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Guedes LFF, Vegi ASF, Felisbino-Mendes MS, Menezes MC, Meireles AL, Malta DC, Machado ÍE. Economic burden for the Unified Health System attributable to excessive sodium consumption in Brazil. Public Health 2024; 228:178-185. [PMID: 38377832 DOI: 10.1016/j.puhe.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This study aimed to estimate the economic costs of excessive sodium consumption in terms of hospitalizations and outpatient procedures of medium and high complexity (OPMHC) for the Brazilian Unified Health System (SUS) and its states in 2019. STUDY DESIGN Ecological study. METHOD This study used population attributable fractions (PAFs) of excessive sodium consumption estimated by the Global Burden of Disease study based on the theoretical minimum risk exposure level (3 g of sodium per day), the average population consumption, and relative risks of sodium-outcome pairs. PAFs were applied to the total costs of hospitalizations and OPMHC paid by SUS for each outcome obtained from the Outpatient and Hospital Information Systems. The costs per 10,000 inhabitants in all the Brazilian states were calculated and converted into international dollars (Int$), considering the purchasing parity power in the year 2019. RESULTS Excessive sodium consumption resulted in Int$ 98,882,386.36 (95% uncertainty interval: Int$ 3,398,343.53-312,065,319.80) in hospitalizations and OPMHC costs in Brazil in 2019. Males and the 55- to 69-year-old age group had the highest expenditures attributable to excessive sodium consumption. Cardiovascular diseases were the most significant contributors to the costs associated with the risk factor. Southern and southeastern states had the highest costs of diseases attributable to sodium. CONCLUSION Excessive sodium consumption has a significant economic burden on SUS, particularly among men and more developed states. This underscores the inequalities in socio-economic factors and access to health services throughout the country. Economic analyses at the subnational level can provide evidence for public policy planning to define the most appropriate actions for the population's sociodemographic reality.
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Affiliation(s)
- L F F Guedes
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil
| | - A S F Vegi
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil
| | - M S Felisbino-Mendes
- Universidade Federal de Minas Gerais, Postgraduate Program in Nursing, Department of Maternal and Child Nursing and Public Health, Belo Horizonte, Minas Gerais, Brazil
| | - M C Menezes
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil; Universidade Federal de Ouro Preto, School of Nutrition, Department of Clinical and Social Nutrition, Ouro Preto, Minas Gerais, Brazil
| | - A L Meireles
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil; Universidade Federal de Ouro Preto, School of Nutrition, Department of Clinical and Social Nutrition, Ouro Preto, Minas Gerais, Brazil
| | - D C Malta
- Universidade Federal de Minas Gerais, Postgraduate Program in Nursing, Department of Maternal and Child Nursing and Public Health, Belo Horizonte, Minas Gerais, Brazil
| | - Í E Machado
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil; Universidade Federal de Ouro Preto, Department of Family Medicine, Mental and Collective Health, Ouro Preto, Minas Gerais, Brazil.
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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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Perera V, Allen LN, Farrand C, Kwong EJL, Liyanage I, Wickramasinghe K. Evaluating the role of salt intake in achieving WHO NCD targets in the Eurasian Economic Union: A PRIME modeling study. PLoS One 2023; 18:e0289112. [PMID: 37478108 PMCID: PMC10361522 DOI: 10.1371/journal.pone.0289112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/11/2023] [Indexed: 07/23/2023] Open
Abstract
The World Health Organization has set clear global targets in reducing non-communicable disease mortality by 2030 in its sustainable development goals. This study models the number of deaths that could be averted if Eurasian Economic Union (EEU) member states met the target of reducing their population's current mean salt intake by 30% to achieve mortality reduction targets. Using the WHO Preventable Risk Integrated ModEl (PRIME), we modelled the mortality impact of reducing salt consumption by 30%, as well as according to WHO recommended levels (5 g/person/day), for the five member states of the EEU. PRIME models the number of averted deaths from reducing salt intake by applying established risk ratios to a given population. The baseline demographic and mortality data that are required to generate these estimates were obtained from the relevant government statistical bodies, and salt intake data were referenced from surveillance studies. Uncertainty intervals were generated using Monte Carlo simulation. If salt consumption was reduced by 30%, we estimate that there would have been 94,150 (95%UI: 47,329 to 137,131) fewer deaths due to cardiovascular disease in the EEU in the baseline year, with males and the elderly being more affected. If the WHO-recommended maximum salt intake of 5 g/day was achieved, a total of 193,155 (95%UI: 98,548 to 272,536) deaths would have been prevented. These findings underline the importance of incorporating effective policy changes to meet targets in reducing NCD mortality by one-third by 2030.
