ORCID Profile
0000-0003-2073-3562
Current Organisations
George Institute for Global Health
,
UNSW Sydney
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-05-2019
DOI: 10.1161/CIRCULATIONAHA.118.038908
Abstract: Global dietary recommendations for and cardiovascular effects of linoleic acid, the major dietary omega-6 fatty acid, and its major metabolite, arachidonic acid, remain controversial. To address this uncertainty and inform international recommendations, we evaluated how in vivo circulating and tissue levels of linoleic acid (LA) and arachidonic acid (AA) relate to incident cardiovascular disease (CVD) across multiple international studies. We performed harmonized, de novo, in idual-level analyses in a global consortium of 30 prospective observational studies from 13 countries. Multivariable-adjusted associations of circulating and adipose tissue LA and AA biomarkers with incident total CVD and subtypes (coronary heart disease, ischemic stroke, cardiovascular mortality) were investigated according to a prespecified analytic plan. Levels of LA and AA, measured as the percentage of total fatty acids, were evaluated linearly according to their interquintile range (ie, the range between the midpoint of the first and fifth quintiles), and categorically by quintiles. Study-specific results were pooled using inverse-variance–weighted meta-analysis. Heterogeneity was explored by age, sex, race, diabetes mellitus, statin use, aspirin use, omega-3 levels, and fatty acid desaturase 1 genotype (when available). In 30 prospective studies with medians of follow-up ranging 2.5 to 31.9 years, 15 198 incident cardiovascular events occurred among 68 659 participants. Higher levels of LA were significantly associated with lower risks of total CVD, cardiovascular mortality, and ischemic stroke, with hazard ratios per interquintile range of 0.93 (95% CI, 0.88–0.99), 0.78 (0.70–0.85), and 0.88 (0.79–0.98), respectively, and nonsignificantly with lower coronary heart disease risk (0.94 0.88–1.00). Relationships were similar for LA evaluated across quintiles. AA levels were not associated with higher risk of cardiovascular outcomes in a comparison of extreme quintiles, higher levels were associated with lower risk of total CVD (0.92 0.86–0.99). No consistent heterogeneity by population subgroups was identified in the observed relationships. In pooled global analyses, higher in vivo circulating and tissue levels of LA and possibly AA were associated with lower risk of major cardiovascular events. These results support a favorable role for LA in CVD prevention.
Publisher: Cambridge University Press (CUP)
Date: 03-08-2020
DOI: 10.1017/S1368980020002360
Abstract: To describe the Na concentration of pre-packaged foods available in Hong Kong. The Na concentrations (mg/100 g or mg/100 ml or per serving) of all pre-packaged foods available for sale in major supermarket chains in Hong Kong were obtained from the 2017 Hong Kong FoodSwitch database. Median and interquartile range (IQR) of Na concentration for different food groups and the proportion of foods and beverages considered low and high Na ( mg/100 g or mg/100 ml and mg/100 g or mg/100 ml, respectively) were determined. Hong Kong. Not applicable. We analysed 11 518 pre-packaged products. ‘Fruit and vegetables (including table salt)’ had the highest variability in Na concentration ranging from 0 to 39 000 mg/100 g, followed by ‘sauces, dressings, spreads and dips’ ranging from 0 to 34 130. The latter also had the highest median Na concentration (mg/100 g or mg/100 ml) at 1180 (IQR 446–3520), followed by meat and meat products (median 800, IQR 632–1068) and snack foods (median 650, IQR 453–926). Fish and fish products (median 531, 364–791) and meat and meat products (median 444, IQR 351–593) had the highest Na concentration per serving. Overall, 46·7 and 26·7 % of products were low and high in Na, respectively. Our results can serve as a baseline for food supply interventions in Hong Kong. We have identified several food groups as priority areas for reformulation, demonstrating the potential of such initiatives to improve the healthiness of the food supply in Hong Kong.
