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Pourmoradian S, Kalantari N, Eini-Zinab H, Ostadrahimi A, Tabrizi JS, Faramarzi E. Estimated reductions in type 2 diabetes burden through nutrition policies in AZAR cohort population: A PRIME microsimulation study for primary health care. Health Promot Perspect 2024; 14:53-60. [PMID: 38623351 PMCID: PMC11016142 DOI: 10.34172/hpp.42452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/19/2024] [Indexed: 04/17/2024] Open
Abstract
Background Given the impact of high intake of sugar-sweetened beverages on type 2 diabetes, intervention to reduce their consumption can be a top priority for any health system. Thus, the purpose of the present study is to simulate the impact of policy options related to reduce consumption of sugar-sweetened beverages (SSBs) on the prevalence and mortality of type 2 diabetes in Iranian men and women. Methods A discrete event simulation (DES) model was used to predict the effect of several policy options on the prevalence and death from type 2 diabetes in Azar Cohort Databases. Population age- and sex-specific prevalence and incidence rate of diagnosed diabetes were derived from the national health data. The Preventable Risk Integrated Model (PRIME) model was used for coding the input parameters of simulation using R and Python software. Results The prevalence and mortality rate of type 2 diabetes under the scenario of reduced consumption of SSBs indicated that the highest and the lowest prevalence and mortality rates of type 2 diabetes for men and women were related to no policy condition and replacing SSBs with healthy drinks, like water, respectively. Also, the maximum "number of deaths postponed/ prevented" from type 2 diabetes was related to replacing SSBs with water (n=2015), and an integration of reformulation and applying 10% tax on SSBs (n=1872), respectively. Conclusion Simulating the effect of different policy options on reducing the consumption of SSBs showed "replacing of SSBs with water" as the most effective policy option in Iranian setting.
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Affiliation(s)
- Samira Pourmoradian
- Nutrition Research Center, Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Kalantari
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Eini-Zinab
- Nutrition Research Center, Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Department of Health Service Management, Tabriz Health Service Management Research Centre, School of Health Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Brown V, Sheppard L, Salmon J, Arundell L, Cerin E, Ridgers ND, Hesketh KD, Daly RM, Dunstan DW, Brown H, Gatta JD, Chinapaw JMM, Moodie M. Cost-effectiveness of reducing children's sedentary time and increasing physical activity at school: the Transform-Us! intervention. Int J Behav Nutr Phys Act 2024; 21:15. [PMID: 38347579 PMCID: PMC10860323 DOI: 10.1186/s12966-024-01560-3] [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: 08/13/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Improving physical activity and reducing sedentary behavior represent important areas for intervention in childhood in order to reduce the burden of chronic disease related to obesity and physical inactivity in later life. This paper aims to determine the cost-effectiveness of a multi-arm primary school-based intervention to increase physical activity and/or reduce sedentary time in 8-9 year old children (Transform-Us!). METHODS Modelled cost-utility analysis, using costs and effects from a cluster randomized controlled trial of a 30-month intervention that used pedagogical and environmental strategies to reduce and break up sedentary behaviour (SB-I), promote physical activity (PA-I), or a combined approach (PA + SB-I), compared to current practice. A validated multiple-cohort lifetable model (ACE-Obesity Policy model) estimated the obesity and physical activity-related health outcomes (measured as change in body mass index and change in metabolic equivalent task minutes respectively) and healthcare cost-savings over the cohort's lifetime from the public-payer perspective, assuming the intervention was delivered to all 8-9 year old children attending Australian Government primary schools. Sensitivity analyses tested the impact on cost-effectiveness of varying key input parameters, including maintenance of intervention effect assumptions. RESULTS Cost-effectiveness results demonstrated that, when compared to control schools, the PA-I and SB-I intervention arms were "dominant", meaning that they resulted in net health benefits and healthcare cost-savings if the intervention effects were maintained. When the costs and effects of these intervention arms were extrapolated to the Australian population, results suggested significant potential as obesity prevention measures (PA-I: 60,780 HALYs saved (95% UI 15,007-109,413), healthcare cost-savings AUD641M (95% UI AUD165M-$1.1B); SB-I: 61,126 HALYs saved (95% UI 11,770 - 111,249), healthcare cost-savings AUD654M (95% UI AUD126M-1.2B)). The PA-I and SB-I interventions remained cost-effective in sensitivity analysis, assuming the full decay of intervention effect after 10 years. CONCLUSIONS The PA-I and SB-I Transform-Us! intervention arms represent good value for money and could lead to health benefits and healthcare cost-savings arising from the prevention of chronic disease in later life if intervention effects are sustained. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN83725066). Australia and New Zealand Clinical Trials Registry Number (ACTRN12609000715279).
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Affiliation(s)
- Vicki Brown
- Deakin University, Deakin Health Economics, Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation (IHT), Geelong, Australia.
| | - Lauren Sheppard
- Deakin University, Deakin Health Economics, Institute for Health Transformation, Geelong, Australia
| | - Jo Salmon
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), Geelong, Australia
| | - Lauren Arundell
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), Geelong, Australia
| | - Ester Cerin
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Nicola D Ridgers
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia; Deakin University, Institute for Physical Activity and Nutrition, Geelong, Australia
| | - Kylie D Hesketh
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), Geelong, Australia
| | - Robin M Daly
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), Geelong, Australia
| | | | - Helen Brown
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), Geelong, Australia
| | - Jacqueline Della Gatta
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), Geelong, Australia
| | - J M M Chinapaw
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, Netherlands
| | - Marj Moodie
- Deakin University, Deakin Health Economics, Institute for Health Transformation, Geelong, Australia
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Onyimadu O, Violato M, Astbury NM, Hüls H, Heath L, Shipley A, Taylor H, Wilkins LE, Abhari RE, Jebb SA, Petrou S. A systematic review of economic evaluations of interventions targeting childhood overweight and obesity. Obes Rev 2023; 24:e13597. [PMID: 37463862 DOI: 10.1111/obr.13597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 05/03/2023] [Accepted: 05/29/2023] [Indexed: 07/20/2023]
Abstract
This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One-hundred fifty-one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention-only (13 studies), prevention and treatment (100 studies), and treatment-only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost-effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost-effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home-based general practitioner consultations, tended to be cost-effective. However, cost-effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.
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Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hannah Hüls
- The TUM School of Medicine, Technical University Munich, Munich, Germany
- The TUM School of Management, Technical University Munich, Munich, Germany
| | - Laura Heath
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alexandra Shipley
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | - Harriet Taylor
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | | | - Roxanna E Abhari
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Coyle DH, Sanavio L, Barrett E, Huang L, Law KK, Nanayakkara P, Hodgson JM, O’Connell M, Meggitt B, Tsai C, Pettigrew S, Wu JHY. A Cross-Sectional Evaluation of the Food Environment at an Australian University Campus. Nutrients 2023; 15:nu15071623. [PMID: 37049463 PMCID: PMC10097222 DOI: 10.3390/nu15071623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
University food environments have a strong influence on the dietary choices of students and staff. The aim of this study was to assess the food environment at a large university in Sydney, Australia. Data were collected between March and July 2022 from 27 fixed food outlets and 24 vending machines. The healthiness of the food environment was evaluated using the Healthy Food and Drink in NSW Health Facilities for Staff and Visitors Framework (‘Framework’), which assesses food environment parameters including the availability, placement, and promotion of ‘Everyday’ (healthy) and ‘Occasional’ (less healthy) products. Each parameter was evaluated overall and across each food outlet type. Across all outlets, Everyday foods and drinks made up 43.9% of all products. Only two outlets met the Framework’s product availability benchmark of ≥75% Everyday foods and drinks. A total of 43 outlets (84.3%) sold sugary drinks as part of their product range. Occasional products made up 68.4%, 53.3%, and 59.9% of all items for sale at checkout areas, countertops, and eye-level shelves, respectively. Finally, 79.7% of meal deals included Occasional products. Our findings highlight the need to improve the availability, placement, and promotion of foods and drinks sold at a major university campus in Sydney, Australia.
