Healthcare Costs Associated with an Adequate Intake of Sugars, Salt and Saturated Fat in Germany: A Health Econometrical Analysis

Relationship between consumption of high fat, sugar or sodium (HFSS) food and obesity and non-communicable diseases

The objective of this study was to investigate the relationship between high in fat, sugar or salt consumption, obesity and non-communicable diseases (NCDs) in the population in Thailand, and other associated factors. This study used data from participants age 15 years or older from the 2021 Health Behaviour of Population Survey. The final analytical sample included 74 894 respondents with complete data. Binary logistic regression analysis was used to investigate the relationship between socio-demographic characteristics, unhealthy food, NCDs and obesity. People with obesity had the significant ORs for sugar-sweetened beverages or SSB (OR 1.208; 95% CI 1.159 to 1.259), high-fat foods (OR 1.162; 95% CI 1.120 to 1.207) and snacks (OR 1.048; 95% CI 1.004 to 1.093), but had the significant protective ORs for meat products (OR 0.964; 95% CI 0.930 to 0.999), instant food (OR 0.903; 95% CI 0.865 to 0.942) and fast food (OR 0.871; 95% CI 0.831 to 0.913). People with any NCDs had the significant protective ORs for meat products (p≤0.001), instant food (p≤0.05) and fast food (p≤0.01). People with diabetes tended not to drink SSB while people with heart disease tended not to consume SSB and snacks. The findings suggest a need for prevention and control strategies such as promoting healthy snacking behaviour, modifying food environments and paying specific attention to the population most at risk of obesity and NCDs.

Nitric Oxide as a Determinant of Human Longevity and Health Span

The master molecular regulators and mechanisms determining longevity and health span include nitric oxide (NO) and superoxide anion radicals (SOR). L-arginine, the NO synthase (NOS) substrate, can restore a healthy ratio between the dangerous SOR and the protective NO radical to promote healthy aging. Antioxidant supplementation orchestrates protection against oxidative stress and damage-L-arginine and antioxidants such as vitamin C increase NO production and bioavailability. Uncoupling of NO generation with the appearance of SOR can be induced by asymmetric dimethylarginine (ADMA). L-arginine can displace ADMA from the site of NO formation if sufficient amounts of the amino acid are available. Antioxidants such as ascorbic acids can scavenge SOR and increase the bioavailability of NO. The topics of this review are the complex interactions of antioxidant agents with L-arginine, which determine NO bioactivity and protection against age-related degeneration.

Modelling health and economic impact of nutrition interventions: a systematic review

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.

The direct and indirect costs of cardiovascular diseases in Brazil

OBJECTIVE

To evaluate the direct and indirect costs of cardiovascular diseases (such as coronary heart disease and stroke) by sex and age group, attributed to the excessive consumption of salt, saturated fat and trans fat in Brazil.

MATERIALS AND METHODS

The data for estimating the Population Attributable Fraction (PAF) corresponding to the consumption of salt, saturated fat and trans-fat were obtained from the Household Budget Survey 2017-2018. The calculation of direct costs for cardiovascular diseases (CVD) was made from the accounting sum of costs with hospitalizations and outpatient care found in the National Health System (Hospital Information System and Outpatient Information System), from 2017 to 2019, including the costs of treatment, such as medical consultations, medical procedures, and drugs. Regarding the indirect costs, they were measured by the loss of human capital, given the premature death, resulting in loss of productivity. To define the attributable costs, they were multiplied by the PAF.

RESULTS

Higher burden of CVD attributable to the consumption of salt, saturated fat and trans fat were observed in younger individuals, which progressively decreased with advancing age, but still generated economic costs in the order of US$ 7.18 billion, in addition to 1.53 million productive years of life lost (YLL) to premature death, if considering salt as an inducer. Although attributable burden of CVD is higher among younger individuals, the highest costs are associated with males aged 45 to 74 years old for direct costs and 45 to 64 years old for indirect costs.

