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Rigutto-Farebrother J, Zimmermann MB. Salt Reduction and Iodine Fortification Policies Are Compatible: Perspectives for Public Health Advocacy. Nutrients 2024; 16:2517. [PMID: 39125397 PMCID: PMC11314281 DOI: 10.3390/nu16152517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Cardiovascular diseases account for almost 18 million deaths annually, the most of all non-communicable diseases. The reduction of dietary salt consumption is a modifiable risk factor. The WHO recommends a daily sodium intake of <2000 mg but average consumption exceeds this in many countries globally. Strategies proposed to aid effective salt reduction policy include product reformulation, front of pack labelling, behavioural change campaigns and establishing a low-sodium-supportive environment. Yet, salt for household and processed food use is, in countries wholly or partially adopting a universal salt iodisation policy, the principal vehicle for population-wide iodine fortification. With salt reduction policies in place, there is concern that iodine deficiency disorders may re-emerge. Recognising the urgency to tackle the rising prevalence of NCDs yet not risk the re-emergence and detrimental effect of inadequate iodine intakes, this review lays out the feasibility of integrating both salt reduction and salt iodine fortification strategies. Reducing the burden of health risks associated with an excessive sodium intake or inadequate iodine through population-tailored, cost-effective strategies involving salt is both feasible and achievable, and represents an opportunity to improve outcomes in public health.
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Affiliation(s)
- Jessica Rigutto-Farebrother
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
- Laboratory of Nutrition and Metabolic Epigenetics, Institute of Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
| | - Michael B. Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
- MRC Human Immunology Unit, MRC Wetherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
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2
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Uthman OA, Court R, Anjorin S, Enderby J, Al-Khudairy L, Nduka C, Mistry H, Melendez-Torres GJ, Taylor-Phillips S, Clarke A. The potential impact of policies and structural interventions in reducing cardiovascular disease and mortality: a systematic review of simulation-based studies. Health Technol Assess 2023:1-32. [PMID: 38140927 DOI: 10.3310/nmfg0214] [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: 12/24/2023] Open
Abstract
Background The aim of the study was to investigate the potential effect of different structural interventions for preventing cardiovascular disease. Methods Medline and EMBASE were searched for peer-reviewed simulation-based studies of structural interventions for prevention of cardiovascular disease. We performed a systematic narrative synthesis. Results A total of 54 studies met the inclusion criteria. Diet, nutrition, tobacco and alcohol control and other programmes are among the policy simulation models explored. Food tax and subsidies, healthy food and lifestyles policies, palm oil tax, processed meat tax, reduction in ultra-processed foods, supplementary nutrition assistance programmes, stricter food policy and subsidised community-supported agriculture were among the diet and nutrition initiatives. Initiatives to reduce tobacco and alcohol use included a smoking ban, a national tobacco control initiative and a tax on alcohol. Others included the NHS Health Check, WHO 25 × 25 and air quality management policy. Future work and limitations There is significant heterogeneity in simulation models, making comparisons of output data impossible. While policy interventions typically include a variety of strategies, none of the models considered possible interrelationships between multiple policies or potential interactions. Research that investigates dose-response interactions between numerous modifications as well as longer-term clinical outcomes can help us better understand the potential impact of policy-level interventions. Conclusions The reviewed studies underscore the potential of structural interventions in addressing cardiovascular diseases. Notably, interventions in areas such as diet, tobacco, and alcohol control demonstrate a prospective decrease in cardiovascular incidents. However, to realize the full potential of such interventions, there is a pressing need for models that consider the interplay and cumulative impacts of multiple policies. Rigorous research into holistic and interconnected interventions will pave the way for more effective policy strategies in the future. Study registration The study is registered as PROSPERO CRD42019154836. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/148/05.
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Affiliation(s)
- Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Rachel Court
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Seun Anjorin
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Jodie Enderby
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Chidozie Nduka
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Hema Mistry
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV7 4AL, UK
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3
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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.
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Affiliation(s)
- Mariska Dötsch-Klerk
- Unilever Foods Innovation Centre, Wageningen, The Netherlands.
- Unilever Foods Innovation Centre, Wageningen, Bronland 14, 6708 WH, The Netherlands.
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4
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Does health economics research align with the disease burden in the Middle East and North Africa region? A systematic review of economic evaluation studies on public health interventions. Glob Health Res Policy 2022; 7:25. [PMID: 35879742 PMCID: PMC9309606 DOI: 10.1186/s41256-022-00258-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/11/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction Economic evaluation studies demonstrate the value of money in health interventions and enhance the efficiency of the healthcare system. Therefore, this study reviews published economic evaluation studies of public health interventions from 26 Middle East and North Africa (MENA) countries and examines whether they addressed the region's major health problems.
Methods PubMed and Scopus were utilized to search for relevant articles published up to June 26, 2021. The reviewers independently selected studies, extracted data, and assessed the quality of studies using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.
Results The search identified 61 studies. Approximately half (28 studies; 46%) were conducted in Israel and Iran. The main areas of interest for economic evaluation studies were infectious diseases (21 studies; 34%), cancers (13 studies; 21%), and genetic disorders (nine studies; 15%). Five (8%), 39 (64%), 16 (26%), and one (2%) studies were classified as excellent, high, average, and poor quality, respectively. The mean of CHEERS checklist items reported was 80.8% (SD 14%). Reporting the structure and justification of the selected model was missed in 21 studies (37%), while price and conversion rates and the analytical methods were missed in 21 studies (34%). Conclusions The quantity of economic evaluation studies on public health interventions in the MENA region remains low; however, the overall quality is high to excellent. There were obvious geographic gaps across countries regarding the number and quality of studies and gaps within countries concerning disease prioritization. The observed research output, however, did not reflect current and upcoming disease burden and risk factors trends in the MENA region.
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Zrubka Z, Péntek M, Mhanna L, Abu-Zahra T, Mahdi-Abid M, Fgaier M, El-Dahiyat F, Al-Abdulkarim H, Drummond M, Gulácsi L. Disease-Related Costs Published in The Middle East and North Africa Region: Systematic Review and Analysis of Transferability. PHARMACOECONOMICS 2022; 40:587-599. [PMID: 35578009 PMCID: PMC9130178 DOI: 10.1007/s40273-022-01146-6] [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: 04/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the Middle East and North Africa (MENA) the scarcity of local cost data is a key barrier to conducting health economic evaluations. We systematically reviewed reports of disease-related costs from MENA and analysed their transferability within the region. METHODS We searched PubMed and included full text English papers that reported disease-related costs from the local populations of Algeria, Bahrain, Egypt, Iraq, Jordan, Saudi Arabia, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Syria, Tunisia, United Arab Emirates and Yemen between 1995 and 2019. Screening, study selection and data extraction were done in duplicate. Study-related variables, costing methods, all costs and their characteristics were extracted and analysed via descriptive methods. From multi-country studies of MENA employing homogenous costing methods, we estimated the ratio (cost transfer coefficient) between the relative differences in direct medical costs and macroeconomic indicators via robust regression. We predicted each cost via the estimated cost transfer formula and evaluated prediction error between true and predicted (transferred) costs. RESULTS The search yielded 1646 records, 206 full text papers and 3525 costs from 84 diagnoses. Transferability was analysed involving 144 direct medical costs from eight multi-country studies. Adjusting the average of available foreign costs by 0.28 times the relative difference in GDP per capita provided the most accurate estimates. The correlation between true and predicted costs was 0.96; 68% of predicted costs fell in the true ± 50% range. Predictions were more accurate for costs from studies that involved the largest number of countries, for countries outside the Gulf region and for drug costs versus unit or disease costs. CONCLUSION The estimated cost transfer formula allows the prediction of missing costs in MENA if only GDP per capita is available for adjustment to the local setting. Input costs for the formula should be collected from multiple sources and match the decision situation.
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Affiliation(s)
- Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University Budapest, Óbudai Egyetem, Bécsi út 96, Budapest, 1034 Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University Budapest, Óbudai Egyetem, Bécsi út 96, Budapest, 1034 Hungary
| | - Lea Mhanna
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
| | - Teebah Abu-Zahra
- Health Policy and Financing Masters Course, Corvinus University of Budapest, Budapest, Hungary
| | - Mohamed Mahdi-Abid
- Research Center of Epidemiology and Statistics, Paris University, Paris, France
| | - Meriem Fgaier
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
| | - Faris El-Dahiyat
- College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
| | - Hana Al-Abdulkarim
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
- Drug Policy and Economic Center, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | | | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Óbuda University Budapest, Óbudai Egyetem, Bécsi út 96, Budapest, 1034 Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
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Labban M, Itani MM, Maaliki D, Nasreddine L, Itani HA. The Sweet and Salty Dietary Face of Hypertension and Cardiovascular Disease in Lebanon. Front Physiol 2022; 12:802132. [PMID: 35153813 PMCID: PMC8835350 DOI: 10.3389/fphys.2021.802132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
According to the World Health Organization (WHO), an estimated 1.28 billion adults aged 30–79 years worldwide have hypertension; and every year, hypertension takes 7.6 million lives. High intakes of salt and sugar (mainly fructose from added sugars) have been linked to the etiology of hypertension, and this may be particularly true for countries undergoing the nutrition transition, such as Lebanon. Salt-induced hypertension and fructose-induced hypertension are manifested in different mechanisms, including Inflammation, aldosterone-mineralocorticoid receptor pathway, aldosterone independent mineralocorticoid receptor pathway, renin-angiotensin system (RAS), sympathetic nervous system (SNS) activity, and genetic mechanisms. This review describes the evolution of hypertension and cardiovascular diseases (CVDs) in Lebanon and aims to elucidate potential mechanisms where salt and fructose work together to induce hypertension. These mechanisms increase salt absorption, decrease salt excretion, induce endogenous fructose production, activate fructose-insulin-salt interaction, and trigger oxidative stress, thus leading to hypertension. The review also provides an up-to-date appraisal of current intake levels of salt and fructose in Lebanon and their main food contributors. It identifies ongoing salt and sugar intake reduction strategies in Lebanon while acknowledging the country’s limited scope of regulation and legislation. Finally, the review concludes with proposed public health strategies and suggestions for future research, which can reduce the intake levels of salt and fructose levels and contribute to curbing the CVD epidemic in the country.