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Pinho-Gomes AC, Dunford E, Jones A. Trends in sugar content of non-alcoholic beverages in Australia between 2015 and 2019 during the operation of a voluntary industry pledge to reduce sugar content. Public Health Nutr 2023; 26:287-296. [PMID: 36274642 PMCID: PMC11077450 DOI: 10.1017/s1368980022002300] [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: 03/05/2022] [Revised: 09/14/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate changes in mean sugar content of non-alcoholic beverages (overall and sugar-sweetened beverages (SSB)) available for purchase in Australia and to compare signatories v. non-signatories of the Australian Beverages Council voluntary pledge from 2018. DESIGN Retrospective observational study. SETTING Australia. PARTICIPANTS About 1500 non-alcoholic beverages per year included in the FoodSwitch Monitoring Datasets for 2015-2019. RESULTS Overall, mean sugar content fell by 1·3 g/100 ml (17·1 %) from 7·5 g/100 ml in 2015 to 6·2 g/100 ml in 2019. SSB have accounted for about 56 % of all beverages available for purchase since 2015. Between 2015 and 2019, the sugar content of SSB dropped by about 10 % (0·8 g/100 ml). Soft drinks and milk-based drinks were the categories with the largest decrease in sugar content. The greater reduction in sugar observed for beverages overall than SSB suggests at least some of the overall decrease in sugar content is due to the appearance of new products with low or no sugar rather than reformulation. Over the same period, beverages with added non-nutritive sweeteners increased from 41 % to 44 %. The decrease in sugar content for all beverages and SSB was, in general, larger for non-signatories than signatories of the voluntary industry pledge. CONCLUSIONS Between 2015 and 2019, the small reduction in sugar content of non-alcoholic beverages in Australia resulted from the combined effects of introducing low- or no-sugar products and reformulation of some categories of SSB. Further policy and regulatory measures are required to reap the most benefit that sugar reduction among non-alcoholic beverages can bring to population health.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine of Population, King’s College London, London, UK
- The George Institute for Global Health, Imperial College London, 84 Wood Lane, LondonW12 0BZ, UK
| | - Elizabeth Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina, Chapel Hill, USA
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Ananthapavan J, Tran HNQ, Morley B, Hart E, Kennington K, Stevens-Cutler J, Bowe SJ, Crosland P, Moodie M. Cost-effectiveness of LiveLighter® - a mass media public education campaign for obesity prevention. PLoS One 2022; 17:e0274917. [PMID: 36129952 PMCID: PMC9491524 DOI: 10.1371/journal.pone.0274917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background The Western Australian LiveLighter® program has implemented a series of mass media advertising campaigns that aim to encourage adults to achieve and maintain a healthy weight through healthy behaviours. This study aimed to assess the cost-effectiveness of the LiveLighter® campaign in preventing obesity-related ill health in the Western Australian population from the health sector perspective. Methods Campaign effectiveness (delivered over 12 months) was estimated from a meta-analysis of two cohort studies that surveyed a representative sample of the Western Australian population aged 25–49 years on discretionary food consumption one month pre- and one month post-campaign. Campaign costs were derived from campaign invoices and interviews with campaign staff. Long-term health (measured in health-adjusted life years (HALYs)) and healthcare cost-savings resulting from reduced obesity-related diseases were modelled over the lifetime of the population using a validated multi-state lifetable Markov model (ACE-Obesity Policy model). All cost and health outcomes were discounted at 7% and presented in 2017 values. Uncertainty analyses were undertaken using Monte-Carlo simulations. Results The 12-month intervention was estimated to cost approximately A$2.46 million (M) (95% uncertainty interval (UI): 2.26M; 2.67M). The meta-analysis indicated post-campaign weekly reduction in sugary drinks consumption of 0.78 serves (95% UI: 0.57; 1.0) and sweet food of 0.28 serves (95% UI: 0.07; 0.48), which was modelled to result in average weight reduction of 0.58 kilograms (95%UI: 0.31; 0.92), 204 HALYs gained (95%UI: 103; 334), and healthcare cost-savings of A$3.17M (95%UI: A$1.66M; A$5.03M). The mean incremental cost-effectiveness ratio showed that LiveLighter® was dominant (cost-saving and health promoting; 95%UI: dominant; A$7 703 per HALY gained). The intervention remained cost-effective in all sensitivity analyses conducted. Conclusion The LiveLighter® campaign is likely to represent very good value-for-money as an obesity prevention intervention in Western Australia and should be included as part of an evidence-based obesity prevention strategy.
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Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Huong Ngoc Quynh Tran
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Ellen Hart
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Kelly Kennington
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | | | - Steven J. Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Paul Crosland
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Sugar Content and Warning Criteria Evaluation for Popular Sugar-Sweetened Beverages in Taipei, Taiwan. Nutrients 2022; 14:nu14163339. [PMID: 36014844 PMCID: PMC9415069 DOI: 10.3390/nu14163339] [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: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022] Open
Abstract
Sugar intake may increase the risk of obesity, cardiovascular disease, diabetes, and dental caries. In Taiwan, people frequently consume sugar-sweetened beverages (SSBs). This study explored the energy and sugar content of Taiwanese SSBs and evaluated them using the Chilean warning label system (>70 kcal/100 mL and >5 g sugar/100 mL) and the World Health Organization (WHO) sugar guideline (≤25 g sugar). A total of 341 SSBs with volumes ≤600 mL were analyzed. No significant differences were observed in sugar per serving among different types of SSBs, but a great variation in portion size (i.e., package size for individual consumption) was noted. The energy and sugar ratios per serving were lower in soft drinks and coffee and tea containing >1 serving than in those containing only one serving. The calorie and sugar ratios per portion were higher in all types of SSBs containing >1 serving per portion than in those containing exactly one serving. Approximately 70.0% of Taiwanese SSBs were classified as high sugar according to the Chilean criteria, and 41.6% of SSBs exceeded the WHO guideline. Moreover, 40.8% of SSBs that were not considered as high sugar according to the Chilean criteria contained >25 g sugar per portion. For individual consumption, it is more clear that nutrition labeling is based on portion rather than serving. Evaluating SSBs on sugar/portion rather than sugar/100 mL will help consumers make better choices.
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Nguyen P, Ananthapavan J, Tan EJ, Crosland P, Bowe SJ, Gao L, Dunstan DW, Moodie M. Modelling the potential health and economic benefits of reducing population sitting time in Australia. Int J Behav Nutr Phys Act 2022; 19:28. [PMID: 35305678 PMCID: PMC8934131 DOI: 10.1186/s12966-022-01276-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/28/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives. METHODS A sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014-2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings. RESULTS According to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year. CONCLUSIONS Excessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives.