CONCLUSION

The attributable fractions to consumption of salt are the ones that cause the most effects on CVD, followed by saturated fat and trans fat, with direct and indirect costs being higher for males.

Der Stellenwert gesundheitsbewusster Ernährungsbildung in der Schule

Einleitung

Übergewicht, auch bei Kindern und Jugendlichen, stellt national wie international ein großes Problem dar, welches stark mit Ernährung verknüpft ist. Ernährungsgewohnheiten werden bereits früh geprägt und können Einfluss auf die Krankheitsentstehung nehmen. Schulen als Lern- und Lebensorte können dabei ausgewogene und nachhaltige Ernährungsgewohnheiten fördern. Ziel der vorliegenden Arbeit war daher die Analyse ausgewählter Lehrpläne zur Ernährungsbildung (EB), um darauf basierend Defizite und Verbesserungsvorschläge für die schulische EB herauszuarbeiten.

Methodik

Untersucht wurden naturwissenschaftliche und hauswirtschaftliche Rahmenlehrpläne weiterführender allgemeinbildender Schulen der neuen Bundesländer in der aktuellsten Version bis 2019 mittels qualitativer Lehrplananalyse. Im Fokus standen Ernährungsthemen sowie deren Vertiefungsmöglichkeiten, praktische Umsetzung und Zeitumfang.

Ergebnisse und Diskussion

Ernährung und Humanbiologie werden vorrangig bis Klasse 8 in allen Lehrplänen unterrichtet, komplexere Themen größtenteils ab Klasse 9. Konkrete alltagsrelevante Lerninhalte zu praktischen Ernährungsweisen, zur Lebensmittelqualität sowie zur Rolle der Ernährung für die Krankheitsprävention können die Ernährungskompetenzen der Schüler:innen maßgeblich verbessern, finden jedoch derzeit zu wenig Beachtung in den Lehrplänen. Die Hauswirtschaftsfächer thematisieren u. a. Verbraucherthemen, werden aber nicht an Gymnasien bzw. nicht in allen Bundesländern angeboten. Wahlbereiche und Leistungskurse können die EB ergänzen, sind aber nicht an allen Schulen Teil des Lehrplans. Der Zeitumfang und die praktische Umsetzung für die EB sind u. a. stark von schulinternen Faktoren abhängig. Es lassen sich teilweise erhebliche Defizite in der EB feststellen.

Schlussfolgerung

Als sinnvoll erachtet werden eine intensivierte EB in höheren Jahrgängen, die Einführung von Hauswirtschaftsfächern in allen Schulformen und eine Vereinheitlichung der Lehrplaninhalte zwischen den einzelnen Bundesländern.

Nutrition policies in Germany: a systematic assessment with the Food Environment Policy Index

OBJECTIVE

To systematically assess Germany's nutrition policies, to benchmark them against international best practices and to identify priority policy actions to improve population-level nutrition in Germany.

DESIGN

We applied the Food Environment Policy Index (Food-EPI), a methodological framework developed by the International Network for Food and Obesity/non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) network. Qualitative content analysis of laws, directives and other documents formed the basis of a multistaged, structured consultation process.

SETTING

Germany.

PARTICIPANTS

The expert consultation process included fifty-five experts from academia, public administration and civil society.

RESULTS

Germany lags behind international best practices in several key policy areas. For eighteen policy indicators, the degree of implementation compared with international best practices was rated as very low, for twenty-one as low, for eight as intermediate and for none as high. In particular, indicators on food taxation, regulation of food marketing as well as retail and food service sector policies were rated as very low to low. Identified priority actions included the binding implementation of nutrition standards for schools and kindergartens, a reform of the value added tax on foods and beverages, a sugar-sweetened beverage tax and stricter regulation of food marketing directed at children.

CONCLUSIONS

The results show that Germany makes insufficient use of the potential of evidence-informed health-promoting nutrition policies. Adopting international best practices in key policy areas could help to reduce the burden of nutrition-related chronic disease and related inequalities in nutrition and health in Germany. Implementation of relevant policies requires political leadership, a broad societal dialogue and evidence-informed advocacy by civil society, including the scientific community.