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Affiliation(s)
- Vern Perera
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Luke N. Allen
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clare Farrand
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Edwin Jit Leung Kwong
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isurujith Liyanage
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Kremlin Wickramasinghe
- WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), Moscow, Russian Federation
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Vargas-Meza J, Nilson EAF, Nieto C, Khandpur N, Denova-Gutiérrez E, Valero-Morales I, Barquera S, Campos-Nonato I. Modelling the impact of sodium intake on cardiovascular disease mortality in Mexico. BMC Public Health 2023; 23:983. [PMID: 37237296 DOI: 10.1186/s12889-023-15827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) represent the main cause of death in Mexico, while high blood pressure is suffered by about half of the adult population. Sodium intake is one of the main risk factors for these diseases. The Mexican adult population consumes about 3.1 g/day, an amount that exceeds what is recommended by the World Health Organization (WHO) < 2 g sodium/day. The objective of this study was to estimate the impact of reducing sodium intake on CVD mortality in Mexico using a scenario simulation model. METHODS The Integrated Model of Preventable Risk (PRIME) was used to estimate the number of deaths prevented or postponed (DPP) due to CVD in the Mexican adult population following the following sodium intake reduction scenarios: (a) according to the WHO recommendations; (b) an "optimistic" reduction of 30%; and (c) an "intermediate" reduction of 10%. RESULTS The results show that a total of 27,700 CVD deaths could be prevented or postponed for scenario A, 13,900 deaths for scenario B, and 5,800 for scenario C. For all scenarios, the highest percentages of DPP by type of CVD are related to ischemic heart disease, hypertensive disease, and stroke. CONCLUSIONS The results show that if Mexico considers implementing policies with greater impact to reduce sodium/salt consumption, a significant number of deaths from CVD could be prevented or postponed.
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Affiliation(s)
- Jorge Vargas-Meza
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
- El Poder del Consumidor A.C., Ciudad de México, Mexico
| | - Eduardo Augusto Fernandes Nilson
- Center for Epidemiological Research on Nutrition and Health, School of Public Health, University of Sao Paulo, Sao Paulo, São Paulo, Brazil.
- Programa de Alimentação, Nutrição e Cultura, Oswaldo Cruz Foundation (Fiocruz), Brasília, Brazil.