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Affiliation(s)
- Phuong Nguyen
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia.
- Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia.
| | - Jaithri Ananthapavan
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
- Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
| | - Eng Joo Tan
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
| | - Paul Crosland
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
| | - Steve J Bowe
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Lan Gao
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Marj Moodie
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
- Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia
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Sugar-sweetened beverage purchases and intake at event arenas with and without a portion size cap. Prev Med Rep 2022; 25:101661. [PMID: 35127348 PMCID: PMC8800009 DOI: 10.1016/j.pmedr.2021.101661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/03/2022] Open
Abstract
This real-world study examined sugar-sweetened beverage (SSB) and food purchases and consumption during basketball games at sporting arenas with and without a voluntary 16-ounce portion size cap. A portion-size cap at an event arena was associated with customers’ purchasing and consuming fewer SSB oz. This study provides some of the first real-world evidence that an SSB portion-size cap policy may decrease SSB ounces purchased and consumed.
This is the first real-world study to examine the association between a voluntary 16-ounce (oz) portion-size cap on sugar-sweetened beverages (SSB) at a sporting arena on volume of SSBs and food calories purchased and consumed during basketball games. Cross-sectional survey data from adults exiting a Brooklyn, NY, USA arena (Barclays, n = 464) with a 16-oz portion-size restriction and a Manhattan, NY, USA arena with no portion-size restriction (Madison Square Garden, control, n = 295) after the portion cap policy was put in place from March through June 2014 were analyzed. Linear regression models adjusting for sex, age, BMI, ethnicity, race, marital status, education, and income were used to compare the two arenas during the post-implementation period. The survey response rate was 45.9% and equivalent between venues. Among all arena goers, participants at Barclays purchased significantly fewer SSB oz (−2.24 oz, 95% CI [−3.95, −0.53], p = .010) and consumed significantly fewer SSB oz (−2.34 oz, 95% CI[−4.01, −0.68], p = .006) compared with MSG after adjusting for covariates. Among those buying at least one SSB, Barclays’ participants purchased on average 11.03 fewer SSB oz. (95% CI = [4.86, 17.21], p < .001) and consumed 12.10 fewer SSB oz (95% CI = [5.78, 18.42], p < .001). There were no statistically significant differences between arenas in food calories and event satisfaction. In addition, no one reported not ordering a drink due to small size. An SSB portion-size cap was associated with purchasing and consuming fewer SSB oz. without evidence of decreasing satisfaction with the event experience.
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Wen J, Ma H, Yu Y, Zhang X, Guo D, Yin X, Yu X, Yin N, Wang J, Zhao Y. Sugar Content of Market Beverages and Children's Sugar Intake from Beverages in Beijing, China. Nutrients 2021; 13:nu13124297. [PMID: 34959849 PMCID: PMC8708007 DOI: 10.3390/nu13124297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study aims to find the sugar content of market beverages and estimate the sugar intake from beverages among students in Beijing. (2) Methods: Using snapshotting, we collected the sugar content of beverages through their packages or nutrition labels. Combined with the statistic of student beverage consumption, we estimated students' sugar intake. (3) Results: The median sugar content of total beverages was 9.0 g/100 mL, among which the fruits/vegetable juices and beverages had the highest sugar content (10.0 g/100 mL). Sugar content in most beverages in Beijing was generally higher than the recommendations, and fruit/vegetable juices and beverages exceeded the most. The median of sugar intake from beverages among students was 5.3 g/d, and the main sources were fruit/vegetable juices and beverages, protein beverages and carbonated beverages. Sugar intake from beverages differed according to gender, age and living area. Higher sugar intake was found among boys, older students and rural students. (4) Conclusions: Sugar content in market beverages in Beijing were high. Gender, age and residence were the influencing factors of sugar intake. Targeted measures should be taken to decrease the sugar content in beverages, especially the fruit/vegetable juices and beverages and the sugar intake among students.
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Affiliation(s)
- Jing Wen
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (J.W.); (H.M.); (X.Z.); (X.Y.); (N.Y.)
| | - Huijuan Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (J.W.); (H.M.); (X.Z.); (X.Y.); (N.Y.)
| | - Yingjie Yu
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 100013, China; (Y.Y.); (D.G.); (X.Y.)
| | - Xiaoxuan Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (J.W.); (H.M.); (X.Z.); (X.Y.); (N.Y.)
| | - Dandan Guo
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 100013, China; (Y.Y.); (D.G.); (X.Y.)
| | - Xueqian Yin
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (J.W.); (H.M.); (X.Z.); (X.Y.); (N.Y.)
| | - Xiaohui Yu
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 100013, China; (Y.Y.); (D.G.); (X.Y.)
| | - Ning Yin
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (J.W.); (H.M.); (X.Z.); (X.Y.); (N.Y.)
| | - Junbo Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China; (J.W.); (H.M.); (X.Z.); (X.Y.); (N.Y.)
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, Beijing 100191, China
- Correspondence: (J.W.); (Y.Z.); Tel.: +86-10-8280-1575 (J.W.); +86-1368-158-3701 (Y.Z.)
| | - Yao Zhao
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 100013, China; (Y.Y.); (D.G.); (X.Y.)
- Correspondence: (J.W.); (Y.Z.); Tel.: +86-10-8280-1575 (J.W.); +86-1368-158-3701 (Y.Z.)
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11
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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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12
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Alcaraz A, Pichon-Riviere A, Palacios A, Bardach A, Balan DJ, Perelli L, Augustovski F, Ciapponi A. Sugar sweetened beverages attributable disease burden and the potential impact of policy interventions: a systematic review of epidemiological and decision models. BMC Public Health 2021; 21:1460. [PMID: 34315428 PMCID: PMC8317409 DOI: 10.1186/s12889-021-11046-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Around 184,000 deaths per year could be attributable to sugar-sweetened beverages (SSBs) consumption worldwide. Epidemiological and decision models are important tools to estimate disease burden. The purpose of this study was to identify models to assess the burden of diseases attributable to SSBs consumption or the potential impact of health interventions. METHODS We carried out a systematic review and literature search up to August 2018. Pairs of reviewers independently selected, extracted, and assessed the quality of the included studies through an exhaustive description of each model's features. Discrepancies were solved by consensus. The inclusion criteria were epidemiological or decision models evaluating SSBs health interventions or policies, and descriptive SSBs studies of decision models. Studies published before 2003, cost of illness studies and economic evaluations based on individual patient data were excluded. RESULTS We identified a total of 2766 references. Out of the 40 included studies, 45% were models specifically developed to address SSBs, 82.5% were conducted in high-income countries and 57.5% considered a health system perspective. The most common model's outcomes were obesity/overweight (82.5%), diabetes (72.5%), cardiovascular disease (60%), mortality (52.5%), direct medical costs (57.35%), and healthy years -DALYs/QALYs- (40%) attributable to SSBs. 67.5% of the studies modelled the effect of SSBs on the outcomes either entirely through BMI or through BMI plus diabetes independently. Models were usually populated with inputs from national surveys -such us obesity prevalence, SSBs consumption-; and vital statistics (67.5%). Only 55% reported results by gender and 40% included children; 30% presented results by income level, and 25% by selected vulnerable groups. Most of the models evaluated at least one policy intervention to reduce SSBs consumption (92.5%), taxes being the most frequent strategy (75%). CONCLUSIONS There is a wide range of modelling approaches of different complexity and information requirements to evaluate the burden of disease attributable to SSBs. Most of them take into account the impact on obesity, diabetes and cardiovascular disease, mortality, and economic impact. Incorporating these tools to different countries could result in useful information for decision makers and the general population to promote a deeper implementation of policies to reduce SSBs consumption. PROSPERO PROTOCOL NUMBER CRD42020121025 .