Assessing the Association of Sodium, Potassium Intake and Sodium/Potassium Ratio on Blood Pressure and Central Adiposity Measurements amongst Ellisras Undernourished, Rural Children Aged 5–13 Years: South Africa

Background: Numerous studies have shown how diet, such as sodium (Na) and potassium (K) intake, is an important risk factor for non-communicable diseases (NCDs). This study aimed to assess the relationship between sodium intake, potassium intake; and sodium/potassium ratio with blood pressure (BP) and abdominal obesity amongst Ellisras rural children. Method: In this cross-sectional study, data on dietary intake of sodium and potassium were collected using a 24-h recall questionnaire from a total of 765 participants, aged 5–13 years. Blood pressure and anthropometric measurements were also collected. Generalised linear models and Pearson correlation were conducted to assess the association of sodium intake, potassium intake; and their ratio with BP, waist circumference (WC), and waist-to-height ratio (WHtR). Results: In both age groups, less than 14.9% of males and 19.8% of females consumed above the recommended adequate intake (AI) of sodium. In addition, both age groups had more than 90% of males and females who consumed below the recommended AI of potassium. Moreover, the sodium/potassium ratio was above the WHO recommended level in more than 30% of males and females. The study found a significant, weak positive correlation of sodium intake with systolic BP (SBP), diastolic BP (DBP), and with WHtR. A significant, weak positive correlation was also found between sodium/potassium ratio and WHtR. In addition, a significant association was found between potassium intake and systolic BP. Conclusion: Although our study found a notable low average intake of sodium and potassium as compared to the recommended values. There was positive correlation found between sodium intake and BP. Furthermore, a positive correlation of sodium intake and sodium/potassium ratio with WHtR was also found.

Impact of interventions to reduce overnutrition on healthcare costs related to obesity and type 2 diabetes: a systematic review

CONTEXT

In recent decades, obesity and type 2 diabetes mellitus (T2DM) have both become global epidemics associated with substantial healthcare needs and costs.

OBJECTIVE

The aim of this review was to critically assess nutritional interventions for their impact on healthcare costs to community-dwelling individuals regarding T2DM or obesity or both, specifically using CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria to assess the economic components of the evidence.

DATA SOURCES

Searches were executed in Embase, EconLit, AgEcon, PubMed, and Web of Science databases.

STUDY SELECTION

Studies were included if they had a nutritional perspective, reported an economic evaluation that included healthcare costs, and focused on obesity or T2DM or both. Studies were excluded if they examined clinical nutritional preparations, dietary supplements, industrially modified dietary components, micronutrient deficiencies, or undernutrition; if they did not report the isolated impact of nutrition in complex or lifestyle interventions; or if they were conducted in animals or attempted to transfer findings from animals to humans.

DATA EXTRACTION

A systematic review was performed according to PRISMA guidelines. Using predefined search terms, 21 studies evaluating food habit interventions or taxation of unhealthy foods and beverages were extracted and evaluated using CHEERS criteria.

RESULTS

Overall, these studies showed that nutrition interventions and taxation approaches could lead to cost savings and improved health outcomes when compared with current practice. All of the included studies used external sources and economic modeling or risk estimations with population-attributable risks to calculate economic outcomes.

CONCLUSIONS

Most evidence supported taxation approaches. The effect of nutritional interventions has not been adequately assessed. Controlled studies to directly measure economic impacts are warranted.

A qualitative study on knowledge, perception, and practice related to non-communicable diseases in relation to happiness among rural and urban residents in Bhutan

PURPOSE

Bhutan, known as a country of happiness, has experienced rapid social changes and the increasing burden of non-communicable diseases (NCDs) that can impact health and happiness. To inform future NCD prevention programs in Bhutan, this study explores knowledge, perception, and the practices of Bhutanese related to NCDs in the context of the philosophy of happiness.