| | - Claudia Nieto
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Neha Khandpur
- Department of Nutrition, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Edgar Denova-Gutiérrez
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Isabel Valero-Morales
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Simón Barquera
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Ismael Campos-Nonato
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
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Padilla-Moseley J, Sivakumar B, Flexner N, Grajeda R, Gamble B, Blanco-Metzler A, Arcand J. Factors Impacting the Uptake of Research into Dietary Sodium Reduction Policies in Five Latin American Countries: A Qualitative Study. Curr Dev Nutr 2023; 7:100073. [PMID: 37180848 PMCID: PMC10126926 DOI: 10.1016/j.cdnut.2023.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023] Open
Abstract
Background Diets high in sodium are a risk factor for cardiovascular disease (CVD). Latin American countries (LAC) consume more than double the recommended sodium levels. Research uptake in dietary sodium reduction policies has been inconsistent in LAC, and the factors impacting research uptake are largely unknown. This study aimed to describe the barriers and facilitators to the uptake of research into sodium reduction policies from a funded research consortium with 5 LAC (Argentina, Brazil, Costa Rica, Paraguay, and Peru). Methods A qualitative case study included 5 researchers and 4 Ministry of Health officers from the funded consortium. Dimensions from Trostle's framework of actors, content, context, and process and relative advantages from the Diffusion of Innovation informed the semi-structured interview guide and analysis. One-on-one interviews were completed from November 2019 to January 2020. The participants validated transcripts, coded, and analyzed using NVivo software. Results Key barriers to policy advancements included 1) conflicts of interest from the food industry and some government actors; 2) government turnover resulting in policy and personnel changes; 3) a lack of human and financial resources; and 4) and communication gaps among key actors. Key facilitators to policy advancement included: 1) the content and quality of health economic, food supply, and qualitative data; 2) support, technical assistance, and alliances with the government, non-governmental organizations, and international experts; and 3) researchers enhanced skillsets facilitated with communication and dissemination with policymakers. Conclusion Researchers and policymakers are faced with several barriers and facilitators on research uptake in policies and programs in LAC; these factors should be addressed and leveraged to advance sodium reduction policy development. Future LAC studies can draw from the insights and lessons learned from this case study and apply the results to future efforts on policy nutrition to promote healthy eating and reduce CVD risk.
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Affiliation(s)
| | - Bridve Sivakumar
- Faculty of Health Sciences, Ontario Tech University, Oshawa ON, Canada
| | - Nadia Flexner
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, Ontario, Canada
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
| | - Ruben Grajeda
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
| | - Brenda Gamble
- Faculty of Health Sciences, Ontario Tech University, Oshawa ON, Canada
| | - Adriana Blanco-Metzler
- Costa Rican Institute of Research and Teaching in Nutrition and Health, Tres Ríos, Costa Rica Costa Rica
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, Oshawa ON, Canada
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Flexner N, Ng AP, Ahmed M, Khandpur N, Acton RB, Lee JJ, L’Abbe MR. Estimating the dietary and health impact of implementing front-of-pack nutrition labeling in Canada: A macrosimulation modeling study. Front Nutr 2023; 10:1098231. [PMID: 37006927 PMCID: PMC10065472 DOI: 10.3389/fnut.2023.1098231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Background Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy diets. Health Canada has recently published FOPL regulations that will require food and beverages that meet or exceed set thresholds for sodium, sugars, or saturated fat to display a 'high in' symbol on the front of the package. Although a promising measure, its potential impact on dietary intakes and health have not yet been estimated in Canada. Objective This study aims to estimate (1) the potential dietary impact of implementing a mandatory FOPL among Canadian adults; and (2) the number of diet-related non-communicable disease (NCD) deaths that could be averted or delayed due to these estimated dietary changes. Methods Baseline and counterfactual usual intakes of sodium, total sugars, saturated fats, and calories were estimated among Canadian adults (n = 11,992) using both available days of 24 h recalls from the 2015 Canadian Community Health Survey-Nutrition. The National Cancer Institute method was used to estimate usual intakes, and adjusted for age, sex, misreporting status, weekend/weekday, and sequence of recall. Estimated counterfactual dietary intakes were modeled from reductions observed in experimental and observational studies that examined changes in sodium, sugars, saturated fat, and calorie content of food purchases in the presence of a 'high in' FOPL (four counterfactual scenarios). The Preventable Risk Integrated ModEl was used to estimate potential health impacts. Results Estimated mean dietary reductions were between 31 and 212 mg/day of sodium, 2.3 and 8.7 g/day of total sugars, 0.8 and 3.7 g/day of saturated fats, and 16 and 59 kcal/day of calories. Between 2,183 (95% UI 2,008-2,361) and 8,907 (95% UI 8,095-9,667) deaths due to diet-related NCDs, mostly from cardiovascular diseases (~70%), could potentially be averted or delayed by implementing a 'high in' FOPL in Canada. This estimation represents between 2.4 and 9.6% of the total number of diet-related NCD deaths in Canada. Conclusion Results suggest that implementing a FOPL could significantly reduce sodium, total sugar, and saturated fat intakes among Canadian adults and subsequently prevent or postpone a substantial number of diet-related NCD deaths in Canada. These results provide critical evidence to inform policy decisions related to implementing FOPL in Canada.