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Affiliation(s)
- Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
| | - Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Dario Javier Balan
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS) /Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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13
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Ananthapavan J, Sacks G, Brown V, Moodie M, Nguyen P, Veerman L, Mantilla Herrera AM, Lal A, Peeters A, Carter R. Priority-setting for obesity prevention-The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study. PLoS One 2020; 15:e0234804. [PMID: 32559212 PMCID: PMC7304600 DOI: 10.1371/journal.pone.0234804] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022] Open
Abstract
The aim of the ACE-Obesity Policy study was to assess the economic credentials of a suite of obesity prevention policies across multiple sectors and areas of governance for the Australian setting. The study aimed to place the cost-effectiveness results within a broad decision-making context by providing an assessment of the key considerations for policy implementation. The Assessing Cost-Effectiveness (ACE) approach to priority-setting was used. Systematic literature reviews were undertaken to assess the evidence of intervention effectiveness on body mass index and/or physical activity for selected interventions. A standardised evaluation framework was used to assess the cost-effectiveness of each intervention compared to a 'no intervention' comparator, from a limited societal perspective. A multi-state life table Markov cohort model was used to estimate the long-term health impacts (quantified as health adjusted life years (HALYs)) and health care cost-savings resulting from each intervention. In addition to the technical cost-effectiveness results, qualitative assessments of implementation considerations were undertaken. All 16 interventions evaluated were found to be cost-effective (using a willingness-to-pay threshold of AUD50,000 per HALY gained). Eleven interventions were dominant (health promoting and cost-saving). The incremental cost-effectiveness ratio for the non-dominant interventions ranged from AUD1,728 to 28,703 per HALY gained. Regulatory interventions tended to rank higher on their cost-effectiveness results, driven by lower implementation costs. However, the program-based policy interventions were generally based on higher quality evidence of intervention effectiveness. This comparative analysis of the economic credentials of obesity prevention policies for Australia indicates that there are a broad range of policies that are likely to be cost-effective, although policy options vary in strength of evidence for effectiveness, affordability, feasibility, acceptability to stakeholders, equity impact and sustainability. Implementation of these policies will require sustained co-ordination across jurisdictions and multiple government sectors in order to generate the predicted health benefits for the Australian population.
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Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Vicki Brown
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phuong Nguyen
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Ana Maria Mantilla Herrera
- Queensland Centre for Mental Health Research, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Anita Lal
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Rob Carter
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
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14
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Lal A, Peeters A, Brown V, Nguyen P, Tran HNQ, Nguyen T, Tonmukayakul U, Sacks G, Calache H, Martin J, Moodie M, Ananthapavan J. The Modelled Population Obesity-Related Health Benefits of Reducing Consumption of Discretionary Foods in Australia. Nutrients 2020; 12:E649. [PMID: 32121199 PMCID: PMC7146305 DOI: 10.3390/nu12030649] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/16/2022] Open
Abstract
Over one third of Australians' daily energy intake is from discretionary foods and drinks. While many health promotion efforts seek to limit discretionary food intake, the population health impact of reductions in the consumption of different types of discretionary foods (e.g., sugar-sweetened beverages (SSBs), confectionery, sweet biscuits) has not been quantified. This study estimated the potential reductions in body weight, obesity-related disease incidence, and healthcare cost savings associated with consumption of one less serving per week of different discretionary foods. Reductions in the different types of discretionary food were modelled individually to estimate the impact on energy consumption and population body weight by 5-year age and sex groups. It was assumed that one serving of discretionary food each week was replaced with either a serving of fruit or popcorn, and a serving (375 mL) of SSBs was replaced with coffee, tea, or milk. Proportional multi-state multiple-cohort Markov modelling estimated likely resultant health adjusted life years (HALYs) gained and healthcare costs saved over the lifetime of the 2010 Australian population. A reduction of one serving of SSBs (375 mL) had the greatest potential impact in terms of weight reduction, particularly in ages 19-24 years (mean 0.31 kg, 95% UI: 0.23 kg to 0.37 kg) and overall healthcare cost savings of AUD 793.4 million (95% UI: 589.1 M to 976.1 M). A decrease of one serving of sweet biscuits had the second largest potential impact on weight change overall, with healthcare cost savings of $640.7 M (95% CI: $402.6 M to $885.8 M) and the largest potential weight reduction amongst those aged 75 years and over (mean 0.21 kg, 95% UI: 0.14 kg to 0.27 kg). The results demonstrate that small reductions in discretionary food consumption are likely to have substantial health benefits at the population level. Moreover, the study highlights that policy responses to improve population diets may need to be tailored to target different types of foods for different population groups.
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Affiliation(s)
- Anita Lal
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Anna Peeters
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Phuong Nguyen
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Huong Ngoc Quynh Tran
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Tan Nguyen
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Jane Martin
- Obesity Policy Coalition, Cancer Council Victoria, Melbourne, VIC 3004, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
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15
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Robinson E, Nguyen P, Jiang H, Livingston M, Ananthapavan J, Lal A, Sacks G. Increasing the Price of Alcohol as an Obesity Prevention Measure: The Potential Cost-Effectiveness of Introducing a Uniform Volumetric Tax and a Minimum Floor Price on Alcohol in Australia. Nutrients 2020; 12:E603. [PMID: 32110864 PMCID: PMC7146351 DOI: 10.3390/nu12030603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to estimate, from an obesity prevention perspective, the cost-effectiveness of two potential policies that increase the price of alcohol in Australia: a volumetric tax applied to all alcohol (Intervention 1) and a minimum unit floor price (Intervention 2). Estimated changes in alcoholic drink consumption and corresponding changes in energy intake were calculated using the 2011-12 Australian Health Survey data, published price elasticities, and nutrition information. The incremental changes in body mass index (BMI), BMI-related disease outcomes, healthcare costs, and Health Adjusted Life Years (HALYs) were estimated using a validated model. Costs associated with each intervention were estimated for government and industry. Both interventions were estimated to lead to reductions in mean alcohol consumption (Intervention 1: 20.7% (95% Uncertainty Interval (UI): 20.2% to 21.1%); Intervention 2: 9.2% (95% UI: 8.9% to 9.6%); reductions in mean population body weight (Intervention 1: 0.9 kg (95% UI: 0.84 to 0.96); Intervention 2: 0.45 kg (95% UI: 0.42 to 0.48)); HALYs gained (Intervention 1: 566,648 (95% UI: 497,431 to 647,262); Intervention 2: 317,653 (95% UI: 276,334 to 361,573)); and healthcare cost savings (Intervention 1: $5.8 billion (B) (95% UI: $5.1B to $6.6B); Intervention 2: $3.3B (95% UI: $2.9B to $3.7B)). Intervention costs were estimated as $24M for Intervention 1 and $30M for Intervention 2. Both interventions were dominant, resulting in health gains and cost savings. Increasing the price of alcohol is likely to be cost-effective from an obesity prevention perspective in the Australian context, provided consumers substitute alcoholic beverages with low or no kilojoule alternatives.