METHODOLOGY

Research was conducted in rural and urban communities of Bhutan in 2017 among 79 inhabitants of both genders, aged ≥18. Participants were recruited through purposive sampling with the data collected by in-depth interviews, participatory observation, and anthropometric measurements. Data were analyzed by thematic analysis.

RESULTS/DISCUSSION

Across participants, health was considered as an important element of "happiness". However, lifestyle-related NCD risk factors prevailed due to the lack of effective education programs on NCDs and thus the lack of practical knowledge for NCD prevention across society. We further found that the value of happiness "finding happiness in any situation is virtue" was universal as well as other traditional values and customs, shaping people's health behaviors. From these observations, it is recommended that more practical NCD education/prevention programs should be urgently introduced in Bhutan that involve multiple generations, religion authorities, educational settings, and medical services.

ORIGINALITY

This is the first comprehensive qualitative study on the NCD-related lifestyle risks among Bhutanese concerning the concept of happiness.

Economic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases in Russia in 2016

Aim. To assess the socioeconomic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases (CNCDs) in the Russian population in 2016.

Material and methods. The following RF were included in the analysis: smoking, alcohol abuse, high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension (HTN), which have a significant causal relationship with the major CNCDs: cardiovascular diseases (CVDs), type 2 diabetes, chronic obstructive pulmonary disease (COPD), cancer of 10 locations (lung, breast, cervix, ovary, prostate, kidney, stomach, liver, pancreas, colon). Based on the data on the RF prevalence in the Russian population by ESSE-RF study and relative risks by large studies, the population attributable risk for each CNCD was estimated. We used the data of the Federal State Statistics Service, annual forms of Federal Statistical Observation, as well as the results of the Government Guarantee Program for free medical care and the corresponding diagnosis-related groups for 2016. The direct costs of the healthcare system and economic losses due to morbidity and mortality from the major CNCDs associated with the considered RF are determined. The calculations were performed in Microsoft Excel 10.0.

Results. Indirect losses due to premature mortality prevail over direct costs of medical care and disability benefits in the economic damage structure of each RF. The largest damage of four major CNCDs was associated with HTN — 869,9 billion rubles, which is equivalent to 1,01% of gross domestic product (GDP). The next places were taken by obesity — 605,8 billion rubles (0,7% of GDP), smoking — 421,4 billion rubles (0,49% of GDP) and low physical activity — 273,0 billion rubles. (0,32% of GDP). The contribution of improper feeding (high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat) amounted to 0,17% of GDP (145,3 billion rubles), 0,19% of GDP (160,9 billion rubles) and 0,10% of GDP (83,4 billion rubles), respectively. Alcohol abuse made the smallest contribution to CNCD-related damage — 82,5 billion rubles (0.1% of GDP). This is due to the low prevalence of alcohol abuse in the Russian population according to ESSE-RF study.

Conclusion. Assessment of the economic damage of CNCD RF allows determining the priority areas in healthcare and substantiating the effectiveness of CNCD preventive measures aimed at reducing the RF impact, and, consequently, the burden on the healthcare system and the national economy.

Cardiovascular mortality attributable to dietary risk factors in 51 countries in the WHO European Region from 1990 to 2016: a systematic analysis of the Global Burden of Disease Study