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Affiliation(s)
| | - Maha M Itani
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Dina Maaliki
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lara Nasreddine
- Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hana A Itani
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon.,Adjunct Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
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7
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Abstract
Abstract
Purpose of Review
The scientific consensus on which global health organizations base public health policies is that high sodium intake increases blood pressure (BP) in a linear fashion contributing to cardiovascular disease (CVD). A moderate reduction in sodium intake to 2000 mg per day helps ensure that BP remains at a healthy level to reduce the burden of CVD.
Recent Findings
Yet, since as long ago as 1988, and more recently in eight articles published in the European Heart Journal in 2020 and 2021, some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry’s vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst. Nevertheless, some researchers, often with funding from the food industry, continue to publish such claims without addressing the numerous objections. This article analyzes the eight articles as a case study, summarizes misleading claims, their objections, and it offers possible reasons for such claims.
Summary
Our study calls upon journal editors to ensure that unfounded claims about sodium intake be rigorously challenged by independent reviewers before publication; to avoid editorial writers who have been co-authors with the subject paper’s authors; to require statements of conflict of interest; and to ensure that their pages are used only by those who seek to advance knowledge by engaging in the scientific method and its collegial pursuit. The public interest in the prevention and treatment of disease requires no less.
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Webster J, Waqa G, Thow AM, Allender S, Lung T, Woodward M, Rogers K, Tukana I, Kama A, Wilson D, Mounsey S, Dodd R, Reeve E, McKenzie BL, Johnson C, Bell C. Scaling-up food policies in the Pacific Islands: protocol for policy engagement and mixed methods evaluation of intervention implementation. Nutr J 2022; 21:8. [PMID: 35105346 PMCID: PMC8807012 DOI: 10.1186/s12937-022-00761-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/19/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is a crisis of non-communicable diseases (NCDs) in the Pacific Islands, and poor diets are a major contributor. The COVID-19 pandemic and resulting economic crisis will likely further exacerbate the burden on food systems. Pacific Island leaders have adopted a range of food policies and regulations to improve diets. This includes taxes and regulations on compositional standards for salt and sugar in foods or school food policies. Despite increasing evidence for the effectiveness of such policies globally, there is a lack of local context-specific evidence about how to implement them effectively in the Pacific. METHODS Our 5-year collaborative project will test the feasibility and effectiveness of policy interventions to reduce salt and sugar consumption in Fiji and Samoa, and examine factors that support sustained implementation. We will engage government agencies and civil society in Fiji and Samoa, to support the design, implementation and monitoring of evidence-informed interventions. Specific objectives are to: (1) conduct policy landscape analysis to understand potential opportunities and challenges to strengthen policies for prevention of diet-related NCDs in Fiji and Samoa; (2) conduct repeat cross sectional surveys to measure dietary intake, food sources and diet-related biomarkers; (3) use Systems Thinking in Community Knowledge Exchange (STICKE) to strengthen implementation of policies to reduce salt and sugar consumption; (4) evaluate the impact, process and cost effectiveness of implementing these policies. Quantitative and qualitative data on outcomes and process will be analysed to assess impact and support scale-up of future interventions. DISCUSSION The project will provide new evidence to support policy making, as well as developing a low-cost, high-tech, sustainable, scalable system for monitoring food consumption, the food supply and health-related outcomes.
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Affiliation(s)
- Jacqui Webster
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia.
| | - Gade Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, Fiji National University, Suva, Fiji
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia
| | - Steven Allender
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Thomas Lung
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | - Mark Woodward
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia.,George Institute for Global Health, Oxford University, Oxford, UK.,Johns Hopkins University, Baltimore, USA
| | - Kris Rogers
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | | | - Ateca Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | - Donald Wilson
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, Fiji National University, Suva, Fiji
| | - Sarah Mounsey
- Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia
| | - Rebecca Dodd
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | - Erica Reeve
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Briar Louise McKenzie
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | - Claire Johnson
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | - Colin Bell
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, Australia
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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.
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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
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10
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Al-Jawaldeh A, Taktouk M, Chatila A, Naalbandian S, Al-Thani AAM, Alkhalaf MM, Almamary S, Barham R, Baqadir NM, Binsunaid FF, Fouad G, Nasreddine L. Salt Reduction Initiatives in the Eastern Mediterranean Region and Evaluation of Progress towards the 2025 Global Target: A Systematic Review. Nutrients 2021; 13:2676. [PMID: 34444836 PMCID: PMC8399509 DOI: 10.3390/nu13082676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and classified according to a pre-defined framework: salt intake assessments; leadership and strategic approach; implementation strategies; monitoring and evaluation of program impact. Salt intake levels were estimated in 15 out of the 22 countries (68%), while national salt reduction initiatives were identified in 13 (59%). The majority of countries were found to implement multifaceted reduction interventions, characterized by a combination of two or more implementation strategies. The least common implementation strategy was taxation, while the most common was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%). Monitoring activities were conducted by few countries (27%), while impact evaluations were lacking. Despite the ongoing salt reduction efforts in several countries of the region, more action is needed to initiate reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluations of ongoing programs. Such efforts are vital for the achievement of the targeted 30% reduction in salt intake.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo 11435, Egypt;
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (M.T.); (A.C.)
| | - Aya Chatila
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (M.T.); (A.C.)
| | - Sally Naalbandian
- Science and Agriculture Library, American University of Beirut, Beirut 11-0236, Lebanon;
| | | | - Majid M. Alkhalaf
- National Nutrition Committee, Saudi Food and Drug Authority, Riyadh 13312-6288, Saudi Arabia; (M.M.A.); (N.M.B.)
| | | | - Rawhieh Barham
- Nutrition Department, Ministry of Health, Amman 11118, Jordan;
| | - Nimah M. Baqadir
- National Nutrition Committee, Saudi Food and Drug Authority, Riyadh 13312-6288, Saudi Arabia; (M.M.A.); (N.M.B.)
| | - Faisal F. Binsunaid
- Healthy Food Department, Saudi Food and Drug Authority, Riyadh 13312-6288, Saudi Arabia;
| | - Gihan Fouad
- National Nutrition Institute, Cairo 11435, Egypt;
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (M.T.); (A.C.)
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11
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Doggui R, El Ati J, Sassi S, Ben Gharbia H, Al‐Jawaldeh A, El Ati‐Hellal M. Unbalanced intakes of sodium and potassium among Tunisian adults: A cross-sectional study. Food Sci Nutr 2021; 9:2234-2246. [PMID: 33841839 PMCID: PMC8020952 DOI: 10.1002/fsn3.2197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
The prevention and management of hypertension are untimely associated with a lowering of sodium intake. The present study aimed to evaluate the sodium and potassium intake levels of Tunisian population through measurement of 24-hr urinary sodium excretions. A randomly, multistage, cross-sectional study was conducted in an urban region (Bizerte) in Tunisia during 2015. The target population involved adults aged from 25 to 64 years. Sodium, potassium, and creatinine concentrations were determined in each urine sample using indirect potentiometric method. From the 420 selected participants, only 194 gave urine samples complying completeness criteria. A multivariate regression model was used to assess the variables related to sodium and potassium excretion. The daily mean excretion of sodium and potassium was 138.3 ± 46.5 mmol/d (corresponding to 8.1 ± 2.7 g/d of salt intake) and 61.0 ± 22.7 mmol/d, respectively. More than 87.1% of the participants (89.8% for men vs. 84.9% for women; p = .31) exceeded the WHO recommendation of 5 g/d. The upper limit of 10 g salt intake per day was still exceeded by 26.3%. After adjusted analysis, sex (for women, coef = -1.6; (95% CI: -2.4, -0.7)), level of instruction (≥30 kg/m2, coef = +1.1; (95% IC: 0.4-2.0)), and body mass index (≥30 kg/m2, coef = +1.1; (95% CI: 0.1, 2.0)) were associated with the sodium excretion. High sodium intake and inadequate potassium intake were found among participants. This consumption profile complies with the diet westernization context occurring in Tunisia. The initiated strategy focused on the downward of sodium in bread (the main source of salt intake) seems to be promising.
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Affiliation(s)
- Radhouene Doggui
- INNTA (National Institute of Nutrition and Food Technology)SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research LaboratoryTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology)SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research LaboratoryTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Sonia Sassi
- INNTA (National Institute of Nutrition and Food Technology)SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research LaboratoryTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Houda Ben Gharbia
- INNTA (National Institute of Nutrition and Food Technology)SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research LaboratoryTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Ayoub Al‐Jawaldeh
- World Health Organization (WHO)Regional Office for the Eastern Mediterranean (EMRO)CairoEgypt
| | - Myriam El Ati‐Hellal
- Laboratory Materials Molecules and Applications LR11ES22TunisTunisia
- IPESTUniversity of CarthageTunisTunisia
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12
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Taylor C, Hoek AC, Deltetto I, Peacock A, Ha DTP, Sieburg M, Hoang D, Trieu K, Cobb LK, Jan S, Webster J. The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam. ACTA ACUST UNITED AC 2021; 79:32. [PMID: 33706807 PMCID: PMC7953693 DOI: 10.1186/s13690-021-00540-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~ 70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam. Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (− 3445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (− 43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (− 243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00540-4.