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Affiliation(s)
- Ella Robinson
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
| | - Phuong Nguyen
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
- Deakin Health Economics (DHE), Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Heng Jiang
- Centre for Alcohol Policy Research (CAPR), School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia; (H.J.); (M.L.)
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton VIC 3053, Australia
| | - Michael Livingston
- Centre for Alcohol Policy Research (CAPR), School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia; (H.J.); (M.L.)
| | - Jaithri Ananthapavan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
- Deakin Health Economics (DHE), Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Anita Lal
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
- Deakin Health Economics (DHE), Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
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16
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Jin C, Lin L, Li C, Peng Y, MacGregor GA, He F, Wang H. The sugar and energy in non-carbonated sugar-sweetened beverages: a cross-sectional study. BMC Public Health 2019; 19:1141. [PMID: 31429727 PMCID: PMC6700807 DOI: 10.1186/s12889-019-7486-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The consumption of non-carbonated sugar-sweetened beverages (NCSSBs) has many adverse health effects. However, the sugar and energy content in NCSSBs sold in China remain unknown. We aimed to investigate the sugar and energy content of NCSSBs in China and how these contents were labelled. METHODS A cross-sectional survey was conducted in 15 supermarkets in Haidian District, Beijing from July to October 2017. The product packaging and nutrient information panels of NCSSBs were recorded to obtain type of products (local/imported), serving size, nutrient contents of carbohydrate, sugar and energy. For those NCSSBs without sugar content information, we used carbohydrate content as a replacement. RESULTS A total of 463 NCSSBs met the inclusion criteria and were included in our analysis. The median of sugar content and energy content was 9.6 [interquartile range (IQR): 7.1-11.3] g/100 ml and 176 (IQR: 121-201) kJ/100 ml. The median of sugar contents in juice drinks, tea-based beverages, sports drinks and energy drinks were 10.4, 8.5, 5.0 and 7.4 g/100 ml. Imported products had higher sugar and energy content than local products. There were 95.2% products of NCSSBs receiving a 'red'(high) label for sugars per portion according to the UK criteria, and 81.6% products exceeding the daily free sugar intake recommendation from the World Health Organization (25 g). There were 82 (17.7%) products with sugar content on the nutrition labels and 60.2% of them were imported products. CONCLUSIONS NCSSBs had high sugar and energy content, and few of them provided sugar content information on their nutrition labels especially in local products. Measures including developing better regulation of labelling, reducing sugar content and restricting the serving size are needed for reducing sugar intakes in China.
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Affiliation(s)
- Chuyao Jin
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38, Xueyuan Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Lizi Lin
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38, Xueyuan Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Chenxiong Li
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38, Xueyuan Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Yuanzhou Peng
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38, Xueyuan Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Fengjun He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38, Xueyuan Rd, Haidian District, Beijing, 100191, People's Republic of China.
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Trends in Calories and Nutrients of Beverages in U.S. Chain Restaurants, 2012-2017. Am J Prev Med 2019; 57:231-240. [PMID: 31326007 DOI: 10.1016/j.amepre.2019.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Although beverages comprise one third of all menu items at large chain restaurants, no prior research has examined trends in their calorie and nutrient content. METHODS Beverages (n=13,879) on the menus of 63 U.S. chain restaurants were the final analytic sample obtained from a restaurant nutrition database (MenuStat, 2012-2017). For each beverage type, cluster-bootstrapped mixed-effects regressions estimated changes in mean calories, sugar, and saturated fat for beverages available on menus in all years and for newly introduced beverages. Data were analyzed in 2018. RESULTS Traditional sugar-sweetened beverages, sweetened teas, and blended milk-based beverages (e.g., milkshakes) were significantly higher in calories from 2012 to 2017 for newly introduced beverages (p-value for trend <0.004). For all newly introduced sweetened beverages, sugar increased significantly (2015, +7.9 g; 2016, +8.2 g; p<0.004) whereas saturated fat declined (2016, -2.3 g; 2017, -1.6 g; p<0.004). For beverages on menus in all years, saturated fat declined significantly (p<0.001), whereas mean calories and sugar remained relatively constant. Significant declines were observed for sweetened coffees (-10 kcal, -0.5 g saturated fat, p<0.001), teas (-2.6 g sugar, p=0.001), and blended milk-based beverages (-28 kcal, -4.2 g sugar, -0.8 g saturated fat, p<0.001). From 2012 to 2017, the total number of beverage offerings increased by 155%, with 82% of this change driven by sweetened beverages. CONCLUSIONS Sweetened beverages available in large chain restaurants were consistently high in calories, sugar, and saturated fat and substantially increased in quantity and variety from 2012 to 2017.
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Brown V, Ananthapavan J, Sonntag D, Tan EJ, Hayes A, Moodie M. The potential for long-term cost-effectiveness of obesity prevention interventions in the early years of life. Pediatr Obes 2019; 14:e12517. [PMID: 30816024 DOI: 10.1111/ijpo.12517] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early childhood obesity prevention is gaining increasing importance, as the prevalence of children with overweight and obesity aged 5 years and under increases worldwide. Along with understanding the effectiveness of obesity interventions, it is important to understand the cost-effectiveness of interventions over time. OBJECTIVES To estimate the long-term health benefits and health care cost-savings of reductions in BMI for the Australian population of children aged between 2 and 5 years. METHODS A proportional multistate, multiple cohort lifetable model estimated the health benefits and health care cost-savings related to hypothetical reductions in BMI, informed by a scoping review of systematic reviews reporting the effectiveness of obesity prevention interventions in preschool aged children. RESULTS Results suggest significant potential for cost-effectiveness of obesity prevention interventions in preschool-aged children if intervention effect can be maintained. A relatively small population level reduction in BMI z-score (-0.13 BMIz) in children aged 2 to 5 years would result in 36 496 health-adjusted life years saved (95% uncertainty interval [UI], 30 283-42 945) and health care cost-savings of approximately $301 million (95% UI $234 million-$369 million) if modelled over the lifetime. CONCLUSIONS Scenario results highlight the importance of obesity intervention in the early years of life.