This study was performed to highlight the relationship between single dietary risk factors and cardiovascular diseases (CVDs) in the WHO European Region. We used the comparative risk assessment framework of the Global Burden of Disease Study to estimate CVD mortality attributable to diet; comprising eleven forms of CVDs, twelve food and nutrient groups and 27 risk-outcome pairs in four GBD regions including 51 countries by age and sex between 1990 and 2016. In 2016, dietary risks were associated with 2.1 million cardiovascular deaths (95% uncertainty interval (UI), 1.7-2.5 million) in the WHO European Region, accounting for 22.4% of all deaths and 49.2% of CVD deaths. In terms of single dietary risks, a diet low in whole grains accounted for approximately 429,000 deaths, followed by a diet low in nuts and seeds (341,000 deaths), a diet low in fruits (262,000 deaths), a diet high in sodium (251,000 deaths), and a diet low in omega-3 fatty acids (227,000 deaths). Thus, with an optimized, i.e. balanced diet, roughly one in every five premature deaths could be prevented. Although age-standardized death rates decreased over the last 26 years, the absolute number of diet-related cardiovascular deaths increased between 2010 and 2016 by 25,600 deaths in Western Europe and by 4300 deaths in Central Asia. In 2016, approximately 601,000 deaths (28.6% of all diet-related CVD deaths) occurred among adults younger than 70 years. Compared to other behavioural risk factors, a balanced diet is a potential key lever to avoid premature deaths.

Assessment of Sodium and Potassium Intakes in Children Aged 6 to 18 Years by 24 h Urinary Excretion in City of Rabat, Morocco

Background

The incidence of noncommunicable diseases (NCDs) has greatly increased, mainly due to high level of dietary sodium. Thus, reduction of sodium intake in population has been recognized as one of the most cost-effective strategies to reduce NCDs. The aim of this study was to estimate sodium and potassium consumption in a sample of Moroccan children as a baseline study to implement national strategy for salt intake reduction.

Methods

The study was conducted on 131 children aged 6-18 years recruited from Rabat and its region. Sodium excretion and potassium excretion were measured on 24 h urinary collection, and the creatinine excretion was used to validate completeness of urine collections.

Results

The average of urinary sodium was 2235.3 ± 823.2 mg/day, and 50% of children consume more than 2 g/d of sodium (equivalent to 5 g/day of salt), recommended by the WHO. However, daily urinary excretion of potassium was 1431 ± 636.5 mg/day, and 75% of children consume less than adequate intake. Sodium consumption increased significantly with age. Of particular interest, 46.7% of children aged 6-8 years and 49.3% of children aged 9-13 years consume more than the corresponding upper limits.

Conclusions

Children have high sodium and low potassium status. There is evidence of the urgent need to implement a strategy for reduction of dietary sodium intake in Morocco.

The Twin White Herrings: Salt and Sugar

India has the dubious distinction of being a hotspot for both diabetes and hypertension. Increased salt and sugar consumption is believed to fuel these two epidemics. This review is an in-depth analysis of current medical literature on salt and sugar being the two white troublemakers of modern society. The PubMed, Medline, and Embase search for articles published in January 2018, using the terms "salt" [MeSH Terms] OR "sodium chloride" [All Fields] OR "sugar" [All Fields]. India is world's highest consumer of sugar with one of the highest salt consumption per day. Increased salt intake is associated with increased risk of hypertension, left ventricular hypertrophy and fibrosis, cardiovascular events, renal stones, proteinuria, and renal failure. Increased sugar intake is directly linked to increased risk of obesity, fatty liver disease, and metabolic syndrome. Also, increased sugar intake may be indirectly related to the increased risk of type 2 diabetes. Both salt and sugar intake is directly linked to increased systemic and hypothalamic inflammation, endothelial dysfunction, microangiopathy, cardiovascular remodelling, cancers, and death. High fructose corn is especially damaging. There is no safe limit of sugar consumption, as the human body can produce its own glucose. Being nature's gift to mankind, there is no harm in moderate consumption of salt and sugar, however, modest reduction in the consumption of both can substantially reduce the burden of non-communicable diseases. Public health interventions to facilitate this behavioural change must be instituted and encouraged.