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Affiliation(s)
- Colman Taylor
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia. .,Health Technology Analysts Pty Ltd, Surry Hills, Australia.
| | - Annet C Hoek
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Irene Deltetto
- Health Technology Analysts Pty Ltd, Surry Hills, Australia
| | - Adrian Peacock
- Health Technology Analysts Pty Ltd, Surry Hills, Australia
| | | | | | | | - Kathy Trieu
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Laura K Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York, NY, USA
| | - Stephen Jan
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Jacqui Webster
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
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13
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Alonso S, Tan M, Wang C, Kent S, Cobiac L, MacGregor GA, He FJ, Mihaylova B. Impact of the 2003 to 2018 Population Salt Intake Reduction Program in England: A Modeling Study. Hypertension 2021; 77:1086-1094. [PMID: 33641370 PMCID: PMC7968966 DOI: 10.1161/hypertensionaha.120.16649] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Supplemental Digital Content is available in the text. The United Kingdom was among the first countries to introduce a salt reduction program in 2003 to reduce cardiovascular disease (CVD) incidence risk. Despite its initial success, the program has stalled recently and is yet to achieve national and international targets. We used age- and sex-stratified salt intake of 19 to 64 years old participants in the National Diet and Nutrition Surveys 2000 to 2018 and a multistate life table model to assess the effects of the voluntary dietary salt reduction program on premature CVD, quality-adjusted survival, and health care and social care costs in England. The program reduced population-level salt intake from 9.38 grams/day per adult (SE, 0.16) in 2000 to 8.38 grams/day per adult (SE, 0.17) in 2018. Compared with a scenario of persistent 2000 levels, assuming that the population-level salt intake is maintained at 2018 values, by 2050, the program is projected to avoid 83 140 (95% CI, 73 710–84 520) premature ischemic heart disease (IHD) cases and 110 730 (95% CI, 98 390–112 260) premature strokes, generating 542 850 (95% CI, 529 020–556 850) extra quality-adjusted life-years and £1640 million (95% CI, £1570–£1660) health care cost savings for the adult population of England. We also projected the gains of achieving the World Health Organization target of 5 grams/day per adult by 2030, which by 2050 would avert further 87 870 (95% CI, 82 050–88 470) premature IHD cases, 126 010 (95% CI, 118 600–126 460) premature strokes and achieve £1260 million (95% CI, £1180–£1260) extra health care savings compared with maintaining 2018 levels. Strengthening the salt reduction program to achieve further reductions in population salt intake and CVD burden should be a high priority.
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Affiliation(s)
- Sergi Alonso
- From the Institute of Population Health Sciences (S.A., B.M.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Monique Tan
- Wolfson Institute of Preventive Medicine (M.T., C.W., G.A.M., F.J.H.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Changqiong Wang
- Wolfson Institute of Preventive Medicine (M.T., C.W., G.A.M., F.J.H.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Seamus Kent
- National Institute for Health and Clinical Excellence, London, United Kingdom (S.K.)
| | - Linda Cobiac
- Nuffield Department of Population Health, University of Oxford, United Kingdom (L.C., B.M.)
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine (M.T., C.W., G.A.M., F.J.H.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Feng J He
- Wolfson Institute of Preventive Medicine (M.T., C.W., G.A.M., F.J.H.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Borislava Mihaylova
- From the Institute of Population Health Sciences (S.A., B.M.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.,Nuffield Department of Population Health, University of Oxford, United Kingdom (L.C., B.M.)
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14
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Breda J, Allen LN, Tibet B, Erguder T, Karabulut E, Yildirim HH, Mok A, Wickramasinghe K. Estimating the impact of achieving Turkey's non-communicable disease policy targets: A macro-simulation modelling study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 1:100018. [PMID: 33928267 PMCID: PMC8063152 DOI: 10.1016/j.lanepe.2020.100018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Burden of non-communicable disease (NCDs) has continued to rise globally, particularly in low- and middle-income countries. In Turkey, NCDs account for 89% of all deaths, with nearly one in five deaths occurring before age 70. This study investigates the number of NCD deaths that could be prevented if Turkey met national and international targets for major modifiable NCD risk factors. METHODS Preventable deaths were estimated using the World Health Organization (WHO) 'Preventable Risk Integrated ModEl' (PRIME), by combining: 1) Baseline exposure data for risk factors, referenced from national surveillance and cohort studies; 2) Aetiological associations from published meta-analyses; and 3) Demographic and mortality statistics obtained from the Turkish Statistical Institute (TurkStat). Confidence intervals were estimated using Monte Carlo simulations. FINDINGS If Turkey met its NCD risk factor targets for reducing tobacco and salt consumption by 30%, and physical inactivity by 10% in 2017, an estimated 19,859 deaths (95%CI: 12,802 to 26,609) could have been prevented. Approximately two thirds of these preventable deaths were in men, and one in three were in adults below 75 years. A 30% relative reduction in the consumption of alcohol, tobacco, and salt, as well as physical inactivity, would prevent 180 (107 to 259); 4,786 (3,679 to 5,836); 13,112 (5,819 to 19,952); and 7,124 (5,053 to 9,212) deaths, respectively. INTERPRETATION Among major modifiable NCD risk factors, population-level reductions in salt intake and physical inactivity present the greatest opportunity for reducing NCD mortality in Turkey. These findings can help Turkey prioritise interventions to meet the Sustainable Development Goal target of reducing NCD mortality by one third, by 2030.
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Affiliation(s)
- João Breda
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Luke N Allen
- GP Academic Clinical Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
- Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG UK
| | - Birol Tibet
- Izmir Biomedicine and Genome Center, Izmir, Turkey
- PhD Candidate, Istanbul University Istanbul Faculty of Medicine Department of Public Health, Istanbul, Turkey
| | - Toker Erguder
- National Professional Officer, World Health Organization Noncommunicable Diseases and Promoting Health through the Life-Course
| | - Erdem Karabulut
- Hacettepe University Faculty of Medicine Department of Biostatistics, Ankara, Turkey
| | - Hasan H Yildirim
- Health Institutes of Turkey Turkish Institute for Health Policies, Ministry of Health, Ankara, Turkey
| | - Alexander Mok
- WHO European Office for the Prevention and Control of Noncommunicable Diseases Russian Federation
| | - Kremlin Wickramasinghe
- World Health Organization Regional Office for Europe Russian Federation
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, 9 Leontyevsky Pereulok 125009 Moscow, Russian Federation
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15
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Balanova YA, Kontsevaya AV, Karamnova NS, Mukaneeva DK, Drapkina OM. Population-based Cardiovascular Disease Prevention Measures Aimed at Reducing Salt Intake: Analysis of International Strategies and Prospects for Implementation in the Russian Federation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-12-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
High salt intake is an important risk factor for cardiovascular diseases (CVD), closely related to the level of blood pressure in the population. The purpose of the review: to study population-based interventions for CVD prevention, aimed at reducing salt intake; to assess the potential for their implementation in the Russian Federation. We presented population-based strategies for dietary salt intake reduction used in different countries. The main components of strategies aimed to correct this risk factor in the Russian Federation were identified. The main components of the population-based approach to reducing salt intake are: determining population salt consumption, identifying sources of salt in the diet, monitoring of salt content in products, engaging with the food industry, consumer awareness campaigns, changes in product labeling, tax measures. An integrated approach to the problem is the most successful. Measures which were highly effective have not yet been fully implemented in the Russian Federation. At the moment, taxation of high-salt foods and tax subsidies for healthy food are not applied. Food manufacturers are not sufficiently involved - there are no legislatively introduced measures to reduce salt through food reformulation. Firstly it has to be applied to diet-forming products that are consumed daily, such as bakery and dairy products, and meat products.
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Affiliation(s)
- Yu. A. Balanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. V. Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine
| | - N. S. Karamnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. K. Mukaneeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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16
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Aminde LN, Cobiac L, Veerman JL. Cost-effectiveness analysis of population salt reduction interventions to prevent cardiovascular disease in Cameroon: mathematical modelling study. BMJ Open 2020; 10:e041346. [PMID: 33234652 PMCID: PMC7689085 DOI: 10.1136/bmjopen-2020-041346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/15/2020] [Accepted: 10/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Reducing dietary sodium (salt) intake has been proposed as a population-wide strategy to reduce blood pressure and cardiovascular disease (CVD). The cost-effectiveness of such strategies has hitherto not been investigated in Cameroon. METHODS A multicohort multistate life table Markov model was used to evaluate the cost-effectiveness of three population salt reduction strategies: mass media campaign, school-based salt education programme and low-sodium salt substitute. A healthcare system perspective was considered and adults alive in 2016 were simulated over the life course. Outcomes were changes in disease incidence, mortality, health-adjusted life years (HALYs), healthcare costs and incremental cost-effectiveness ratios (ICERs) over the lifetime. Probabilistic sensitivity analysis was used to quantify uncertainty. RESULTS Over the life span of the cohort of adults alive in Cameroon in 2016, substantial numbers of new CVD events could be prevented, with over 10 000, 79 000 and 84 000 CVD deaths that could be averted from mass media, school education programme and salt substitute interventions, respectively. Population health gains over the lifetime were 46 700 HALYs, 348 800 HALYs and 368 400 HALYs for the mass media, school education programme and salt substitute interventions, respectively. ICERs showed that all interventions were dominant, with probabilities of being cost-saving of 84% for the school education programme, 89% for the mass media campaign and 99% for the low sodium salt substitute. Results were largely robust in sensitivity analysis. CONCLUSION All the salt reduction strategies evaluated were highly cost-effective with very high probabilities of being cost-saving. Salt reduction in Cameroon has the potential to save many lives and offers good value for money.