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Affiliation(s)
- Vicki Brown
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty of the Heidelberg University, Mannheim, Germany.,Department of Health Sciences, University of York, York, UK
| | - Eng Joo Tan
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison Hayes
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marj Moodie
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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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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Coyle DH, Ndanuko R, Singh S, Huang P, Wu JH. Variations in Sugar Content of Flavored Milks and Yogurts: A Cross-Sectional Study across 3 Countries. Curr Dev Nutr 2019; 3:nzz060. [PMID: 31187086 PMCID: PMC6554456 DOI: 10.1093/cdn/nzz060] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/17/2019] [Accepted: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The consumption of dairy products is encouraged at all life stages as a nutrient-rich component of the diet. However, many milk and yogurt products, particularly flavored varieties, may contain large amounts of free sugar. OBJECTIVES The aim of this paper was to evaluate the availability and sugar content of flavored milks and yogurts in supermarkets across 3 countries: Australia, England, and South. METHODS Nutrition information for flavored milks and yogurts was collected by trained researchers and supplemented by crowd-sourced data from a smartphone application. Data were extracted in April 2018 and 3724 milk and yogurt products were available for analysis. Mean sugar concentrations were compared across countries with the use of ANOVA followed by Tukey's post-hoc pairwise comparisons. Sugar concentrations were compared with the UK's "green" traffic-light classifications. RESULTS Approximately 74% (n = 2753) of all products were flavored. Flavored products contained nearly twice the average total sugar content of unflavored products, with substantial variability: mean total sugar was 9.1 g/100 mL (range: 4.3-15.0 g/100 mL) and 11.5 g/100 g (range: 0.1-22.6 g/100 g) for flavored milks and yogurts, respectively. Free sugars contributed an estimated 41% and 42% of total sugar in milks and yogurts, respectively. Flavored milks in England had ∼0.7 g/100 mL higher total sugar on average compared with Australia and South Africa (P ≤ 0.04), whereas flavored yogurts in South Africa had the lowest average total sugar (∼2 g/100 g lower than England and Australia; P < 0.001). Less than 4% of flavored products would receive a "green" rating under the UK traffic-light labeling scheme. CONCLUSIONS In Australia, England, and South Africa, flavored milks and yogurts are highly prevalent in the food supply and contain significantly higher concentrations of total and added sugars than unflavored products.
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Affiliation(s)
- Daisy H Coyle
- The George Institute for Global Health, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Rhoda Ndanuko
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Sarinda Singh
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Polly Huang
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Jason H Wu
- The George Institute for Global Health, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
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Abstract
OBJECTIVE To establish high intake of free sugars and its related disease burden as a significant public health challenge in Australia. DESIGN We discuss five key actions to reduce intake of free sugars tailored to the Australian context. These strategies are informed by reviewing the global scientific evidence on the effectiveness of a range of policy responses to reduce intake of free sugars at the population level. SETTING Australia. PARTICIPANTS Australian population. RESULTS The five key actions to reduce population levels for intake of free sugars tailored to the Australian context include prioritising health in trade agreements and policy; introducing a fiscal policy supporting health and promoting food reformulation; regulating advertising and improving labelling; strengthening the current dietary guidelines; and encouraging healthy choices. CONCLUSIONS The adoption and implementation of the strategies discussed in the current commentary would aid in tackling the rising health burden from the intake of free sugars in Australia.
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Cost-effectiveness of community-based childhood obesity prevention interventions in Australia. Int J Obes (Lond) 2019; 43:1102-1112. [PMID: 30926947 DOI: 10.1038/s41366-019-0341-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 01/13/2019] [Accepted: 03/03/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The objective of this study is to examine, from a limited societal perspective, the cost-effectiveness of community-based obesity prevention interventions (CBIs)-defined as a programme of community-level strategies to promote healthy eating and physical activity for Australian children (aged 5-18 years). METHODS The effectiveness of CBIs was determined by undertaking a literature review and meta-analysis. Commonly implemented strategies to increase physical activity and improve nutrition were costed (in 2010 Australian dollars) to determine the average cost of a generic programme. A multiple cohort Markov model that simulates diseases associated with overweight and obesity was used to estimate the health benefits, measured as health-adjusted life years (HALYs) and healthcare-related cost offsets from diseases averted due to exposure to the intervention. Health and cost outcomes were estimated over the lifetime of the target population. Monte-Carlo simulation was used to assess second-order uncertainty of input parameters to estimate mean incremental cost-effectiveness ratios (ICER) with 95% uncertainty intervals (UIs). Scenario analyses tested variations in programme intensity, target population, and duration of effect. RESULTS The meta-analysis revealed a small but significant difference in BMI z-score (mean difference of - 0.07 (95% UI: - 0.13 to - 0.01)) favouring the CBI community compared with the control. The estimated net cost of implementing CBIs across all local government areas (LGAs) in Australia was AUD426M (95% UI: AUD3M to AUD823M) over 3 years. This resulted in 51,792 HALYs gained (95% UI: 6816 to 96,972) over the lifetime of the cohort. The mean ICER was AUD8155 per HALY gained (95% UI: AUD237 to AUD81,021), with a 95% probability of being cost-effective at a willingness to pay threshold of AUD50,000 per HALY. CONCLUSIONS CBIs are cost-effective obesity prevention initiatives; however, implementation across Australia will be (relatively) expensive when compared with current investments in preventive health.
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Cleghorn C, Blakely T, Mhurchu CN, Wilson N, Neal B, Eyles H. Estimating the health benefits and cost-savings of a cap on the size of single serve sugar-sweetened beverages. Prev Med 2019; 120:150-156. [PMID: 30660706 DOI: 10.1016/j.ypmed.2019.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/20/2018] [Accepted: 01/15/2019] [Indexed: 01/22/2023]
Abstract
Sugar-sweetened beverage (SSB) intake is associated with tooth decay, obesity and diabetes. We aimed to model the health and cost impact of reducing the serving size of all single serve SSB to a maximum of 250 ml in New Zealand. A 250 ml serving size cap was modeled for all instances of single serves (<600 ml) of sugar-sweetened carbonated soft drinks, fruit drinks, carbonated energy drinks, and sports drinks in the New Zealand National Nutrition Survey intake data (2008/09). A multi-state life-table model used the change in energy intake and therefore BMI to predict the resulting health gains in quality-adjusted life-years (QALYs) and health system costs over the remaining life course of the New Zealand population alive in 2011 (N = 4.4 million, 3% discounting). The 'base case' model (no compensation for reduced energy intake) resulted in an average reduction in SSB and energy intake of 23 ml and 44 kJ (11 kcal) per day or 0.22 kg of weight modeled over two years. The total health gain and cost-savings were 82,100 QALYs (95% UI: 65100 to 101,000) and NZ$1.65 billion [b] (95% UI: 1.19 b to 2.24 b, (US$1.10 b)) over the lifespan of the cohort. QALY gains increased to 116,000 when the SSB definition was widened to include fruit juices and sweetened milks. A cap on single serve SSB could be an effective part of a suite of obesity prevention and sugar reduction interventions in high income countries.
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Affiliation(s)
- Christine Cleghorn
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, Wellington, New Zealand.
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, Wellington, New Zealand.
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, Wellington, New Zealand.
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Faculty of Medicine, Sydney, Australia; Imperial College London, London, UK.