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Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alena P. Ng
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neha Khandpur
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- Center for Epidemiological Research in Nutrition and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Rachel B. Acton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mary R. L’Abbe
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Vega-Solano J, Madriz-Morales K, Blanco-Metzler A, Fernandes-Nilson EA. Estimation of the economic benefits for the public health system related to salt reduction in Costa Rica. PLoS One 2023; 18:e0279732. [PMID: 36800401 PMCID: PMC9937478 DOI: 10.1371/journal.pone.0279732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/14/2022] [Indexed: 02/18/2023] Open
Abstract
Excessive salt and sodium intake are strongly associated with high blood pressure and increased risk of cardiovascular disease. High blood pressure in turn is the main risk factor for the global burden of morbidity and mortality. The prevalence of this disease in the adult population of Costa Rica in 2018 was 37.2%. Costa Rica has limited information on the economic costs for the public health system and related of the prevalence of this type of disease mediated by dietary factors such as salt intake. OBJECTIVE to estimate the economic benefits for the public health system related to salt reduction in Costa Rica for the year 2018. METHODOLOGY estimation of the economic benefits for the public healthcare costs and productivity losses associated to reducing the per capita salt consumption of Costa Ricans to 5g/day, including the estimation of the Years of Life Productive Lost and of the direct costs on consultations, hospitalizations, and medications for the Costa Rica Social Security System. RESULTS The total annual costs of hospitalization, consultations, and medications attributable to excessive salt intake in the population older than 15 years of age for the year 2018, were estimated at USD $15.1 million. The highest were in hospitalizations (53%), followed by consultations and medications (32% and 15%, respectively). CONCLUSION NCDs caused by excessive salt intake represent important economic losses for the country, not only in terms of direct health costs, but also indirect due to the increase in years of potential life lost due to premature deaths because of CVD, which causes significant losses of human capital and, therefore, to the economy and the development of Costa Rica.
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Affiliation(s)
- Jaritza Vega-Solano
- Former Researcher at the IDRC Project 108167, FUNDEVI-INCIENSA Costa Rica, Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - Karol Madriz-Morales
- Planning Department, Ministry of Health, Secretariat of National Food and Nutrition Policy, San José, Costa Rica
| | - Adriana Blanco-Metzler
- Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA), Cartago, Costa Rica
- * E-mail:
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Flexner N, Christoforou AK, Bernstein JT, Ng AP, Yang Y, Fernandes Nilson EA, Labonté MÈ, L'Abbe MR. Estimating Canadian sodium intakes and the health impact of meeting national and WHO recommended sodium intake levels: A macrosimulation modelling study. PLoS One 2023; 18:e0284733. [PMID: 37163471 PMCID: PMC10171671 DOI: 10.1371/journal.pone.0284733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 04/09/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the second leading cause of total deaths in Canada. High blood pressure is the main metabolic risk factor for developing CVDs. It has been well established that excess consumption of sodium adversely affects blood pressure. Canadians' mean sodium intakes are well above recommended levels. Reducing dietary sodium intake through food reformulation has been identified as a cost-effective intervention, however, dietary sodium intake and the potential health impact of meeting recommended sodium intake levels due to food reformulation have not been determined in Canada. OBJECTIVE This study aimed to 1) obtain robust estimates of Canadians' usual sodium intakes, 2) model sodium intakes had foods been reformulated to align with Health Canada's sodium reduction targets, and 3) estimate the number of CVD deaths that could be averted or delayed if Canadian adults were to reduce their mean sodium intake to recommended levels under three scenarios: A) 2,300 mg/d-driven by a reduction of sodium levels in packaged foods to meet Health Canada targets (reformulation); B) 2,000 mg/d to meet the World Health Organization (WHO) recommendation; and