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Affiliation(s)
| | - Linda Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - J Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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17
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Santos O, Alarcão V, Feteira-Santos R, Fernandes J, Virgolino A, Sena C, Vieira CP, Gregório MJ, Nogueira P, Graça P, Costa A. Impact of different front-of-pack nutrition labels on online food choices. Appetite 2020; 154:104795. [PMID: 32798050 DOI: 10.1016/j.appet.2020.104795] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/09/2020] [Accepted: 06/29/2020] [Indexed: 01/10/2023]
Abstract
Front-of-pack nutrition labels (FOP-NL) are efficient tools for increasing consumers' awareness of the nutritional quality of food products, prompting healthier food choices. The main goal of this study was to evaluate the impact of four FOP-NL schemes - Traffic Light label (TL), Guideline Daily Amounts (%GDA), Nutri-Score (NS) and Health Star Rating (HSR) - on consumers' selection of food products according to perceived nutritional quality. A cross-sectional open-label crossover randomized controlled study was carried out among Portuguese consumers. A web-based questionnaire was used to assess participants' a) preferences regarding FOP-NLs and b) capacity to select healthy products in a food selection task using the information from FOP-NL schemes. When performing the selection task, participants had the option to indicate that they could not decide simply based on the presented FOP-NL (requiring more information). Overall, 357 adults participated in the study. Regarding consumers' preferences, TL received the most favorable responses, while NS received the fewest. All FOP-NLs performed better than the no-nutritional label control condition in the food selection task. The highest proportion of correct choices was obtained for TL (72.3%), followed by HSR (70.9%), %GDA (70.0%) and NS (62.2%), though no significant differences were found among FOP-NLs. Percentages of respondents indicating not being able to answer due to lack of information affected the proportion of correct choices, with 10.3% for TL, 12.9% for %GDA, 14.6% for HSR, and 25.8% for NS, indicating they were unable to choose without additional information. Although no particular FOP-NL system stood out as the most significantly effective, TL was the most preferred by Portuguese adults. Long-term real-world evidence is necessary to assess the impact of FOP-NL systems on individuals' food choices.
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Affiliation(s)
- Osvaldo Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal; Unbreakable Idea Research, Lda, Painho, Portugal.
| | - Violeta Alarcão
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal; Centro de Investigação e Estudos de Sociologia (CIES-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisboa, Portugal.
| | - Rodrigo Feteira-Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.
| | - João Fernandes
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.
| | - Ana Virgolino
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.
| | - Catarina Sena
- Direção-Geral da Saúde, Lisboa, Portugal. Alameda D, Afonso Henriques, 45, 1049-005, Lisboa, Portugal
| | - Carlota Pacheco Vieira
- Direção-Geral da Saúde, Lisboa, Portugal. Alameda D, Afonso Henriques, 45, 1049-005, Lisboa, Portugal
| | - Maria João Gregório
- Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, Lisboa, Portugal, Alameda D, Afonso Henriques, 45, 1049-005, Lisboa, Portugal; Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto. Rua do Campo Alegre, 823, 4150-180, Porto, Portugal.
| | - Paulo Nogueira
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal; Direção-Geral da Saúde, Lisboa, Portugal. Alameda D, Afonso Henriques, 45, 1049-005, Lisboa, Portugal; Laboratório de Biomatemática, Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.
| | - Pedro Graça
- Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, Lisboa, Portugal, Alameda D, Afonso Henriques, 45, 1049-005, Lisboa, Portugal; Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto. Rua do Campo Alegre, 823, 4150-180, Porto, Portugal.
| | - Andreia Costa
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal; Direção-Geral da Saúde, Lisboa, Portugal. Alameda D, Afonso Henriques, 45, 1049-005, Lisboa, Portugal; Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.
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Tekle DY, Santos JA, Trieu K, Thout SR, Ndanuko R, Charlton K, Hoek AC, Huffman MD, Jan S, Webster J. Monitoring and implementation of salt reduction initiatives in Africa: A systematic review. J Clin Hypertens (Greenwich) 2020; 22:1355-1370. [PMID: 32770701 PMCID: PMC7496579 DOI: 10.1111/jch.13937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 01/18/2023]
Abstract
This systematic review aims to document salt consumption patterns and the implementation status and potential impact of salt reduction initiatives in Africa, from studies published between January 2009 and November 2019. Studies were sourced using MEDLINE, Embase, Cochrane Library electronic databases, and gray literature. Of the 887 records retrieved, 38 studies conducted in 18 African countries were included. Twelve studies measured population salt intake, 11 examined salt level in foods, 11 assessed consumer knowledge, attitudes, and behaviors, 1 study evaluated a behavior change intervention, and 3 studies modeled potential health gains and cost savings of salt reduction interventions. The population salt intake studies determined by 24‐hour urine collections showed that the mean (SD) salt intake in African adults ranged from 6.8 (2.2) g to 11.3 (5.4) g/d. Salt levels in foods were generally high, and consumer knowledge was fairly high but did not seem to translate into salt lowering behaviors. Modeling studies showed that interventions for reducing dietary sodium would generate large health gains and cost savings for the health system. Despite this evidence, adoption of population salt reduction strategies in Africa has been slow, and dietary consumption of sodium remains high. Only South Africa adopted legislation in 2016 to reduce population salt intake, but success of this intervention has not yet been fully evaluated. Thus, rigorous evaluation of the salt reduction legislation in South Africa and initiation of salt reduction programs in other African countries will be vital to achieving the targeted 30% reduction in salt intake by 2025.
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Affiliation(s)
- Dejen Yemane Tekle
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Rhoda Ndanuko
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Karen Charlton
- Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Annet C Hoek
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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19
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Rincón-Gallardo Patiño S, Zhou M, Da Silva Gomes F, Lemaire R, Hedrick V, Serrano E, Kraak VI. Effects of Menu Labeling Policies on Transnational Restaurant Chains to Promote a Healthy Diet: A Scoping Review to Inform Policy and Research. Nutrients 2020; 12:E1544. [PMID: 32466387 PMCID: PMC7352298 DOI: 10.3390/nu12061544] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/06/2023] Open
Abstract
There is insufficient evidence that restaurant menu labeling policies are cost-effective strategies to reduce obesity and diet-related non-communicable diseases (NCDs). Evidence suggests that menu labeling has a modest effect on calories purchased and consumed. No review has been published on the effect of menu labeling policies on transnational restaurant chains globally. This study conducted a two-step scoping review to map and describe the effect of restaurant menu labeling policies on menu reformulation. First, we identified national, state, and municipal menu labeling policies in countries from global databases. Second, we searched four databases (i.e., PubMed, CINHAL/EBSCO, Web of Science, and Google Scholar) for peer-reviewed studies and gray-literature sources in English and Spanish (2000-2020). Step 1 identified three voluntary and eight mandatory menu labeling policies primarily for energy disclosures for 11 upper-middle and high-income countries, but none for low- or middle-income countries. Step 2 identified 15 of 577 studies that met the inclusion criteria. The analysis showed reductions in energy for newly introduced menu items only in the United States. We suggesr actions for governments, civil society organizations, and the restaurant businesses to develop, implement, and evaluate comprehensive menu labeling policies to determine whether these may reduce obesity and NCD risks worldwide.
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Affiliation(s)
- Sofía Rincón-Gallardo Patiño
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
| | - Mi Zhou
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
| | - Fabio Da Silva Gomes
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, World Health Organization, Washington, DC 20037, USA;
| | - Robin Lemaire
- Center for Public Administration and Policy, School of Public and International Affairs, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA;
| | - Valisa Hedrick
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
| | - Vivica I. Kraak
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (M.Z.); (V.H.); (E.S.); (V.I.K.)
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Znyk M, Polańska K, Bąk-Romaniszyn L, Kaleta D. Correlates of Blood Pressure and Cholesterol Level Testing Among a Socially-Disadvantaged Population in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2123. [PMID: 32210004 PMCID: PMC7142992 DOI: 10.3390/ijerph17062123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/29/2022]
Abstract
As part of cardiovascular disease prevention, the performance of BMI determination, blood pressure measurement, biochemical tests, as well as a lifestyle-related risk assessment are recommended. The aim of this study was to evaluate the correlates of blood pressure and cholesterol level testing among a socially-disadvantaged population in Poland. This cross-sectional study was performed between 2015 and 2016 among 1710 beneficiaries of government welfare assistance. Face-to-face interviews conducted by trained staff at each participant's place of residence allowed for completion of questionnaires that covered socio-demographic, health and lifestyle-related information. Sixty-five percent of the participants declared a blood pressure and 27% of them cholesterol level testing at least once within the year proceeding the study. A higher chance of having blood pressure testing was observed among the women (OR = 1.5; p = 0.002) and people with high blood pressure (OR = 3.9; p < 0.001). The women (OR = 1.4; p = 0.04) and older people (OR = 1.9; p = 0.02; OR = 2.6; p < 0.001, OR = 2.7; p = 0.002, for the following age groups: 30-39, 40-49, 50-59 years respectively), the respondents who declared health problems such as heart attack (OR = 3.0; p = 0.04), high blood pressure (OR = 2.3; p < 0.001) and type 2 diabetes (OR = 3.3; p = 0.004) and those with a family history of chronic diseases (OR = 1.5; p = 0.03) had a higher chance of cholesterol level checking. Higher healthy lifestyle index, indicating that the study participants have followed almost all of the studied lifestyle-related recommendations, was a significant correlate of cholesterol level testing (OR = 1.7; p = 0.006). Actions that promote lifestyle changes, blood pressure, and cholesterol level testing should take into account the needs of the disadvantaged population and should especially target men, people with existing chronic diseases, and those with unfavorable lifestyle characteristics. With respect to the socially-disadvantaged population, the social assistance institutions and outpatient clinics are the best places to conduct activities promoting a healthy lifestyle. The most commonly applied strategies to promote lifestyle changes can cover risk assessment, increasing awareness, emotional support and encouragement, as well as a referral to specialists.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (D.K.)
| | - Kinga Polańska
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (D.K.)
| | - Leokadia Bąk-Romaniszyn
- Department of Nutrition in Digestive Tract Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (K.P.); (D.K.)