| | - Helen Eyles
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
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Basto-Abreu A, Braverman-Bronstein A, Camacho-García-Formentí D, Zepeda-Tello R, Popkin BM, Rivera-Dommarco J, Hernández-Ávila M, Barrientos-Gutiérrez T. Expected changes in obesity after reformulation to reduce added sugars in beverages: A modeling study. PLoS Med 2018; 15:e1002664. [PMID: 30289898 PMCID: PMC6173390 DOI: 10.1371/journal.pmed.1002664] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/31/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several strategies have been proposed to reduce the intake of added sugars in the population. In Mexico, a 10% sugar-sweetened beverages (SSBs) tax was implemented in 2014, and the implementation of other nutritional policies, such as product reformulation to reduce added sugars, is under discussion. WHO recommends that all individuals consume less than 10% of their total energy intake (TEI) from added sugars. We propose gradually reducing added sugars in SSBs to achieve an average 10% consumption of added sugars in the Mexican population over 10 years and to estimate the expected impact of reformulation in adult body weight and obesity. METHODS AND FINDINGS Baseline consumption for added sugars and SSBs, sex, age, socioeconomic status (SES), height, and weight for Mexican adults were obtained from the 2012 Mexico National Health and Nutrition Survey (ENSANUT). On average, 12.6% of the TEI was contributed by added sugars; we defined a 50% reduction in added sugars in SSBs over 10 years as a reformulation target. Using a dynamic weight change model, sugar reductions were translated into individual expected changes in body weight assuming a 43% caloric compensation and a 2-year lag for the full effect of reformulation to occur. Results were stratified by sex, age, and SES. Twelve years after reformulation, the TEI from added sugars is expected to decrease to 10%, assuming no compensation from added sugars; 44% of the population would still be above WHO recommendations, requiring further sugar reductions to food. Body weight could be reduced by 1.3 kg (95% CI -1.4 to -1.2) in the adult population, and obesity could decrease 3.9 percentage points (pp; -12.5% relative to baseline). Our sensitivity analyses suggest that the impact of the intervention could vary from 0.12 kg after 6 months to 1.52 kg in the long term. CONCLUSIONS Reformulation to reduce added sugars in SSBs could produce large reductions in sugar consumption and obesity in the Mexican adult population. This study is limited by the use of a single dietary recall and by data collected in all seasons except summer; still, these limitations should lead to conservative estimates of the reformulation effect. Reformulation success could depend on government enforcement and industry and consumer response, for which further research and evidence are needed.
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Affiliation(s)
- Ana Basto-Abreu
- National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | | | | | - Rodrigo Zepeda-Tello
- National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | - Barry M. Popkin
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | | | - Mauricio Hernández-Ávila
- University Center of Los Altos, Tepatitlan de Morelos, University of Guadalajara, Guadalajara, Jalisco, Mexico
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25
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Lin L, Li C, Jin C, Peng Y, Hashem KM, MacGregor GA, He FJ, Wang H. Sugar and energy content of carbonated sugar-sweetened beverages in Haidian District, Beijing: a cross-sectional study. BMJ Open 2018; 8:e022048. [PMID: 30104316 PMCID: PMC6091898 DOI: 10.1136/bmjopen-2018-022048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The consumption of carbonated sugar-sweetened beverages (CSSBs) is associated with a range of health problems, but little is known about the sugar and energy content of CSSBs in China. The study aimed to investigate the sugar and energy content of CSSBs in Beijing, China. STUDY DESIGN We carried out a cross-sectional survey in 15 different supermarkets from July to October 2017 in Haidian District, Beijing. METHODS The product packaging and nutrient labels of CSSBs were recorded by a snapshot in time to obtain company name, product name, serving size, and nutrient content, that is, carbohydrate, sugar and energy. For CSSB labels not showing sugar content, we used carbohydrate content as substitute. The sugar and energy content of CSSBs within each type of flavour were compared using Kruskal-Wallis test. The sugar content within the recommended levels was described using frequency. We also compared the sugar and energy content of top 5 CSSBs in terms of sales among three countries (China, UK and USA). RESULTS A total of 93 CSSB products were found. The median sugar content was 9.3 (IQR: 5.7-11.2) g/100 mL, and the energy content was 38 (IQR: 23-46) kcal/100 mL. There were 79 products labelled 'Red' (high) per serving based on the criteria set in the UK (>11.25 g/100 mL). We found 62.4% of CSSBs had sugar content per serving that exceeds the daily free sugar intake for adults (25 g) recommended by the WHO. Some of the branded products sold in China had higher sugar content when they were compared with those in Western countries. CONCLUSIONS CSSBs in Beijing, China have high sugar and energy content. Reduction in sugar content and serving size of CSSBs and taxation policy on beverages will be beneficial in reducing sugar intake in China.
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Affiliation(s)
- Lizi Lin
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Chenxiong Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Chuyao Jin
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Yuanzhou Peng
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Kawther M Hashem
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
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Ronto R, Wu JHY, Singh GM. The global nutrition transition: trends, disease burdens and policy interventions. Public Health Nutr 2018; 21:2267-2270. [PMID: 29506593 PMCID: PMC11106010 DOI: 10.1017/s1368980018000423] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/15/2018] [Accepted: 01/25/2018] [Indexed: 11/05/2022]
Abstract
Non-communicable diseases (NCD) have increased dramatically in developed and developing countries. Unhealthy diet is one of the major factors contributing to NCD development. Recent evidence has identified deterioration in aspects of dietary quality across many world regions, including low- and middle-income countries (LMIC). Most burdens of disease attributable to poor diet can be prevented or delayed as they occur prematurely. Therefore, it is important to identify and target unhealthy dietary behaviours in order to have the greatest impact. National dietary-related programmes have traditionally focused on micronutrient deficiency and food security and failed to acknowledge unhealthy dietary intakes as a risk factor that contributes to the development of NCD. Inadequate intakes of healthy foods and nutrients and excess intakes of unhealthy ones are commonly observed across the world, and efforts to reduce the double burden of micronutrient deficiency and unhealthy diets should be a particular focus for LMIC. Interventions and policies targeting whole populations are likely to be the most effective and sustainable, and should be prioritized. Population-based approaches such as health information and communication campaigns, fiscal measures such as taxes on sugar-sweetened beverages, direct restrictions and mandates, reformulation and improving the nutrient profile of food products, and standards regulating marketing to children can have significant and large impacts to improve diets and reduce the incidence of NCD. There is a need for more countries to implement population-based effective approaches to improve current diets.
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Affiliation(s)
- Rimante Ronto
- School of Allied Health, Public Health, Australian Catholic University, 8–20 Napier Street, North Sydney, NSW 2060, Australia
| | - Jason HY Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Newtown, NSW, Australia
| | - Gitanjali M Singh
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, MA, USA
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27
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Demaio A, Jones A. The true price of sugar-sweetened disease: political inertia requires renewed, strategic action. Med J Aust 2018; 209:60-61. [PMID: 29976130 DOI: 10.5694/mja18.00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/18/2018] [Indexed: 11/17/2022]
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Sugar-sweetened beverages: still cause for concern in New Zealand and Australia. Public Health Nutr 2018; 21:2532-2534. [PMID: 29978774 DOI: 10.1017/s1368980018001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Factors Influencing Children's Eating Behaviours. Nutrients 2018; 10:nu10060706. [PMID: 29857549 PMCID: PMC6024598 DOI: 10.3390/nu10060706] [Citation(s) in RCA: 555] [Impact Index Per Article: 92.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 12/31/2022] Open
Abstract
Relevant factors involved in the creation of some children’s food preferences and eating behaviours have been examined in order to highlight the topic and give paediatricians practical instruments to understand the background behind eating behaviour and to manage children’s nutrition for preventive purposes. Electronic databases were searched to locate and appraise relevant studies. We carried out a search to identify papers published in English on factors that influence children’s feeding behaviours. The family system that surrounds a child’s domestic life will have an active role in establishing and promoting behaviours that will persist throughout his or her life. Early-life experiences with various tastes and flavours have a role in promoting healthy eating in future life. The nature of a narrative review makes it difficult to integrate complex interactions when large sets of studies are involved. In the current analysis, parental food habits and feeding strategies are the most dominant determinants of a child’s eating behaviour and food choices. Parents should expose their offspring to a range of good food choices while acting as positive role models. Prevention programmes should be addressed to them, taking into account socioeconomic aspects and education.
