Unhealthy diets / Alimentation malsaine

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    Update of the cardiovascular disease policy model to predict cardiovascular events in Argentina
    (MEDICINA (Buenos Aires), 2019) Salgado, M. Victoria;; Coxson, Pam; Konfino, Jonatan; Penko, Joanne; Irazola, Vilma E; Gutiérrez, Laura; Fernández, Alicia; Mejía, Raúl
    The Cardiovascular Disease Policy Model (CVDPM) is a computer simulation model used to represent and project future CVD mortality and morbidity. The objective was to update Argentina’s version of the CVDPM. For this purpose, information from the 2010 National Census, the 2013 National Risk Factor Survey, CESCAS I study, and PrEViSTA study were used to update the dynamics of population size, demographics, and cardiovascular disease (CVD) risk factor distributions over time. Results of the project are provided in model predictions and national statistics following calibration. Cardiovascular disease is the leading cause of death in Argentina.
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    Regulatory initiatives to reduce sugarsweetened beverages (SSBs) in Latin America
    (2018-10-19) Bergallo, Paola; Castagnari, Valentina; Fernández, Alicia; Mejía, Raúl; Romer, Daniel
    The study tracked legal and public health databases for public and private regulation of sugar-sweetened beverages (SSB) in 14 Latin American (LA) countries, and conducted a systematic review of the available literature. Comparative variations in the type of governance body issuing the regulations, their scope, and binding status were examined. In the past two decades, non-communicable disease (NCD) levels have soared across Latin America, in part due to the fastest growing obesity rates in the world. The paper also assesses the available evidence on new regulatory strategies, their enforcement challenges, and their impacts.
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    Contenido de azúcares en bebidas no alcohólicas comercializadas en Argentina y Costa Rica
    (Dirección de Investigación para la Salud, 2017-03) Tiscornia, María Victoria; Heredia-Blonval, Katrina; Allemandi, Lorena; Blanco-Metzler, Adriana; Ponce, Miguel
    INTRODUCCIÓN: El consumo de bebidas azucaradas está vinculado con un mayor riesgo de obesidad. OBJETIVOS: Comparar el contenido de azúcares declarado en el etiquetado nutricional de diferentes bebidas no alcohólicas comercializadas en Argentina y Costa Rica. MÉTODOS: Se recogieron datos de azúcares reportados en 13 categorías de bebidas no alcohólicas comercializadas en supermercados en 2012 y 2013. En ambos países se calculó la media de azúcares en una porción estándar de 200 ml. RESULTADOS: Dentro de las bebidas no alcohólicas comercializadas en Argentina (n=287) y Costa Rica (n=495) predominaron las azucaradas (77,6%), de las cuales la mayoría (56%; n=435) mostró contenidos de azúcares por encima del 20% del valor diario recomendado por la Organización Mundial de la Salud. Costa Rica presentó en promedio niveles superiores a los de Argentina. Las categorías con mayor contenido de azúcares en Costa Rica fueron: néctares (24,7 g/200 ml), jugos de fruta (22,5 g/200 ml) y gaseosas regulares (22,5 g/200 ml). En Argentina, gaseosas regulares (20,9 g/200 ml), jugos de fruta (18,5 g/200 ml) y bebidas a base de soja (14,9 g/200 ml). CONCLUSIONES: Este es el primer estudio que analiza y compara el contenido de azúcares de bebidas no alcohólicas en dos países latinoamericanos. El alto contenido observado y la elevada prevalencia de sobrepeso y obesidad en la región evidencian la necesidad de establecer políticas públicas para reducir el consumo de bebidas azucaradas.
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    Analysis of a voluntary initiative to reduce sodium in processed and ultra-processed food products in Argentina : the views of public and private sector representatives
    (Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2017) Castronuovo, Luciana; Allemandi, Lorena; Tiscornia, Victoria; Champagne, Beatriz; Campbell, Norm; Schoj, Veronica
    This study is part of a comprehensive quantitative and qualitative research strategy to monitor sodium reduction policies in Argentina. The qualitative study design aims to contribute to the body of research in the public health sector regarding voluntary initiatives and public-private partnerships (PPPs) towards prevention of non-communicable diseases, and to understand the policy process of PPPs from stakeholders’ perspectives. Objectives include: (1) to identify the role and resources of the different major stakeholders; (2) analyze the main challenges and controversies perceived by stakeholders; and (3) analyze stakeholders’ perspectives concerning mandatory vs. voluntary initiatives. The article discusses the initiative’s challenges and controversies.
