommendation of 1 En%. In 16 out of 21 countries with data on dietary sources, intakes of trans fat from animal sources were higher than that from industrial sources. Time trend data from 20 countries showed substantial declines in industrial trans fat intake since 1995. In conclusion, nowadays, in the majority of countries for which data are available, average trans fat intake is lower than the recommended maximum intake of 1 En%, with intakes from animal sources being higher than from industrial sources. In the past 20 years, substantial reductions in industrial trans fat have been achieved in many countries.
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Pérez-Escamilla R, Lutter CK, Rabadan-Diehl C, Rubinstein A, Calvillo A, Corvalán C, Batis C, Jacoby E, Vorkoper S, Kline L, Ewart-Pierce E, Rivera JA. Prevention of childhood obesity and food policies in Latin America: from research to practice. Obes Rev 2017; 18 Suppl 2:28-38. [PMID: 28741904 DOI: 10.1111/obr.12574] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Addressing childhood obesity in Latin America requires a package of multisectoral, evidence-based policies that enable environments conducive to healthy lifestyles. OBJECTIVE Identify and examine key elements to translating research into effective obesity policies in Latin America. METHODS We examined obesity prevention policies through case studies developed with an expert in the specific policy. Policies were selected based on their level of implementation, visibility and potential impact to reduce childhood obesity. They include: (i) excise taxes on sugar sweetened beverages and energy-dense foods; (ii) front-of-package food label legislation; (iii) trans fatty acids removal from processed foods; and (iv) Ciclovías recreativas or 'open streets'. Case studies were coded to identify components that explained successful implementation and sustainability using the Complex Adaptive Health Systems framework. RESULTS The analysis identified key elements for effective and sustainable policy, including evidence justifying policy; evidence-based advocacy by civil society; political will; and legislation and skillful negotiations across government, academia, the private sector and civil society. Scientific evidence and evaluation played an important role in achieving tipping points for policies' launch and sustain effective implementation. CONCLUSIONS Well-coordinated, intersectoral partnerships are needed to successfully implement evidence-based anti-obesity policies. Prospective policy research may be useful for advancing knowledge translation.
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Affiliation(s)
| | - C K Lutter
- Pan American Health Organization/World Health Organization, Washington, DC, USA
| | - C Rabadan-Diehl
- Department of Health and Human Services, Office of Global Affairs, Washington, DC, USA
| | - A Rubinstein
- Centro de Excelencia en Salud Cardiovascular para América del Sur, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - A Calvillo
- El Poder del Consumidor, Mexico City, Mexico
| | - C Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - C Batis
- National Institute of Public Health, Cuernavaca, Mexico.,Mexican Council for Science and Technology (CONACyT), Mexico
| | - E Jacoby
- Pan American Health Organization/World Health Organization, Washington, DC, USA
| | - S Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - L Kline
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - E Ewart-Pierce
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - J A Rivera
- National Institute of Public Health, Cuernavaca, Mexico
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20
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Progress towards elimination of trans-fatty acids in foods commonly consumed in four Latin American cities. Public Health Nutr 2017. [DOI: 10.1017/s1368980017001227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractObjectiveTo assess progress towards the elimination of trans-fatty acids (TFA) in foods after the 2008 Pan American Health Organization (PAHO) recommendation of virtual elimination of TFA in Latin America.DesignA descriptive, comparative analysis of foods that were likely to contain TFA and were commonly consumed in four cities in Latin America.SettingSan José (Costa Rica), Mexico City (Mexico), Rio de Janeiro (Brazil), Buenos Aires (Argentina).SubjectsFoods from each city were sampled in 2011; TFA content was analysed using GC. TFA of selected foods was also monitored in 2016.ResultsIn 2011–2016, there was a significant decrease in the content of TFA in the sampled foods across all sites, particularly in Buenos Aires (from 12·6–34·8 % range in 2011–2012 to nearly 0 % in 2015–2016). All sample products met the recommended levels of TFA content set by the PAHO. TFA were replaced with a mixture of saturated and unsaturated fats.ConclusionsOur results indicate a virtual elimination of TFA from major food sources in the cities studied. This could be due to a combination of factors, including recommendations by national and global public health authorities, voluntary and/or mandatory food reformulation made by the food industry.