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2020; 290:140-205. [PMID: 31504418 DOI: 10.1016/j.atherosclerosis.2019.08.014] [Citation(s) in RCA: 550] [Impact Index Per Article: 137.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41:111-188. [PMID: 31504418 DOI: 10.1093/eurheartj/ehz455] [Citation(s) in RCA: 4301] [Impact Index Per Article: 1075.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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The Impact of Obesity on the Association between Vitamin D Deficiency and Cardiovascular Disease. Nutrients 2019; 11:nu11102458. [PMID: 31615154 PMCID: PMC6835874 DOI: 10.3390/nu11102458] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of this article is to review the literature regarding the relationship between vitamin D deficiency and cardiovascular disease (CVD) and its modification in the presence of obesity. Despite the strong association between vitamin D status and cardiovascular outcomes, vitamin D supplementation trials in the general population have failed to decrease the incidence of cardiovascular events and mortality. A comprehensive study of the published literature and a comparison with experimental data lead to the conclusion that obesity, due to its high prevalence and strong association with both vitamin D deficiency and CVD, may act as a critical confounder, which is responsible for the different results on this association. Adoption of a vitamin D preventive supplementation strategy for CVD is unlikely to yield any benefit to the general population. However, it might be particularly useful in obese adults with increased risk for CVD.
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Balanova YA, Kontsevaya AV, Myrzamatova AO, Mukaneeva DK, Khudyakov MB. Economic damage associated with excess salt intake of Russian people in 2016. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-4-62-68] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Effect of Formulation, Labelling, and Taxation Policies on the Nutritional Quality of the Food Supply. Curr Nutr Rep 2019; 8:240-249. [DOI: 10.1007/s13668-019-00289-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Briggs ADM, Wolstenholme J, Scarborough P. Estimating the cost-effectiveness of salt reformulation and increasing access to leisure centres in England, with PRIMEtime CE model validation using the AdViSHE tool. BMC Health Serv Res 2019; 19:489. [PMID: 31307459 PMCID: PMC6631881 DOI: 10.1186/s12913-019-4292-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND PRIMEtime CE is a multistate life table model that can directly compare the cost effectiveness of public health interventions affecting diet and physical activity levels, helping to inform decisions about how to spend finite resources. This paper estimates the costs and health outcomes in England of two scenarios: reformulating salt and expanding subsidised access to leisure centres. The results are used to help validate PRIMEtime CE, following the steps outlined in the Assessment of the Validation Status of Health-Economic decision models (AdViSHE) tool. METHODS The PRIMEtime CE model estimates the difference in quality adjusted life years (QALYs) and difference in NHS and social care costs of modelled interventions compared with doing nothing. The salt reformulation scenario models how salt consumption would change if food producers met the 2017 UK Food Standards Agency salt reformulation targets. The leisure centre scenario models change in physical activity levels if the Birmingham Be Active scheme (where swimming pools and gym access is free to residents during defined periods) was rolled out across England. The AdViSHE tool was developed by health economic modellers and divides model validation into five parts: validation of the conceptual model, input data validation, validation of computerised model, operational validation, and other validation techniques. PRIMEtime CE is discussed in relation to each part. RESULTS Salt reformulation was dominant compared with doing nothing, and had a 10-year return on investment of £1.44 (£0.50 to £2.94) for every £1 spent. By contrast, over 10 years the Be Active expansion would cost £727,000 (£514,000 to £1,064,000) per QALY. PRIMEtime CE has good face validity of its conceptual model and has robust input data. Cross-validation produces mixed results and shows the impact of model scope, input parameters, and model structure on cost-per-QALY estimates. CONCLUSIONS This paper illustrates how PRIMEtime CE can be used to compare the cost-effectiveness of two different public health measures affecting diet and physical activity levels. The AdViSHE tool helps to validate PRIMEtime CE, identifies some of the key drivers of model estimates, and highlights the challenges of externally validating public health economic models against independent data.
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Affiliation(s)
- Adam D. M. Briggs
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention and NIHR Biomedical Research Centre at Oxford, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Saidi O, O'Flaherty M, Zoghlami N, Malouche D, Capewell S, Critchley JA, Bandosz P, Ben Romdhane H, Guzman Castillo M. Comparing Strategies to Prevent Stroke and Ischemic Heart Disease in the Tunisian Population: Markov Modeling Approach Using a Comprehensive Sensitivity Analysis Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:2123079. [PMID: 30838048 PMCID: PMC6374861 DOI: 10.1155/2019/2123079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Mathematical models offer the potential to analyze and compare the effectiveness of very different interventions to prevent future cardiovascular disease. We developed a comprehensive Markov model to assess the impact of three interventions to reduce ischemic heart diseases (IHD) and stroke deaths: (i) improved medical treatments in acute phase, (ii) secondary prevention by increasing the uptake of statins, (iii) primary prevention using health promotion to reduce dietary salt consumption. METHODS We developed and validated a Markov model for the Tunisian population aged 35-94 years old over a 20-year time horizon. We compared the impact of specific treatments for stroke, lifestyle, and primary prevention on both IHD and stroke deaths. We then undertook extensive sensitivity analyses using both a probabilistic multivariate approach and simple linear regression (metamodeling). RESULTS The model forecast a dramatic mortality rise, with 111,134 IHD and stroke deaths (95% CI 106567 to 115048) predicted in 2025 in Tunisia. The salt reduction offered the potentially most powerful preventive intervention that might reduce IHD and stroke deaths by 27% (-30240 [-30580 to -29900]) compared with 1% for medical strategies and 3% for secondary prevention. The metamodeling highlighted that the initial development of a minor stroke substantially increased the subsequent probability of a fatal stroke or IHD death. CONCLUSIONS The primary prevention of cardiovascular disease via a reduction in dietary salt consumption appeared much more effective than secondary or tertiary prevention approaches. Our simple but comprehensive model offers a potentially attractive methodological approach that might now be extended and replicated in other contexts and populations.
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Affiliation(s)
- Olfa Saidi
- Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Nada Zoghlami
- Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Dhafer Malouche
- Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- National Institute of Statistics and Data Analysis Tunis, Tunis, Tunisia
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Julia A. Critchley
- Population Health Research Institute, St George's University of London, London, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Federici C, Detzel P, Petracca F, Dainelli L, Fattore G. The impact of food reformulation on nutrient intakes and health, a systematic review of modelling studies. BMC Nutr 2019; 5:2. [PMID: 32153917 PMCID: PMC7050744 DOI: 10.1186/s40795-018-0263-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/12/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Unhealthy diet is a risk factor for adverse health outcomes. Reformulation of processed foods has the potential to improve population diet, but evidence of its impact is limited. The purpose of this review was to explore the impact of reformulation on nutrient intakes, health outcomes and quality of life; and to evaluate the quality of modelling studies on reformulation interventions. METHODS A systematic review of peer-reviewed articles published between January 2000 and December 2017 was performed using MEDLINE, ScienceDirect, Embase, Scopus, Cochrane, and the Centre for Reviews and Dissemination of the University of York. Additional studies were identified through informal searches on Google and specialized websites. Only simulation studies modelling the impact of food reformulation on nutrient intakes and health outcomes were included. Included articles were independently extracted by 2 reviewers using a standardized, pre-piloted data form, including a self-developed tool to assess study quality. RESULTS A total of 33 studies met the selected inclusion criteria, with 20, 5 and 3 studies addressing sodium, sugar and fats reformulation respectively, and 5 studies addressing multiple nutrients. Evidence on the positive effects of reformulation on consumption and health was stronger for sodium interventions, less conclusive for sugar and fats. Study features were highly heterogeneous including differences in methods, the type of policy implemented, the extent of the reformulation, and the spectrum of targeted foods and nutrients. Nonetheless, partial between-study comparisons show a consistent relationship between percentages reformulated and reductions in individual consumption. Positive results are also shown for health outcomes and quality of life measures, although comparisons across studies are limited by the heterogeneity in model features and reporting. Study quality was often compromised by short time-horizons, disregard of uncertainty and time dependencies, and lack of model validation. CONCLUSIONS Reformulation models highlight relevant improvements in diets and population health. While models are valuable tools to evaluate reformulation interventions, comparisons are limited by non-homogeneous designs and assumptions. The use of validated models and extensive scenario analyses would improve models' credibility, providing useful insights for policy-makers. REVIEW REGISTRATION A research protocol was registered within the PROSPERO database (ID number CRD42017057341).