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    Modelling the potential impact of a sugar-sweetened beverage tax on stroke mortality, costs and health-adjusted life years in South Africa
    (BioMed Central, 2016) Manyema, Mercy; Veerman, Lennert J.; Tugendhaft, Aviva; Labadarios, Demetre; Hofman, Karen J.
    This study estimates the potential impact of a tax on sugar-sweetened beverages (SSBs) in South Africa, where stroke is the third leading cause of death after HIV/AIDS and ischemic heart disease. Excess sugar consumption, especially from SSBs, has been associated with increased obesity and stroke risk. A tax on sugar-sweetened beverages is advocated by policy makers and public health experts world-wide as an effective tool to reduce obesity. Research shows that price increases for SSBs can influence consumption, suggesting the potential for reducing obesity, stroke-related mortality, and related diseases.
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    Cost of inaction on sugar-sweetened beverage consumption : implications for obesity in South Africa
    (Cambridge University Press, 2015-10) Tugendhaft, Aviva; Manyema, Mercy; Veerman, Lennert J.; Chola, Lumbwe; Labadarios, Demetre; Hofman, Karen J.
    Objective To estimate the effect of increased sugar-sweetened beverage (SSB) consumption on future adult obesity prevalence in South Africa in the absence of preventive measures. Design A model was constructed to simulate the effect of a 2·4 % annual increase in SSB consumption on obesity prevalence. The model computed the change in energy intake assuming a compounding increase in SSB consumption. The population distribution of BMI by age and sex was modelled by fitting measured data from the 2012 South African National Income Dynamics Survey to the log-normal distribution and shifting the mean values. Setting Over the past decade the prevalence of obesity and related non-communicable diseases has increased in South Africa, as have the sales and availability of SSB. Soft drink sales in South Africa are projected to grow between 2012 and 2017 at an annual compounded growth rate of 2·4 % in the absence of preventive measures to curb consumption. Results A 2·4 % annual growth in SSB sales alongside population growth and ageing will result in an additional 1 287 000 obese adults in South Africa by 2017, 22 % of which will be due to increased SSB consumption. Conclusions In order to meet the South African target of reducing the number of people who are obese and/or overweight by 10 % by 2020, the country cannot afford to delay implementing effective population-wide interventions. In the face of plans to increase growth of SSB, the country will soon face even greater challenges in overcoming obesity and related non-communicable diseases.
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    Sugar and health in South Africa : potential challenges to leveraging policy change
    (Routledge, 2015) Myers, Alex; Fig, David; Tugendhaft, Aviva; Mandle, Jessie; Myers, Jonathan; Hofman, Karen
    This paper focuses on a sugar sweetened beverage (SSB) tax. The purpose of the paper is to highlight the challenges that government might anticipate. Affected industry actors have been part of the South African economy for over a century and remain influential. In summary, policy needs to be introduced with a political strategy sensitive to the various interests at stake. To deflect attention, the sugar industry can be expected either to advocate for self-regulation or to promote public–private partnerships. This paper cautions against both approaches as evidence suggests they will be ineffective in curbing the negative health impacts caused by excessive sugar consumption.
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    Obesogenic environments : access to and advertising of sugar-sweetened beverages in Soweto, South Africa, 2013
    (Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2015)
    Marketing of products that contribute to obesity is common in urban Soweto. This is the first study in South Africa to document the location of billboard advertisements and vendors in relation to schools. The study findings have implications for policies that regulate sugar sweetened beverage (SSB) advertising, especially in the proximity of schools. In urban areas of South Africa, disposable incomes are growing and ultra-processed food is increasingly available at low cost. The project aimed to investigate the density of outdoor advertising and the number of formal and informal vendors selling SSBs in a transforming, historically disadvantaged urban setting of South Africa.