Deleting Death and Dialysis: Conservative Care of Cardio-Vascular Risk and Kidney Function Loss in Chronic Kidney Disease (CKD)

The uremic syndrome, which is the clinical expression of chronic kidney disease (CKD), is a complex amalgam of accelerated aging and organ dysfunctions, whereby cardio-vascular disease plays a capital role. In this narrative review, we offer a summary of the current conservative (medical) treatment options for cardio-vascular and overall morbidity and mortality risk in CKD. Since the progression of CKD is also associated with a higher cardio-vascular risk, we summarize the interventions that may prevent the progression of CKD as well. We pay attention to established therapies, as well as to novel promising options. Approaches that have been considered are not limited to pharmacological approaches but take into account lifestyle measures and diet as well. We took as many randomized controlled hard endpoint outcome trials as possible into account, although observational studies and post hoc analyses were included where appropriate. We also considered health economic aspects. Based on this information, we constructed comprehensive tables summarizing the available therapeutic options and the number and kind of studies (controlled or not, contradictory outcomes or not) with regard to each approach. Our review underscores the scarcity of well-designed large controlled trials in CKD. Nevertheless, based on the controlled and observational data, a therapeutic algorithm can be developed for this complex and multifactorial condition. It is likely that interventions should be aimed at targeting several modifiable factors simultaneously.

Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis

An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million-$1.6 billion for CVD and AUD$18.2 million-$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia.

Global smoking-attributable burden of periodontal disease in 186 countries in the year 2015

AIM

We aimed to quantify the smoking-attributable burden of periodontal disease (PD).

METHODS

The association between smoking and PD was evaluated. Population, smoking and PD data from the Global Burden of Disease Study were used, and the burden in different sex and age groups in 186 countries in 2015 calculated, adjusted for PD prevalence and numbers of cigarettes smoked. No adjustment was performed in a sensitivity analysis.

RESULTS

The global smoking-attributable burden was 251,160 disability-adjusted life years (DALYs; 95% uncertainty interval: 190,721-324,241; sensitivity analysis: 344,041 DALYs) or 38.5 million cases. The burden was lower in females than males, and highest in the age group of the 50- to 69-year-olds. On super-regional level, the burden was highest in South-East Asia, East Asia and Oceania (83,052 DALYs), and high-income North America and Asia Pacific (55,362 DALYs). On regional level, it was highest in East Asia (70,845 DALYs), South Asia (30,808 DALYs) and North Africa and the Middle East (24,095 DALYs). On national level, it was highest in China (69,148 DALYs), India (29,362 DALYs) and the United States (12,714 DALYs). The relative smoking-attributable burden ranged between >25% in Suriname and <1% in Chad.

CONCLUSIONS

There is great need to monitor and tackle the smoking-attributable burden of PD.

Identifying Eating Occasion-Based Opportunities to Improve the Overall Diets of Australian Adolescents

Adolescents in Australia have a poor dietary intake, leading to large numbers of them being at risk for inadequate intake of micronutrients, and excessive intake of less healthful dietary components. This study examined dietary intakes at multiple eating occasions to identify opportunities for more targeted recommendations and strategies to improve dietary intakes among adolescents. Data from the first 24-h recall of 14-18 years old in the 2011-2012 National Nutrition and Physical Activity Survey were analysed (n = 772). Participant-defined eating occasions were classified as breakfast, lunch, dinner or other eating occasions combined. The mean percent contribution to the total day intake of top shortfall nutrients (calcium, magnesium, vitamin A, iron), discretionary calories, saturated fat, free sugars and sodium, as well as nutrient density, the foods consumed and the percent of consumers at each eating occasion, were calculated. Breakfast had the lowest prevalence of consumers (81%), contributed the least to total daily energy (14.6%) and almost a quarter of daily calcium and iron. Other eating occasions combined contributed 47.5% of free sugars and were top contributors of daily calcium (34.6%) and magnesium (31.7%). Discretionary foods contributed 32.4% of the energy at lunch, and the sodium content at lunch was 415 mg/1000 kJ. Key opportunities identified for adolescents were to increase breakfast consumption, given the high nutrient densities of breakfasts consumed; improve overall lunch quality, particularly the sodium content; promote the intake of milk, fruit and a variety of vegetables at both lunch and dinner; maintain healthful choices at in-between meal eating occasions while focusing on decreasing the intake of discretionary foods.