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Affiliation(s)
- Carlo Federici
- CeRGAS (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Patrick Detzel
- Nestlé Research Center, Nestec SA, Lausanne, Switzerland
| | - Francesco Petracca
- CeRGAS (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Livia Dainelli
- Nestlé Research Center, Nestec SA, Lausanne, Switzerland
| | - Giovanni Fattore
- CeRGAS (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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Saleh S, El Harakeh A, Baroud M, Zeineddine N, Farah A, Sibai AM. Costs associated with management of non-communicable diseases in the Arab Region: a scoping review. J Glob Health 2018; 8:020410. [PMID: 30546867 PMCID: PMC6287209 DOI: 10.7189/jogh.08.020410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Global mortality rates resulting from non-communicable diseases (NCDs) are reaching alarming levels, especially in low- and middle-income countries, imposing a considerable burden on individuals and health systems as a whole. This scoping review aims at synthesizing the existing literature evaluating the cost associated with the management and treatment of major NCDs across all Arab countries; at evaluating the quality of these studies; and at identifying the gap in existing literature. METHODS A systematic search was conducted using Medline electronic database to retrieve articles evaluating costs associated with management of NCDs in Arab countries, published in English between January 2000 and April 2016. 55 studies met the eligibility criteria and were independently screened by two reviewers who extracted/calculated the following information: country, theme (management of NCD, treatment/medication, or procedure), study design, setting, population/sample size, publication year, year for cost data cost conversion (US$), costing approach, costing perspective, type of costs, source of information and quality evaluation using the Newcastle-Ottawa Scale (NOS). RESULTS The reviewed articles covered 16 countries in the Arab region. Most of the studies were observational with a retrospective or prospective design, with a relatively low to very low quality score. Our synthesis revealed that NCDs' management costs in the Arab region are high; however, there is a large variation in the methods used to quantify the costs of NCDs in these countries, making it difficult to conduct any type of comparisons. CONCLUSIONS The findings revealed that data on the direct costs of NCDs remains limited by the paucity of this type of evidence and the generally low quality of studies published in this area. There is a need for future studies, of improved and harmonized methodology, as such evidence is key for decision-makers and directs health care planning.
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Affiliation(s)
- Shadi Saleh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Amena El Harakeh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maysa Baroud
- Refugee Research and Policy Program, Issam Fares Institute for Public Policy and International Affairs. American University of Beirut, Beirut, Lebanon
| | - Najah Zeineddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Angie Farah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Abla Mehio Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, Bart van der Worp H, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2018; 252:207-274. [PMID: 27664503 DOI: 10.1016/j.atherosclerosis.2016.05.037] [Citation(s) in RCA: 348] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societie: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societie: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societie: European Society of Cardiology (ESC)
| | | | - Josep Redon
- Societie: European Society of Hypertension (ESH)
| | | | - Naveed Sattar
- Societie: European Association for the Study of Diabetes (EASD)
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Aminde LN, Takah NF, Zapata-Diomedi B, Veerman JL. Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:22. [PMID: 29983644 PMCID: PMC6003072 DOI: 10.1186/s12962-018-0108-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study. Methods In this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond’s checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis. Results From a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving. Conclusions This evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Population-based interventions especially those targeting reduction in salt intake and tobacco control are very cost-effective in LMICs with potential to generate economic gains that can be reinvested to improve health and/or other sectors. While this evidence is relevant for policy across these regions, decision makers should additionally take into account other multi-sectoral perspectives, including considerations in budget impact, fairness, affordability and implementation while setting priorities for resource allocation. Electronic supplementary material The online version of this article (10.1186/s12962-018-0108-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leopold Ndemnge Aminde
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,Non-communicable Diseases Unit, Clinical Research Education, Network & Consultancy, Douala, Cameroon
| | | | - Belen Zapata-Diomedi
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia
| | - J Lennert Veerman
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,4School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia.,5Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW 2011 Australia
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Allen LN, Pullar J, Wickramasinghe KK, Williams J, Roberts N, Mikkelsen B, Varghese C, Townsend N. Evaluation of research on interventions aligned to WHO 'Best Buys' for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015. BMJ Glob Health 2018. [PMID: 29527342 PMCID: PMC5841523 DOI: 10.1136/bmjgh-2017-000535] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed ‘best buys’. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs). Aim To systematically review research on interventions aligned to WHO ‘best buys’ for NCDs in LLMICs. Methods We searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence. Results We identified 2672 records, of which 36 were included (608 940 participants). No studies on ‘best buys’ were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related ‘best buys’, presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the ‘best buy’ interventions did not have any good evidence for effectiveness in LLMICs. Conclusions We found studies on only 11 of the 24 interventions aligned with the WHO ‘best buys’ from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate ‘best buys’ in their national context, based on national priorities, and starting with interventions with the strongest evidence base.
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Affiliation(s)
- Luke N Allen
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jessica Pullar
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kremlin Khamarj Wickramasinghe
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julianne Williams
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nia Roberts
- Health Library, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bente Mikkelsen
- Global Coordination Mechanism for Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Cherian Varghese
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, WHO, Geneva, Switzerland
| | - Nick Townsend
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Radmerikhi S, Tabatabaei SVA, Jahani Y, Mohseni M. Predicting effective factors on eating behaviors in the prevention of cardiovascular disease based on the PRECEDE model. Electron Physician 2017; 9:5894-5901. [PMID: 29560139 PMCID: PMC5843413 DOI: 10.19082/5894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/06/2017] [Indexed: 11/20/2022] Open
Abstract
Background and aim Changes in eating behavior can reduce the risk of developing cardiovascular disease. The aim of this study was to predict the effective factors of eating behaviors in the prevention of cardiovascular disease using the PRECEDE model. Methods This cross-sectional study was performed on 400 subjects aged from 20 to 60 years old in Kerman, Iran in 2016. The participants were selected using a multistage random sampling method. A self-administered questionnaire including questions regarding demographic characteristics, eating behavior, and PRECEDE model constructs were completed by the participants. Data were analyzed using SPSS 22 and STATA 12. For data analysis, Spearman correlation coefficient, univariate and multiple median regression were applied. The predictive power of the model constructs was determined by analysis of artificial neural networks. Results Among participants, the score of knowledge was high (84.15±10.7), and the scores of perceived self-efficacy (59.1±16.57), reinforcing factors (60.66±14.01), enabling factors (56.5±12.91), and eating behavior (62.1±14.7) were intermediate, and the score of attitude was low (47.84±7.67). Attitude, self-perceived efficacy, enabling factors, and knowledge predicted 32%, 30%, 26%, and 0.93% of participants' eating behavior respectively. The relationship between all variables and eating behavior was positive and significant (p<0.0001). Perceived self-efficacy had the most, and reinforcing factors the least correlation with eating behavior. Conclusion According to the results of this study, self-efficacy, attitude, and enabling factors were the main predicting factors for eating behaviors; therefore, to prevent cardiovascular disease and enhance healthy eating behavior, it is recommended to change attitude, and enhance self-efficacy and enabling factors in the community.
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Affiliation(s)
- Samera Radmerikhi
- MSc. of Health Education, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Vahid Ahmady Tabatabaei
- M.D-MPH-Ph.D., Assistant Professor, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Yunes Jahani
- Ph.D. of Biostatistics, Assistant Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohabbat Mohseni
- Ph.D. of Public Health and Health Promotion, Assistant Professor, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Zhang D, Cogswell ME, Wang G, Bowman BA. Evidence of Dietary Improvement and Preventable Costs of Cardiovascular Disease. Am J Cardiol 2017; 120:1681-1688. [PMID: 28847593 DOI: 10.1016/j.amjcard.2017.07.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/13/2017] [Accepted: 07/21/2017] [Indexed: 01/24/2023]
Abstract
We conducted a review to summarize preventable medical costs of cardiovascular disease (CVD) associated with improved diet, as defined by the 2020 Strategic Impact Goal of the American Heart Association. We searched databases of PubMed, Embase, CINAHL and ABI/INFORM to identify population-based studies published from January 1995 to December 2015 on CVD medical costs related to excess intake of salt/sodium or sugar-sweetened beverages, and inadequate intake of fruits and vegetables, fish/fish oils/omega-3 fatty acids, or whole grains/fiber/dietary fiber. Based on the American Heart Association's secondary dietary metrics, we also searched the literature on inadequate intake of nuts and excess intake of processed meat and saturated fat. For each component, we evaluated the CVD cost savings if consumption levels were changed. The cost savings were adjusted into 2013 US dollars. Among 330 studies focusing on diet and economic consequences, 16 studies evaluated CVD costs associated with 1 or more dietary components: salt/sodium (n = 13), fruits and vegetables (n = 1), meat (n = 1), and saturated fat (n = 3). In the United States, reducing individual sodium intake to 2,300 mg/day from the current level could potentially save $1,990.9/person per year for hypertension treatment, based on a simulation study. Increasing consumption of fruits and vegetables from <0.5 cup/day to >1.5 cups/day could save $1,568.0/person per year in treatment costs for CVD, based on a cohort study. Potential CVD cost savings associated with diet improvement are substantial. Interventions for reducing sodium intake and increasing fruit and vegetable consumption could be viable means to alleviate the increasing national medical expenditures.