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Downs SM, Singh A, Gupta V, Lock K, Ghosh-Jerath S. The need for multisectoral food chain approaches to reduce trans fat consumption in India. BMC Public Health 2015; 15:693. [PMID: 26197873 PMCID: PMC4511032 DOI: 10.1186/s12889-015-1988-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/29/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends virtually eliminating trans fat from the global food supply. Although several high-income countries have successfully reduced trans fat levels in foods, low- and middle-income countries such as India face additional challenges to its removal from the food supply. This study provides a systems analysis of the Indian food chain to assess intervention options for reducing trans fat intake in low-income consumers. METHODS Data were collected at the manufacturer, retailer and consumer levels. Qualitative interviews were conducted with vanaspati manufacturers (n = 13) and local food vendors (n = 44). Laboratory analyses (n = 39) of street foods/snacks sold by the vendors were also conducted. Trans fat and snack intakes were also examined in low-income consumers in two rural villages (n = 260) and an urban slum (n = 261). RESULTS Manufacturers of vanaspati described reducing trans fat levels as feasible but identified challenges in using healthier oils. The fat content of sampled oils from street vendors contained high levels of saturated fat (24.7-69.3 % of total fat) and trans fat (0.1-29.9 % of total fat). Households were consuming snacks high in trans fat as part of daily diets (31 % village and 84.3 % of slum households) and 4 % of rural and 13 % of urban households exceeded WHO recommendations for trans fat intakes. CONCLUSIONS A multisectoral food chain approach to reducing trans fat is needed in India and likely in other low- and middle-income countries worldwide. This will require investment in development of competitively priced bakery shortenings and economic incentives for manufacturing foods using healthier oils. Increased production of healthier oils will also be required alongside these investments, which will become increasingly important as more and more countries begin investing in palm oil production.
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Affiliation(s)
- Shauna M Downs
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia.
| | - Archna Singh
- Indian Institute for Public Health, Public Health Foundation of India and All India Institute of Medical Sciences, Delhi, India.
| | - Vidhu Gupta
- Indian Institute for Public Health, Public Health Foundation of India, Haryana, India.
| | - Karen Lock
- London School of Hygiene and Tropical Medicine and Leverhulme Centre for Integrative Research on Agriculture and Health, London, UK.
| | - Suparna Ghosh-Jerath
- Indian Institute for Public Health, Public Health Foundation of India, Plot No.34, Sector - 44, Institutional Area, Gurgaon, 122002, Haryana, India.
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Rubinstein A, Elorriaga N, Garay OU, Poggio R, Caporale J, Matta MG, Augustovski F, Pichon-Riviere A, Mozaffarian D. Eliminating artificial trans fatty acids in Argentina: estimated effects on the burden of coronary heart disease and costs. Bull World Health Organ 2015; 93:614-22. [PMID: 26478625 PMCID: PMC4581646 DOI: 10.2471/blt.14.150516] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/15/2015] [Accepted: 04/10/2015] [Indexed: 11/27/2022] Open
Abstract
Objective To estimate the impact of Argentine policies to reduce trans fatty acids (TFA) on coronary heart disease (CHD), disability-adjusted life years (DALYs) and associated health-care costs. Methods We estimated the baseline intake of TFA before 2004 to be 1.5% of total energy intake. We built a policy model including baseline intake of TFA, the oils and fats used to replace artificial TFAs, the clinical effect of reducing artificial TFAs and the costs and DALYs saved due to averted CHD events. To calculate the percentage of reduction of CHD, we calculated CHD risks on a population-based sample before and after implementation. The effect of the policies was modelled in three ways, based on projected changes: (i) in plasma lipid profiles; (ii) in lipid and inflammatory biomarkers; and (iii) the results of prospective cohort studies. We also estimated the present economic value of DALYs and associated health-care costs of coronary heart disease averted. Findings We estimated that projected changes in lipid profile would avert 301 deaths, 1066 acute CHD events, 5237 DALYs and 17 million United States dollars (US$) in health-care costs annually. Based on the adverse effects of TFA intake reported in prospective cohort studies, 1517 deaths, 5373 acute CHD events, 26 394 DALYs and US$ 87 million would be averted annually. Conclusion Even under the most conservative scenario, reduction of TFA intake had a substantial effect on public health. These findings will help inform decision-makers in Argentina and other countries on the potential public health and economic impact of this policy.
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Affiliation(s)
- Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Natalia Elorriaga
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Osvaldo U Garay
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Joaquin Caporale
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Maria G Matta
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Andres Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, United States of America
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