Reducing the costs of chronic kidney disease while delivering quality health care: a call to action

The treatment of chronic kidney disease (CKD) and of end-stage renal disease (ESRD) imposes substantial societal costs. Expenditure is highest for renal replacement therapy (RRT), especially in-hospital haemodialysis. Redirection towards less expensive forms of RRT (peritoneal dialysis, home haemodialysis) or kidney transplantation should decrease financial pressure. However, costs for CKD are not limited to RRT, but also include nonrenal health-care costs, costs not related to health care, and costs for patients with CKD who are not yet receiving RRT. Even if patients with CKD or ESRD could be given the least expensive therapies, costs would decrease only marginally. We therefore propose a consistent and sustainable approach focusing on prevention. Before a preventive strategy is favoured, however, authorities should carefully analyse the cost to benefit ratio of each strategy. Primary prevention of CKD is more important than secondary prevention, as many other related chronic diseases, such as diabetes mellitus, hypertension, cardiovascular disease, liver disease, cancer, and pulmonary disorders could also be prevented. Primary prevention largely consists of lifestyle changes that will reduce global societal costs and, more importantly, result in a healthy, active, and long-lived population. Nephrologists need to collaborate closely with other sectors and governments, to reach these aims.

Human cell-based taste perception - a bittersweet job for industry

Covering: 2000 to 2016On the molecular level humans sense food by a variety of specialized tissues which express sensory receptors to handle nutritive value. In general, this means the interplay of gustatory, olfactory, trigeminal and haptic sensation is translated into perception and leads, in terms of taste, to descriptions like sweet, bitter, salty, sour and umami. Further perceptions include astringent, cool, hot, prickle, lingering, kokumi and fatty to name predominant characterizations. It is still not fully understood how this plethora of impressions can be perceived by quite a limited number of receptors obviously being the initial compilers to judge palatability. However, since the discovery of mammalian taste receptors (TASRs) almost 30 years ago the use of taste receptors in cell-based screening campaigns is advancing in industrial approaches. The article will highlight the impacts and the limits of cell-based guided identification of taste modulators for food applications with an emphasis on sweet, bitter and savory taste as well as implications emerging from natural products.

Global Burden of Sugar-Related Dental Diseases in 168 Countries and Corresponding Health Care Costs

Oral diseases such as dental caries, edentulism (tooth loss), periodontal disease (PD), and oral cancer currently constitute an increased major public health burden across the globe, with significant differences between countries. One of the main drivers of caries, edentulism, and PD is the excessive intake of sugars. Here, we aimed to quantify the global sugar-related dental health and cost burden in the year 2010. This study used a health-econometrical model to calculate the disease burden as well as the direct and indirect costs attributable to the intake of free sugars (mono- and disaccharides [MDS]). To this end, several databases from the Institute for Health Metrics and Evaluation (IHME), Organisation for Economic Co-operation and Development (OECD), Food and Agriculture Organization (FAO), and World Bank were used. In total, the corresponding disease burden in 168 countries and economic burden in 31 OECD countries were quantified. In 2010, the consumption of MDS was associated with a global dental disease burden of 4.1 million disability-adjusted life years (DALYs; 95% uncertainty interval [UI]: 2.1 to 7.4 million DALYs), with 2.7 million DALYs from MDS-related caries and 1.4 million DALYs from PD. In terms of economic costs, MDS-related dental diseases were associated with a global financial burden of 172 billion US dollars (USD; 95% UI: 91 to 295 billion USD), the largest share of which (151 billion USD) was incurred in OECD countries. Overall, 26.3% (95% UI: 13.3% to 47.5%) of the total global oral disease burden was attributed to the consumption of MDS. The present study emphasizes the need to further address the role of free sugars in oral health and nutrition policy. Although the largest share of the economic burden was accounted for by OECD countries, emerging economies should address this challenge early on in national public health policies if they are to avoid disease and the prospect of increased cost burdens.