C) 1,500 mg/d to meet the Adequate Intake recommendation. METHODS Foods in the University of Toronto's Food Label Information Program 2017, a Canadian branded food composition database, were linked to nationally representative food intake data from the 2015 Canadian Community Health Survey-Nutrition to estimate sodium intakes (and intakes had Health Canada's reformulation strategy been fully implemented). The Preventable Risk Integrated ModEl (PRIME) was used to estimate potential health impact. RESULTS Overall, mean sodium intake was 2758 mg/day, varying by age and sex group. Based on 'reformulation' scenario A, mean sodium intakes were reduced by 459 mg/day, to 2299 mg/day. Reducing Canadians' sodium intake to recommended levels under scenarios A, B and C could have averted or delayed 2,176 (95% UI 869-3,687), 3,252 (95% UI 1,380-5,321), and 5,296 (95% UI 2,190-8,311) deaths due to CVDs, respectively, mainly from ischaemic heart disease, stroke, and hypertensive disease. This represents 3.7%, 5.6%, and 9.1%, respectively, of the total number of CVDs deaths observed in Canada in 2019. CONCLUSION Results suggest that reducing sodium intake to recommended levels could prevent or postpone a substantial number of CVD deaths in Canada. Reduced sodium intakes could be achieved through reformulation of the Canadian food supply. However, it will require higher compliance from the food industry to achieve Health Canada's voluntary benchmark sodium reduction targets.
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Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Jodi T Bernstein
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alena P Ng
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yahan Yang
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo A Fernandes Nilson
- Center for Epidemiological Research on Health and Nutrition, University of São Paulo, São Paulo, State of São Paulo, Brazil
| | - Marie-Ève Labonté
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec, Canada
| | - Mary R L'Abbe
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Nilson EAF, Ferrari G, Louzada MLDC, Levy RB, Monteiro CA, Rezende LFM. The estimated burden of ultra-processed foods on cardiovascular disease outcomes in Brazil: A modeling study. Front Nutr 2022; 9:1043620. [PMID: 36466395 PMCID: PMC9712187 DOI: 10.3389/fnut.2022.1043620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2023] Open
Abstract
Introduction Ultra-processed foods (UPF) have been associated with an increased risk of cardiovascular diseases (CVD). This study aimed to estimate CVD premature deaths, incident cases, and disability adjusted life-years (DALYs) attributable to the consumption of UPF in Brazilian adults in 2019. Methods A validated a comparative risk assessment model was adapted to estimate the burden of major CVD outcomes (coronary heart disease and stroke) attributable to the consumption of UPF in Brazilian adults aged 30 to 69 years. The model inputs included nationally representative data of the UPF contribution to the total energy of the diet, national official demographic records, CVD outcomes (incidence, deaths and DALYs) from the Global Burden of Disease study for 2019, and relative risks from meta-analysis studies. Results We estimated that approximately 19,200 premature deaths (95% uncertainty intervals - UI, 7,097 to 32,353), 74,900 new cases (95% UI, 25,983 to 128,725), and 883,000 DALYs/year (95% UI, 324,279 to 1,492,593) from CVD were attributable to the consumption of UPF in Brazil, corresponding to about 22% of the premature deaths from CVD and to 33% of the total premature all-cause deaths attributable to UPF intake among Brazilian adults. Reducing UPF consumption by 10% in the adult population would avert approximately 11% of the premature CVD deaths, equivalent to 2,100 deaths/year (95% UI, 697 to 4,511). A 20% reduction in UPF intake would avert approximately 21% of the premature CVD deaths or 4,100 deaths (95% UI, 1,413 to 8,047), and a 50% reduction in UPF intake would avert about 52% of the premature CVD deaths, corresponding to 9,900 deaths/year (95% UI, 3,682 to 17,820). If UPF consumption among adults was reduced to that of the first quintile of UPF intake in the baseline scenario, approximately 81% of the premature CVD deaths would be averted, corresponding to some 15,600 deaths/year (95% UI, 5,229 to 27,519). Conclusion Our study estimated a high burden of premature CVD outcomes attributable to the consumption of UPF in Brazil. Our findings support food policies aimed at reducing the consumption of UPF, such as fiscal and regulatory policies, which are imperative to prevent CVD in Brazil.