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The Potential Cost-Effectiveness and Equity Impacts of Restricting Television Advertising of Unhealthy Food and Beverages to Australian Children. Nutrients 2018; 10:nu10050622. [PMID: 29762517 PMCID: PMC5986502 DOI: 10.3390/nu10050622] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/30/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022] Open
Abstract
Television (TV) advertising of food and beverages high in fat, sugar and salt (HFSS) influences food preferences and consumption. Children from lower socioeconomic position (SEP) have higher exposure to TV advertising due to more time spent watching TV. This paper sought to estimate the cost-effectiveness of legislation to restrict HFSS TV advertising until 9:30 pm, and to examine how health benefits and healthcare cost-savings differ by SEP. Cost-effectiveness modelling was undertaken (i) at the population level, and (ii) by area-level SEP. A multi-state multiple-cohort lifetable model was used to estimate obesity-related health outcomes and healthcare cost-savings over the lifetime of the 2010 Australian population. Incremental cost-effectiveness ratios (ICERs) were reported, with assumptions tested through sensitivity analyses. An intervention restricting HFSS TV advertising would cost AUD5.9M (95% UI AUD5.8M⁻AUD7M), resulting in modelled reductions in energy intake (mean 115 kJ/day) and body mass index (BMI) (mean 0.352 kg/m²). The intervention is likely to be cost-saving, with 1.4 times higher total cost-savings and 1.5 times higher health benefits in the most disadvantaged socioeconomic group (17,512 HALYs saved (95% UI 10,372⁻25,155); total cost-savings AUD126.3M (95% UI AUD58.7M⁻196.9M) over the lifetime) compared to the least disadvantaged socioeconomic group (11,321 HALYs saved (95% UI 6812⁻15,679); total cost-savings AUD90.9M (95% UI AUD44.3M⁻136.3M)). Legislation to restrict HFSS TV advertising is likely to be cost-effective, with greater health benefits and healthcare cost-savings for children with low SEP.
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Cost-Effectiveness of Product Reformulation in Response to the Health Star Rating Food Labelling System in Australia. Nutrients 2018; 10:nu10050614. [PMID: 29757979 PMCID: PMC5986494 DOI: 10.3390/nu10050614] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 01/15/2023] Open
Abstract
The Health Star Rating (HSR) system is a voluntary front-of-pack labelling (FoPL) initiative endorsed by the Australian government in 2014. This study examines the impact of the HSR system on pre-packaged food reformulation measured by changes in energy density between products with and without HSR. The cost-effectiveness of the HSR system was modelled using a proportional multi-state life table Markov model for the 2010 Australian population. We evaluated scenarios in which the HSR system was implemented on a voluntary and mandatory basis (i.e., HSR uptake across 6.7% and 100% of applicable products, respectively). The main outcomes were health-adjusted life years (HALYs), net costs, and incremental cost-effectiveness ratios (ICERs). These were calculated with accompanying 95% uncertainty intervals (95% UI). The model predicted that HSR-attributable reformulation leads to small changes [corrected] in mean population energy intake (voluntary: -0.98 kJ/day; mandatory: -11.81 kJ/day). [corrected]. These are likely to result in changes in mean body weight (voluntary: -0.01 kg [95% UI: -0.012 to -0.006]; mandatory: -0.11 kg [95% UI: -0.14 to -0.07, and HALYs gained [corrected] (voluntary: 4207 HALYs gained [corrected] [95% UI: 2438 to 6081]; mandatory: 49,949 HALYs gained [95% UI: 29,291 to 72,153]). The HSR system [corrected] could be considered cost-effective relative to a willingness-to-pay threshold of A$50,000 per HALY (incremental cost effectiveness ratio for voluntary: [corrected] A$1728 per HALY [95% UI: dominant to 10,445] and mandatory: A$4752 per HALY [95% UI: dominant to 16,236]).
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Tsai C, Svensen E, Flood VM, Probst Y, Reilly K, Corbett S, Wu JHY. Healthiness of Food and Beverages for Sale at Two Public Hospitals in New South Wales, Australia. Nutrients 2018; 10:nu10020216. [PMID: 29462881 PMCID: PMC5852792 DOI: 10.3390/nu10020216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 01/23/2023] Open
Abstract
(1) Background: Our aim was to conduct objective, baseline food environment audits of two major western Sydney public hospitals and compare them to recently revised state nutritional guidelines. (2) Methods: A cross-sectional assessment was conducted (June-July2017) across 14 fixed food outlets and 70 vending machines in two hospitals using an audit tool designed to assess the guideline's key food environment parameters of availability, placement, and promotion of 'Everyday' (healthy) and 'Occasional' (less healthy) products. (3) Results: Availability: Overall, Everyday products made up 51% and 44% of all products available at the two hospitals. Only 1/14(7%) fixed outlets and 16/70(23%) vending machines met the guideline's availability benchmarks of ≥75% Everyday food and beverages. Proportion of Everyday products differed among different types of food outlets (café, cafeteria, convenience stores). Placement: On average, food outlets did not meet recommendations of limiting Occasional products in prominent positions, with checkout areas and countertops displaying over 60% Occasional items. Promotion: Over two-thirds of meal deals at both hospitals included Occasional products. (4) Conclusion: Baseline audit results show that substantial improvements in availability, placement, and promotion can be made at these public hospitals to meet the nutrition guidelines. Audits of other NSW hospitals using the developed tool are needed to investigate similarities and differences in food environment between sites. These findings highlight the need for ongoing tracking to inform whether the revised guidelines are leading to improved food environments in health facilities.
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Affiliation(s)
- Carrie Tsai
- Faculty of Dentistry, University of Sydney, Westmead, NSW 2145, Australia.
| | - Erika Svensen
- Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Victoria M Flood
- Western Sydney Local Health District, Westmead, NSW 2145, Australia.
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW 2141, Australia.
| | - Yasmine Probst
- Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia.
| | - Kathryn Reilly
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia.
- Hunter New England Population Health, Wallsend, NSW 2287, Australia.
| | - Stephen Corbett
- Western Sydney Local Health District, Westmead, NSW 2145, Australia.
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia.
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The nutritional content of supermarket beverages: a cross-sectional analysis of New Zealand, Australia, Canada and the UK. Public Health Nutr 2018; 21:2507-2516. [PMID: 29409560 DOI: 10.1017/s1368980017004128] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the nutritional content, serving size and taxation potential of supermarket beverages from four different Western countries. DESIGN Cross-sectional analysis. Multivariate regression analysis and χ 2 comparisons were used to detect differences between countries. SETTING Supermarkets in New Zealand (NZ), Australia, Canada and the UK. SUBJECTS Supermarket beverages in the following categories: fruit juices, fruit-based drinks, carbonated soda, waters and sports/energy drinks. RESULTS A total of 4157 products were analysed, including 749 from NZ, 1738 from Australia, 740 from Canada and 930 from the UK. NZ had the highest percentage of beverages with sugar added to them (52 %), while the UK had the lowest (39 %, P<0.001). CONCLUSIONS There is substantial difference between countries in the mean energy, serving size and proportion of products eligible for fiscal sugar taxation. Current self-regulatory approaches used in these countries may not be effective to reduce the availability, marketing and consumption of sugar-sweetened beverages and subsequent intake of free sugars.
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