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Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
| | - Barbara A Bowman
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Cost and cost-effectiveness of a school-based education program to reduce salt intake in children and their families in China. PLoS One 2017; 12:e0183033. [PMID: 28902880 PMCID: PMC5597122 DOI: 10.1371/journal.pone.0183033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/27/2017] [Indexed: 11/19/2022] Open
Abstract
Objective The School-based Education Program to Reduce Salt Intake in Children and Their Families study was a cluster randomized control trial among grade five students in 28 primary schools and their families in Changzhi, China. It achieved a significant effect in lowering systolic blood pressure (SBP) in all family adults by 2.3 mmHg and in elderlies (aged > = 60 years) by 9.5 mmHg. The aim of this study was to assess the cost-effectiveness of this salt reduction program. Methods Costs of the intervention were assessed using an ingredients approach to identify resource use. A trial-based incremental cost-effectiveness ratio (ICER) was estimated based on the observed effectiveness in lowering SBP. A Markov model was used to estimate the long-term cost-effectiveness of the intervention, and then based on population data, extrapolated to a scenario where the program is scaled up nationwide. Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY). The perspective was that of the health sector. Results The intervention cost Int$19.04 per family and yielded an ICER of Int$2.74 (90% CI: 1.17–12.30) per mmHg reduction of SBP in all participants (combining children and adult participants together) compared with control group. If scaled up nationwide for 10 years and assumed deterioration in treatment effect of 50% over this period, it would reach 165 million families and estimated to avert 42,720 acute myocardial infarction deaths and 107,512 stroke deaths in China. This would represent a gain of 635,816 QALYs over 10-year time frame, translating into Int$1,358 per QALY gained. Conclusion Based on WHO-CHOICE criteria, our analysis demonstrated that the proposed salt reduction strategy is highly cost-effective, and if scaled up nationwide, the benefits could be substantial. Trial registration ClinicalTrials.gov NCT01821144
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Effects of reducing processed culinary ingredients and ultra-processed foods in the Brazilian diet: a cardiovascular modelling study. Public Health Nutr 2017; 21:181-188. [PMID: 28885137 DOI: 10.1017/s1368980017002063] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To estimate the impact of reducing saturated fat, trans-fat, salt and added sugar from processed culinary ingredients and ultra-processed foods in the Brazilian diet on preventing cardiovascular deaths by 2030. DESIGN A modelling study. SETTING Data were obtained from the Brazilian Household Budget Survey 2008/2009. All food items purchased were categorized into food groups according to the NOVA classification. We estimated the energy and nutrient profile of foods then used the IMPACT Food Policy model to estimate the reduction in deaths from CVD up to 2030 in three scenarios. In Scenario A, we assumed that the intakes of saturated fat, trans-fat, salt and added sugar from ultra-processed foods and processed culinary ingredients were reduced by a quarter. In Scenario B, we assumed a reduction of 50 % of the same nutrients in ultra-processed foods and processed culinary ingredients. In Scenario C, we reduced the same nutrients in ultra-processed foods by 75 % and in processed culinary ingredients by 50 %. RESULTS Approximately 390 400 CVD deaths might be expected in 2030 if current mortality patterns persist. Under Scenarios A, B and C, CVD mortality can be reduced by 5·5, 11·0 and 29·0 %, respectively. The main impact is on stroke with a reduction of approximately 6·0, 12·6 and 32·0 %, respectively. CONCLUSIONS Substantial potential exists for reducing the CVD burden through overall improvements of the Brazilian diet. This might require reducing the penetration of ultra-processed foods by means of regulatory policies, as well as improving the access to and promotion of fresh and minimally processed foods.
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Álvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Camafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, de Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. Semergen 2017; 43:295-311. [PMID: 28532894 DOI: 10.1016/j.semerg.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/05/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | | | | | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria
| | | | | | | | | | | | | | | | | | - Ciro Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - Susana Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - Pilar Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O’Flaherty M, McGill R, Orton L, Bromley H, Cappuccio FP, Capewell S. Systematic review of dietary salt reduction policies: Evidence for an effectiveness hierarchy? PLoS One 2017; 12:e0177535. [PMID: 28542317 PMCID: PMC5436672 DOI: 10.1371/journal.pone.0177535] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 04/29/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Non-communicable disease (NCD) prevention strategies now prioritise four major risk factors: food, tobacco, alcohol and physical activity. Dietary salt intake remains much higher than recommended, increasing blood pressure, cardiovascular disease and stomach cancer. Substantial reductions in salt intake are therefore urgently needed. However, the debate continues about the most effective approaches. To inform future prevention programmes, we systematically reviewed the evidence on the effectiveness of possible salt reduction interventions. We further compared "downstream, agentic" approaches targeting individuals with "upstream, structural" policy-based population strategies. METHODS We searched six electronic databases (CDSR, CRD, MEDLINE, SCI, SCOPUS and the Campbell Library) using a pre-piloted search strategy focussing on the effectiveness of population interventions to reduce salt intake. Retrieved papers were independently screened, appraised and graded for quality by two researchers. To facilitate comparisons between the interventions, the extracted data were categorised using nine stages along the agentic/structural continuum, from "downstream": dietary counselling (for individuals, worksites or communities), through media campaigns, nutrition labelling, voluntary and mandatory reformulation, to the most "upstream" regulatory and fiscal interventions, and comprehensive strategies involving multiple components. RESULTS After screening 2,526 candidate papers, 70 were included in this systematic review (49 empirical studies and 21 modelling studies). Some papers described several interventions. Quality was variable. Multi-component strategies involving both upstream and downstream interventions, generally achieved the biggest reductions in salt consumption across an entire population, most notably 4g/day in Finland and Japan, 3g/day in Turkey and 1.3g/day recently in the UK. Mandatory reformulation alone could achieve a reduction of approximately 1.45g/day (three separate studies), followed by voluntary reformulation (-0.8g/day), school interventions (-0.7g/day), short term dietary advice (-0.6g/day) and nutrition labelling (-0.4g/day), but each with a wide range. Tax and community based counselling could, each typically reduce salt intake by 0.3g/day, whilst even smaller population benefits were derived from health education media campaigns (-0.1g/day). Worksite interventions achieved an increase in intake (+0.5g/day), however, with a very wide range. Long term dietary advice could achieve a -2g/day reduction under optimal research trial conditions; however, smaller reductions might be anticipated in unselected individuals. CONCLUSIONS Comprehensive strategies involving multiple components (reformulation, food labelling and media campaigns) and "upstream" population-wide policies such as mandatory reformulation generally appear to achieve larger reductions in population-wide salt consumption than "downstream", individually focussed interventions. This 'effectiveness hierarchy' might deserve greater emphasis in future NCD prevention strategies.
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Affiliation(s)
- Lirije Hyseni
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Alex Elliot-Green
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Chris Kypridemos
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Rory McGill
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Lois Orton
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Helen Bromley
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Francesco P. Cappuccio
- University of Warwick, WHO Collaborating Centre, Warwick Medical School, Coventry, United Kingdom
| | - Simon Capewell
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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Cost-effectiveness of salt reduction to prevent hypertension and CVD: a systematic review. Public Health Nutr 2017; 20:1993-2003. [DOI: 10.1017/s1368980017000593] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractObjectiveTo analyse and compare the cost-effectiveness of different interventions to reduce salt consumption.DesignA systematic review of published cost-effectiveness analyses (CEA) and cost-utility analyses (CUA) was undertaken in the databases EMBASE, MEDLINE (PubMed), Cochrane and others until July 2016. Study selection was limited to CEA and CUA conducted in member countries of the Organisation for Economic Co-operation and Development (OECD) in English, German or French, without time limit. Outcomes measures were life years gained (LYG), disability-adjusted life years (DALY) and quality-adjusted life years (QALY). Relevant aspects in modelling were analysed and compared. Quality assessments were conducted using the Drummond and Jefferson/British Medical Journalchecklist.SettingOECD member countries.SubjectsMainly adults.ResultsFourteen CEA and CUA were included in the review which analysed different strategies: salt reduction or substitution in processed foods, taxes, labelling, awareness campaigns and targeted dietary advice. Fifty-nine out of sixty-two scenarios were cost-saving. The incremental cost-effectiveness ratio in international dollars (Intl.$; 2015) was particularly low for taxes, a salt reduction by food manufacturers and labelling (<−3072 Intl.$/QALY, −6187 Intl.$/LYG and <584 Intl.$/DALY over the time horizon compared with the status quo or no intervention). Targeted dietary advice was rather not cost-effective (24 600 Intl.$/QALY and >303 900 Intl.$/DALY). However, only six studies analysed cost-effectiveness from a societal perspective and quality assessments showed flaws in conducting and a lack of transparency in reporting.ConclusionsA population-wide salt reduction could be cost-effective in prevention of hypertension and CVD in OECD member countries. However, comparability between study results is limited due to differences in modelling, applied perspectives and considered data.
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García-Granja PE, Amat-Santos IJ, Amado MG. Cardiopatía isquémica en inmigrantes de Europa del Este en España: experiencia unicéntrica. Med Clin (Barc) 2017; 148:476-478. [DOI: 10.1016/j.medcli.2017.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
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Hope SF, Webster J, Trieu K, Pillay A, Ieremia M, Bell C, Snowdon W, Neal B, Moodie M. A systematic review of economic evaluations of population-based sodium reduction interventions. PLoS One 2017; 12:e0173600. [PMID: 28355231 PMCID: PMC5371286 DOI: 10.1371/journal.pone.0173600] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/23/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To summarise evidence describing the cost-effectiveness of population-based interventions targeting sodium reduction. METHODS A systematic search of published and grey literature databases and websites was conducted using specified key words. Characteristics of identified economic evaluations were recorded, and included studies were appraised for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS Twenty studies met the study inclusion criteria and received a full paper review. Fourteen studies were identified as full economic evaluations in that they included both costs and benefits associated with an intervention measured against a comparator. Most studies were modelling exercises based on scenarios for achieving salt reduction and assumed effects on health outcomes. All 14 studies concluded that their specified intervention(s) targeting reductions in population sodium consumption were cost-effective, and in the majority of cases, were cost saving. Just over half the studies (8/14) were assessed as being of 'excellent' reporting quality, five studies fell into the 'very good' quality category and one into the 'good' category. All of the identified evaluations were based on modelling, whereby inputs for all the key parameters including the effect size were either drawn from published datasets, existing literature or based on expert advice. CONCLUSION Despite a clear increase in evaluations of salt reduction programs in recent years, this review identified relatively few economic evaluations of population salt reduction interventions. None of the studies were based on actual implementation of intervention(s) and the associated collection of new empirical data. The studies universally showed that population-based salt reduction strategies are likely to be cost effective or cost saving. However, given the reliance on modelling, there is a need for the effectiveness of new interventions to be evaluated in the field using strong study designs and parallel economic evaluations.