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Affiliation(s)
- Eduardo Augusto Fernandes Nilson
- Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil
- Oswaldo Cruz Foundation-Fiocruz, Brasília, Brazil
| | - Gerson Ferrari
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | | | - Renata Bertazzi Levy
- Department of Preventive Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Augusto Monteiro
- Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil
| | - Leandro F. M. Rezende
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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A Program Evaluation of a Dietary Sodium Reduction Research Consortium of Five Low- and Middle-Income Countries in Latin America. Nutrients 2022; 14:nu14204311. [PMID: 36296995 PMCID: PMC9606855 DOI: 10.3390/nu14204311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Excess dietary sodium is a global public health priority, particularly in low- and middle-income countries where rates of hypertension and cardiovascular disease are high. The International Development Research Centre funded a research consortium of five Latin American countries (LAC) to inform public health policy for dietary sodium reduction (2016-2020). The objective of this study was to determine the outcomes of this funding on short-term (e.g., research, capacity building) and intermediary outcomes (e.g., policies). A summative program evaluation was conducted, using a logic model and multiple data sources including document review, surveys and interviews. Researchers from Argentina, Costa Rica, Brazil, Peru and Paraguay produced a significant amount of scientific evidence to guide decision making on sodium policy related to its content in foods, consumer behaviors (social marketing), and the health and economic benefits of dietary reduction. A substantive number of knowledge translation products were produced. The funding enabled training opportunities for researchers who developed skills that can be scaled-up to other critical nutrients and health issues. It was unexpected that intermediary policy changes would occur, however several countries demonstrated early policy improvements derived from this research. A funded research consortium of LAC is a practical approach to invoke policy innovations.
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Vasconcelos Leitão Moreira P, da Costa Pereira de Arruda Neta A, Leite de Lima Ferreira FE, de Araújo JM, da Costa Louzada ML, Lira Formiga Cavalcanti de Lima R, Pinheiro de Toledo Vianna R, Moreira da Silva Neto J, Colombet Z, O'Flaherty M. Projected impact of change in the percentage of energy from each NOVA group intake on cardiovascular disease mortality in Brazil: a modelling study. BMJ Open 2022; 12:e057953. [PMID: 35473748 PMCID: PMC9045117 DOI: 10.1136/bmjopen-2021-057953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Estimate reductions in cardiovascular mortality achievable through improvement in nutrient intakes according to processing level (NOVA classification), that is, reducing consumption of culinary ingredients (G2), processed (G3) and ultra-processed foods (G4) while encouraging consumption of unprocessed and minimally processed foods (G1). DESIGN Modelling study. SETTING General adult population of Brazil. PARTICIPANTS Men and women aged 25 or more years (34 003) investigated in the Household Budget Survey 2017-2018, in the consumption data module. MAIN OUTCOME MEASURES We used the IMPACT Food Policy Model to estimate the reduction in deaths from cardiovascular diseases (CVD) up to 2048 in five scenarios with reductions in saturated fat, trans fat, salt and added sugar intakes resulting from changes in NOVA groups. (1) The optimistic scenario modelised an increase in the energy intake provided by G1 and a reduction in the energy intake from G2, G3 and G4, return to previous levels. (2) The minimal scenario modelised a 3.7% increase in the energy intake from G1, and a reduction in the energy intake from G4 to the 2008-2009 level. (3) The modest scenario only modelised a 25.0% reduction of the energy intake from G2 and G3. (4) The intermediary scenario modelised the minimal scenario plus a 25.0% reduction in the energy intake from G2. (5) Finally, the advanced scenario modelised the minimal scenario plus a 25.0% reduction in the energy intake from G2 and G3. RESULTS Proposed changes in the optimistic scenario could prevent or delay 52.8% CVD-related deaths by 2048. Changes modelled in the minimal, modest, intermediary and advanced scenarios may result in a 10.1%, 28.4%, 31.4% and 38.6% reduction in 2048 CVD mortality, respectively. CONCLUSIONS Substantial health gains can be achieved by improving the diet, through plausible modifications aimed at the level of processing as a tool for Brazilian food policies.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Zoe Colombet