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    Nutrition labelling : a review of research on consumer and industry response in the global South
    (Co-Action Publishing, 2015-01) Mandle, Jessie; Tugendhaft, Aviva; Michalow, Julia; Hofman, Karen
    In response to increasing nutrition-related noncommunicable disease (NCDs) rates, many governments are implementing multi-faceted policy interventions including adoption of nutrition labelling on pre-packaged foods and beverages. This review identifies nutrition labelling research from 20 countries in Asia, Africa, the Middle East, and Latin America. Consumers prefer front-of-pack labelling, although there is a disparity between rates of use and comprehension. Further research into the outlook of the food and beverage industry, which plays an active role in influencing legislation and regulation, and as well on expanded labelling regulations is a priority.
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    Empowering healthy food and beverage choices in the workplace
    (Technique (Pty), Durban, ZA, 2014) Tugendhaft, A.; Hofman, K.J.
    South Africa is now considered the most obese of sub-Saharan Africa. Over half of the country’s adults are overweight or obese (42% of women and 13% of men). Since employees spend approximately 60% of their waking hours at the workplace, worksite programmes to address obesity could have a significant impact on the adult population and, by extension, on their families. A sugar sweetened beverages (SSB) tax has the potential to prevent obesity related diseases as one component of a multifaceted strategy. Worksite interventions are a further nudge to create healthier social norms around diet and eating patterns.
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    Determinants of obesity and associated population attributability, South Africa : empirical evidence from a national panel survey, 2008-2012
    (PLOS, 2015-06) Sartorius, Benn; Veerman, Lennert J.; Manyema, Mercy; Chola, Lumbwe; Hofman, Karen
    Obesity is a major risk factor for emerging non-communicable diseases (NCDs) in middle income countries including South Africa (SA). Understanding the multiple and complex determinants of obesity and their population-attributable impact is critical for informing and developing effective prevention efforts using scientific based evidence. This study identified contextualized high impact factors associated with obesity in South Africa. This analysis can inform culturally sensitive mass communications and wellness campaigns. Knowledge of social determinants is critical to develop “best buys” when it comes to health spending.
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    Decreasing the burden of type 2 diabetes in South Africa : The Impact of Taxing Sugar-Sweetened Beverages
    (PLOS, 2015-11) Manyema, Mercy; Veerman, J. Lennert; Chola, Lumbwe; Tugendhaft, Aviva; Labadarios, Demetre; Hofman, Karen
    Type 2 diabetes poses an increasing public health burden in South Africa (SA) with obesity as the main driver of the epidemic. Consumption of sugar-sweetened beverages (SSBs) is linked to weight gain, and reducing SSB consumption may significantly impact the prevalence of obesity and related diseases. Fiscal policy on SSBs has the potential to mitigate the diabetes epidemic in South Africa. This study estimates the effect of a 20% SSB tax on the burden of diabetes in SA: over 20 years, a 20% SSB tax could reduce diabetes incident cases by 106,000 in women, and by 54,000 in men; and prevalence in all adults by 4.0%.
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    Averting obesity and type 2 diabetes in India through sugar-sweetened beverage taxation : an economic-epidemiologic modeling study
    (PLOS, 2014-01) Basu, Sanjay; Vellakkal, Sukumar; Agrawal, Sutapa; Stuckler, David; Popkin, Barry; Ebrahim, Shah
    Sugar-sweetened beverage (SSB) consumption is a major risk factor for overweight and obesity, as well as an array of cardio-metabolic conditions, especially type 2 diabetes. Nationwide taxation may be perverse if benefits accrue among only select populations while monetary penalties apply universally, especially if the tax burden but not the tax benefit falls disproportionately on the poor. The study estimates potential health effects of such a fiscal strategy in India, where there is heterogeneity in SSB consumption, patterns of substitution between SSBs and other beverages after tax increases, and vast differences in chronic disease risk within the population.