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Affiliation(s)
- Silvia F. Hope
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Jacqui Webster
- The George Institute for Global Health, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, Sydney, Australia
| | - Arti Pillay
- Pacific Research Centre for Prevention of Obesity and Non Communicable Diseases (C-POND)/ Fiji National University, Suva, Fiji
| | | | - Colin Bell
- Global Obesity Centre, Faculty of Health, Deakin University, Melbourne, Australia
| | - Wendy Snowdon
- Global Obesity Centre, Faculty of Health, Deakin University, Melbourne, Australia
| | - Bruce Neal
- The George Institute for Global Health, Sydney, Australia
- The Charles Perkins Centre, University of Sydney, Sydney, Australia
- Division of Epidemiology and Biostatistics, Imperial College, London, United Kingdom
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Global Obesity Centre, Faculty of Health, Deakin University, Melbourne, Australia
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2016 European Guidelines on cardiovascular disease prevention in clinical practice. Int J Behav Med 2017; 24:321-419. [DOI: 10.1007/s12529-016-9583-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Álvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Camafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, de Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. GACETA SANITARIA 2017; 31:255-268. [PMID: 28292529 DOI: 10.1016/j.gaceta.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/24/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | | | | | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria
| | | | | | | | | | | | | | | | | | - Ciro Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - Susana Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - Pilar Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:69-85. [PMID: 28173956 DOI: 10.1016/j.arteri.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/18/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Kypridemos C, Guzman-Castillo M, Hyseni L, Hickey GL, Bandosz P, Buchan I, Capewell S, O'Flaherty M. Estimated reductions in cardiovascular and gastric cancer disease burden through salt policies in England: an IMPACTNCD microsimulation study. BMJ Open 2017; 7:e013791. [PMID: 28119387 PMCID: PMC5278253 DOI: 10.1136/bmjopen-2016-013791] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To estimate the impact and equity of existing and potential UK salt reduction policies on primary prevention of cardiovascular disease (CVD) and gastric cancer (GCa) in England. DESIGN A microsimulation study of a close-to-reality synthetic population. In the first period, 2003-2015, we compared the impact of current policy against a counterfactual 'no intervention' scenario, which assumed salt consumption persisted at 2003 levels. For 2016-2030, we assumed additional legislative policies could achieve a steeper salt decline and we compared this against the counterfactual scenario that the downward trend in salt consumption observed between 2001 and 2011 would continue up to 2030. SETTING Synthetic population with similar characteristics to the non-institutionalised population of England. PARTICIPANTS Synthetic individuals with traits informed by the Health Survey for England. MAIN MEASURE CVD and GCa cases and deaths prevented or postponed, stratified by fifths of socioeconomic status using the Index of Multiple Deprivation. RESULTS Since 2003, current salt policies have prevented or postponed ∼52 000 CVD cases (IQR: 34 000-76 000) and 10 000 CVD deaths (IQR: 3000-17 000). In addition, the current policies have prevented ∼5000 new cases of GCa (IQR: 2000-7000) resulting in about 2000 fewer deaths (IQR: 0-4000). This policy did not reduce socioeconomic inequalities in CVD, and likely increased inequalities in GCa. Additional legislative policies from 2016 could further prevent or postpone ∼19 000 CVD cases (IQR: 8000-30 000) and 3600 deaths by 2030 (IQR: -400-8100) and may reduce inequalities. Similarly for GCa, 1200 cases (IQR: -200-3000) and 700 deaths (IQR: -900-2300) could be prevented or postponed with a neutral impact on inequalities. CONCLUSIONS Current salt reduction policies are powerfully effective in reducing the CVD and GCa burdens overall but fail to reduce the inequalities involved. Additional structural policies could achieve further, more equitable health benefits.
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Affiliation(s)
- Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Graeme L Hickey
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, Poland
| | - Iain Buchan
- Farr Institute @ HeRC, University of Manchester, Manchester, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Kammoun K, Chaker H, Mahfoudh H, Makhlouf N, Jarraya F, Hachicha J. Diet in chronic kidney disease in a Mediterranean African country. BMC Nephrol 2017; 18:34. [PMID: 28114891 PMCID: PMC5259917 DOI: 10.1186/s12882-017-0448-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mediterranean diet is characterized by low to moderate consumption of animal protein and high consumption of fruits, vegetables, bread, beans, nuts, seeds and other cereals. It has been associated with reduced risk of cardiovascular disease. However, it is not suitable for chronic kidney disease because of high potassium intake. DISCUSSION Tunisia is an emerging Mediterranean country with limited resources, a high prevalence of chronic hemodialysis treatment and high dialysis expenditures. In order to limit dialysis cost, primary and secondary prevention of chronic renal disease are of paramount importance. In addition to drugs, secondary prevention includes diet measures (e.g. salt diet, protein diet). The aims of diet practice in chronic kidney disease are to slow chronic renal failure progression and to prevent its complications like hyperphosphatemia and hyperkaliemiae. A few decades ago, a Tunisian diet was exclusively Mediterranean, and protein consumption was not excessive. However, today, protein consumption is more comparable to western countries. Salt consumption is also excessive. Some Tunisian diets still include food with high potassium intake, which are not suitable for patients with chronic kidney disease. Therefore, the role of the dietician is extremely important to help calculate and create a dietary regimen tailored to each of our patients. Advice about diets should be adapted to both the patient and population habits to improve adherence rate. As such, the purpose of this article is to provide our own experience regarding medical nutrition therapy in patients with chronic kidney disease in Tunisia, with some changes in food habits. Prevention is far better than treatment. In this perspective, dietary measures must be at the core of our intervention.
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Affiliation(s)
- Khawla Kammoun
- Neprology Department Hedi Chaker Hospital, Sfax, Tunisia. .,Renal Pathology Unit, UR 12 ES 14 Medecin, University Sfax Tunisia, Sfax, Tunisia.
| | - Hanen Chaker
- Neprology Department Hedi Chaker Hospital, Sfax, Tunisia.,Renal Pathology Unit, UR 12 ES 14 Medecin, University Sfax Tunisia, Sfax, Tunisia
| | - Hichem Mahfoudh
- Neprology Department Hedi Chaker Hospital, Sfax, Tunisia.,Renal Pathology Unit, UR 12 ES 14 Medecin, University Sfax Tunisia, Sfax, Tunisia
| | - Nouha Makhlouf
- Neprology Department Hedi Chaker Hospital, Sfax, Tunisia
| | - Faical Jarraya
- Neprology Department Hedi Chaker Hospital, Sfax, Tunisia.,Renal Pathology Unit, UR 12 ES 14 Medecin, University Sfax Tunisia, Sfax, Tunisia
| | - Jamil Hachicha
- Neprology Department Hedi Chaker Hospital, Sfax, Tunisia.,Renal Pathology Unit, UR 12 ES 14 Medecin, University Sfax Tunisia, Sfax, Tunisia
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Alvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Cammafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. HIPERTENSION Y RIESGO VASCULAR 2016; 34:24-40. [PMID: 28017552 DOI: 10.1016/j.hipert.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/21/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
- M Á Royo-Bordonada
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España.
| | - P Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | - R Elosua
- Sociedad Española de Epidemiología
| | | | - O Cortés
- Asociación Española de Pediatría de Atención Primaria
| | - B Serrano
- Sociedad Española de Medicina y Seguridad en el Trabajo
| | | | | | - A Pérez
- Sociedad Española de Diabetes
| | - A Maiques
- Sociedad Española de Medicina de Familia y Comunitaria
| | | | - A Castro
- Sociedad Española de Cardiología
| | | | - C Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - M Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - S Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - P Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WMM, Vlachopoulos C, Wood DA, Zamorano JL, Cooney MT. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37:2999-3058. [PMID: 27567407 DOI: 10.1093/eurheartj/ehw272] [Citation(s) in RCA: 1882] [Impact Index Per Article: 235.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Atherosclerosis 2016; 253:281-344. [DOI: 10.1016/j.atherosclerosis.2016.08.018] [Citation(s) in RCA: 558] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Karaduman M, Aparci M, Unlu M, Ozturk C, Balta S, Celik T. Role of Screening Tests in the Detection and Management of Blood Pressure Abnormalities Among Young Population. Angiology 2016; 68:441-446. [PMID: 27494938 DOI: 10.1177/0003319716661944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of hypertension is increasing among young population worldwide. So there is an interest in detecting prehypertension and hypertension in childhood. We determined blood pressure (BP) recorded at a screening test in a young population. We retrospectively evaluated the medical records including systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, height, and body mass index (BMI) of 685 male and 130 female apparently healthy adolescents. We evaluated the prevalence of BP categories: normotension, prehypertension, and hypertension. The prevalence of normotension (n = 369), prehypertension (n = 333), and hypertension (n = 113) was 45.3%, 40.9% and 13.9%, respectively; prehypertension and hypertension were significantly higher among males. The prevalence of prehypertension and hypertension was significantly higher among overweight males and females. The BMI significantly correlated with SBP, DBP, and heart rate among both genders. The prevalence of prehypertension and hypertension is high among Turkish adolescents. Screening tests focused on BP and BMI measurement may help detect the young population at risk of hypertension and cardiovascular disease in the future.
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Affiliation(s)
- Mehmet Karaduman
- 1 Department of Internal Medicine, Etimesgut Military Hospital, Ankara, Turkey
| | - Mustafa Aparci
- 2 Department of Cardiology, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Murat Unlu
- 3 Department of Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Cengiz Ozturk
- 3 Department of Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Sevket Balta
- 3 Department of Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Turgay Celik
- 3 Department of Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
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