- 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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Campos-Nonato I, Vargas Meza J, Nieto C, Ariza AC, Barquera S. Reducing Sodium Consumption in Mexico: A Strategy to Decrease the Morbidity and Mortality of Cardiovascular Diseases. Front Public Health 2022; 10:857818. [PMID: 35392467 PMCID: PMC8980680 DOI: 10.3389/fpubh.2022.857818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertension (HTN) and cardiovascular diseases (CVD) are important public health problems in Mexico. High sodium intake is linked to high blood pressure and increased risk of developing CVD. International organizations suggest consuming <2 g of sodium/day; however, the Mexican population consumes amounts above what is recommended: 3.1 g/day. Although efforts have been made to mitigate this problem, interventions are needed to improve cardiovascular health. This policy brief offers a short review of the current sodium consumption situation in Mexico and the importance of why decision makers should consider actions to reduce consumption. Recommendations to reduce sodium/salt intake include: Reformulation of ultra-processed-foods, promote the use warning labels, communication campaign, reduce the use of table salt, and monitor sodium intake.
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Affiliation(s)
- Ismael Campos-Nonato
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Jorge Vargas Meza
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Claudia Nieto
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana Carolina Ariza
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Simón Barquera
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
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Vargas-Meza J, Cervantes-Armenta MA, Campos-Nonato I, Nieto C, Marrón-Ponce JA, Barquera S, Flores-Aldana M, Rodríguez-Ramírez S. Dietary Sodium and Potassium Intake: Data from the Mexican National Health and Nutrition Survey 2016. Nutrients 2022; 14:281. [PMID: 35057461 PMCID: PMC8779568 DOI: 10.3390/nu14020281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 01/03/2023] Open
Abstract
Population studies have demonstrated an association between sodium and potassium intake and blood pressure levels and lipids. The aim of this study was to describe the dietary intake and contribution of sodium and potassium to the Mexican diet, and to describe its association with nutrition status and clinical characteristics. We analyzed a national survey with 4219 participants. Dietary information was obtained with a 24-h recall. Foods and beverages were classified according to level of processing. The mean intake (mg/d) of Na was 1512 in preschool children, 2844 in school-age children, 3743 in adolescents, and 3132 in adults. The mean intake (mg/d) of K was 1616 in preschool children, 2256 in school-age children, 2967 in adolescents, and 3401 in adults. Processed and ultra-processed foods (UPF) contribute 49% of Na intake in preschool children, 50% in school-age children, 47% in adolescents, and 39% in adults. Adults with high Na intake had lower serum concentrations of cholesterol, HDL-c, and LDL-c. A significant proportion of the Mexican population has a high intake of Na (64-82%) and low K (58-73%). Strategies to reduce Na and increase K intake need to reduce the possibility of having high BP and serum lipid disturbances.
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Affiliation(s)
| | | | - Ismael Campos-Nonato
- Center for Nutrition and Health Research, National Institute of Public Health, Av. Universidad 655 Col Santa María Ahuacatitlán, Cuernavaca C.P. 62100, Morelos, Mexico; (J.V.-M.); (M.A.C.-A.); (C.N.); (J.A.M.-P.); (S.B.); (M.F.-A.); (S.R.-R.)
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