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    Palm oil taxes and cardiovascular disease mortality in India: economic-epidemiologic model
    (BMJ, 2013-10) Basu, Sanjay; Babiarz, Kim; Ebrahim, Shah; Vellakkal, Sukumar; Stuckler, David; Goldhaber-Fiebert, Jeremy D.
    A microsimulation model of mortality due to myocardial infarction and stroke among Indian populations was constructed, incorporating nationally representative data. Given estimates of substitution of palm oil with other oils following a 20% price increase for palm oil, the beneficial effects of increased polyunsaturated fat consumption would be expected to enhance the projected reduction in deaths to as much as 421,000 people. Other results: curtailing palm oil intake through taxation may modestly reduce hyperlipidemia and cardiovascular mortality, but with potential distributional consequences – differentially benefiting male and urban populations, as well as affecting food security.
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    Dietary salt reduction and cardiovascular disease rates in India : a mathematical model
    (PLOS, 2012-09) Basu, Sanjay; Stuckler, David; Vellakkal, Sukumar; Ebrahim, Shah
    Modest reductions in salt intake could substantially reduce cardiovascular disease throughout India. This study predicted rates of future myocardial infarctions (MI) and strokes in India using a Markov model, simulating men and women aged 40 to 69 in both urban and rural locations, and incorporating the risk reduction from lower salt intake. Results indicate the largest decline in MIs would be among younger urban men, but the greatest number of averted strokes would be among rural men, and nearly one-third of averted strokes and one-fifth of averted MIs would be among rural women.
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    Effects of licensed characters on children's taste and snack preferences in Guatemala, a low/middle income country
    (Macmillan Publishers, 2014-03) Letona, P.; Chacon, V.; Roberto, C.; Barnoya, J.
    BACKGROUND: Marketing of high-energy, low-nutrient foods is one of the contributing factors to the obesity-promoting environment. Licensed characters are typically used to market these foods to children because they increase brand recognition and sales, and data suggest that they affect the taste and snack preferences of children in high-income countries, but it has not yet been explored in low/middle income countries (LMICs). We sought to examine how licensed characters on food packaging influence children's taste and snack preferences in Guatemala, a LMIC. METHODS: One hundred twenty-one children (mean ± s.d. age, 7.4 ± 1.9 years) from four (two preschool and two elementary) public schools in Guatemala tasted three food types: potato chips, crackers and carrots. Each was presented in two identical packages, except that one had a licensed character and the other did not. Children tasted the foods (six total) in each package and answered whether they tasted the same or one tasted better. Snack preference was also evaluated. RESULTS: Children were significantly (Po0.001) more likely to prefer the taste of the foods inside the package with the licensed character compared with the one with no character (mean ± s.d., 0.24 ± 0.54). Most (66%) chose the food in the package with the character for a snack. Younger children (Po0.001) were more likely to prefer the taste of the food inside the package with the character. CONCLUSIONS: Licensed characters on food packaging influence Guatemalan children's taste and snack preferences. Given that these characters are typically used to promote high-energy, low-nutrient foods, their influence could contribute toward overconsumption of these foods and consequently increased risk of obesity in Guatemalan children. Therefore, public health advocates, in Guatemala and elsewhere, might explore restricting the use of licensed characters on food packaging as a public health strategy.
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    Child-oriented marketing techniques in snack food packages in Guatemala
    (BioMed Central, 2013) Chacon, Violeta; Letona, Paola; Barnoya, Joaquin
    The study assesses availability of child-oriented snack foods in school kiosks and convenience stores near public schools in Guatemala, and identifies marketing techniques used in packaging. Evidence-based policies restricting the use of promotional characters in unhealthy snack food packages need to be explored as a strategy for control of obesity. Child-oriented marketing was identified as packaging that had promotional characters, premium offers, children′s television/movie tie-ins, sports references, or included the word “child.” 55 stores and street-vendors were assessed. This study is the first to document unhealthy snack foods’ advertising strategies targeted to children in a low income country (LMIC).
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    Projected impact of a sodium consumption reduction initiative in Argentina : an analysis from the CVD policy model - Argentina
    (PLOS, 2013-09) Konfino, Jonatan; Mekonnen, Tekeshe A.; Coxson, Pamela G.; Ferrante, Daniel; Bibbins-Domingo, Kirsten
    Sodium reduction policies targeting processed foods were implemented in 2011 in Argentina. The impact of the Argentinean initiative to reduce sodium consumption should substantially reduce mortality and morbidity from cardiovascular disease. This paper provides evidence-based support to continue implementing strategies to reduce sodium consumption at a population level. The aims of this study are to use Argentina-specific data on sodium excretion and project the impact of Argentina’s sodium reduction policies under two scenarios - the 2-year intervention currently being undertaken or a more persistent 10 year sodium reduction strategy.
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    Avances en la reducción del consumo de sal y sodio en Costa Rica
    (Organización Panamericana de la Salud, Washington, DC, 2012) Blanco-Metzler, Adriana; de los Angeles Montero Campos, María; Núñez-Rivas, Hilda; Gamboa-Cerda, Cecilia; Sánchez, Germana
    En el presente artículo se describen los avances logrados en Costa Rica -así como los desafíos y limitaciones- en la reducción del consumo de sal. El establecimiento del Plan Nacional para la Reducción del Consumo de Sal/sodio en la Población de Costa Rica 2011 - 2021 se complementó con programas y proyectos multisectoriales específicos dirigidos a: 1) conocer la ingesta de sodio y el contenido de sal o sodio en los alimentos de mayor consumo; identificar los conocimientos, actitudes y comportamientos del consumidor respecto a la sal/sodio, su relación con la salud y el etiquetado nutricio-nal; evaluar la relación costo-efectividad de las medidas dirigidas a reducir la prevalencia de hipertensión arterial; 2) implementar estrategias para disminuir el contenido de sal/sodio en los alimentos procesados y los preparados en casa; 3) promover cambios de conducta en la población para reducir el consumo de sal en la alimentación; y 4) monitorear y evaluar las acciones dirigidas a reducir el consumo de sal o sodio en la población. Para alcanzar las metas propuestas se debe lograr una exitosa coordinación interinstitucional con los actores estratégicos, negociar compromisos con la industria alimentaria y los servicios de alimentación, y mejorar la regulación de los nutrientes críticos asociados con las enfermedades crónicas no transmisibles, en los alimentos. Se espera que a partir de los avances logrados durante la ejecución del Plan Nacional, Costa Rica logre alcanzar la meta internacional de reducción del consumo de sal.
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    Systematic review of studies comparing 24-hour and spot urine collections for estimating population salt intake
    (Organización Panamericana de la Salud, Washington, DC, 2012) Chen Ji; Sykes, Lindsay; Paul, Christina; Dary, Omar; Legetic, Branka; Campbell, Norm R.C.; Cappuccio, Francesco P.
    OBJECTIVE: To examine the usefulness of urine sodium (Na) excretion in spot or timed urine samples to estimate population dietary Na intake relative to the gold standard of 24-hour (h) urinary Na. METHODS: An electronic literature search was conducted of MEDLINE (from 1950) and EMBASE (from 1980) as well as the Cochrane Library using the terms "sodium," "salt," and "urine." Full publications of studies that examined 30 or more healthy human subjects with both urinary Na excretion in 24-h urine and one alternative method (spot, overnight, timed) were examined. RESULTS: The review included 1 380 130 participants in 20 studies. The main statistical method for comparing 24-h urine collections with alternative methods was the use of a correlation coefficient. Spot, timed, and overnight urine samples were subject to greater intra-individual and interindividual variability than 24-h urine collections. There was a wide range of correlation coefficients between 24-h urine Na and other methods. Some values were high, suggesting usefulness (up to r = 0.94), while some were low (down to r = 0.17), suggesting a lack of usefulness. The best alternative to collecting 24-h urine (overnight, timed, or spot) was not clear, nor was the biological basis for the variability between 24-h and alternative methods. CONCLUSIONS: There is great interest in replacing 24-h urine Na with easier methods to assess dietary Na. However, whether alternative methods are reliable remains uncertain. More research, including the use of an appropriate study design and statistical testing, is required to determine the usefulness of alternative methods.