Publisher: Elsevier BV
Date: 2015
Publisher: MDPI AG
Date: 19-09-2014
DOI: 10.3390/NU6093802
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/20406223221081616
Abstract: Adequate intake of long-chain (LC) omega-3 polyunsaturated fatty acids ( n-3 PUFAs) is considered important for cardiovascular health. However, the effects of LC n-3 PUFAs on the risk of heart failure (HF) remain unclear. This systematic review and meta-analysis aimed to determine the role of LC n-3 PUFAs in the incidence of HF. Electronic databases were searched for studies up to 31 July 2021. Studies were included for the meta-analysis if they reported the adjusted associations between different dietary intakes or circulating concentrations of LC n-3 PUFAs and the risk of HF. A random-effect model was used to calculate the pooled estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for higher LC n-3 PUFA concentrations. Thirteen studies were included in the meta-analysis. Eight studies comprising 316,698 in iduals (11,244 incident HF cases), with a median follow-up of 10.7 years, showed that a higher dietary intake of LC n-3 PUFAs was associated with a lower risk of HF (highest versus lowest quintile: HR = 0.84, 95% CI = 0.75–0.94). Six studies, comprising 17,163 participants (2520 HF cases) with a median follow-up of 9.7 years, showed that higher circulating LC n-3 PUFA concentrations were associated with a lower risk of HF (highest versus lowest quintile: HR = 0.59, 95% CI = 0.39–0.91). Higher circulating docosahexaenoic acid concentrations were associated with a decreased risk of HF (top versus bottom quintile: HR = 0.44, 95% CI = 0.26–0.77). The associations between eicosapentaenoic acid (HR = 0.58, 95% CI = 0.26–1.25), docosahexaenoic acid (HR = 0.66, 95% CI = 0.24–1.82), and the risk of HF were not significant. High LC n-3 PUFA concentrations measured by dietary intake or circulating biomarkers are associated with a lower risk of developing HF.
Publisher: MDPI AG
Date: 02-04-2022
DOI: 10.3390/NU14071489
Abstract: Consumption of trans fatty acids (TFA) is associated with adverse health outcomes and is a considerable burden on morbidity and mortality globally. TFA may be generated by common cooking practices and hence contribute to daily dietary intake. We performed a systematic review and meta-analysis to investigate the relationship between heating edible oils and change in their TFA content. A systematic search of experimental studies investigating the effect of various methods of heating on TFA content of edible oils was conducted in Medline and Embase since their inception up to 1 October 2020 without language restrictions. Comparable data were analysed using mixed multilevel linear models taking into account in idual study variation. Thirty-three studies encompassing twenty-one different oils were included in this review. Overall, heating to temperatures °C had no appreciable impact on different TFA levels. Between 200 and 240 °C, levels of C18:2 t (0.05% increase per 10 °C rise in temperature, 95% CI: 0.02 to 0.05%), C18:3t (0.18%, 95% CI: 0.14 to 0.21%), and total TFA (0.38%, 95% CI: 0.20 to 0.55%) increased with temperature. A further increase in total TFA was observed with prolonged heating between 200 and 240 °C. Our findings suggest that heating edible oils to common cooking temperatures (≤200 °C) has minimal effect on TFA generation whereas heating to higher temperatures can increase TFA level. This provides further evidence in favour of public health advice that heating oils to very high temperatures and prolonged heating of oils should be avoided.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.APPET.2017.11.103
Abstract: Front-of-pack graphical nutritional rating of products is becoming an important strategy in many countries to improve healthy food purchases by consumers. Evidence of the effectiveness of such on facilitating healthy food choices by school food service providers has not been reported. The primary aim of the study was to assess the impact of providing front-of-pack nutritional rating information on school canteen managers' likely food selections. Secondary outcomes were canteen manager awareness, attitudes and reported barriers to using the front-of-pack information. A randomised controlled trial involving primary school canteen managers was conducted in a single region in New South Wales, Australia. Eligible participants were randomised to an intervention or control group and asked in a telephone interview which of 12 common food products sold in school canteens they would sell. Both groups received product name and brand information. The intervention group also received information regarding the nutritional rating of products. Canteen managers in the intervention group were significantly more likely than those in the control group to indicate they would sell three of the six 'healthier' products (p = 0.036, 0.005, 0.009). There was no difference between groups in the likelihood of making available for sale any of the six 'less healthy' products. The majority of canteen managers who had heard of a product nutritional rating system agreed that it was helpful in identifying 'healthier' foods (88%, n = 31). The inclusion of product nutritional rating information has the potential to improve the availability of some 'healthier' items on canteen menus and contribute to improving child dietary intake. Further research is required to determine whether the use of product nutritional rating information actually makes a difference to canteen manager choices.
Publisher: Cambridge University Press (CUP)
Date: 29-06-2015
DOI: 10.1017/S0007114515002056
Abstract: Despite tremendous growth in the consumption of gluten-free (GF) foods, there is a lack of evaluation of their nutritional profile and how they compare with non-GF foods. The present study evaluated the nutritional quality of GF and non-GF foods in core food groups, and a wide range of discretionary products in Australian supermarkets. Nutritional information on the Nutrition Information Panel was systematically obtained from all packaged foods at four large supermarkets in Sydney, Australia in 2013. Food products were classified as GF if a GF declaration appeared anywhere on the product packaging, or non-GF if they contained gluten, wheat, rye, triticale, barley, oats or spelt. The primary outcome was the ‘Health Star Rating’ (HSR: lowest score 0·5 optimal score 5), a nutrient profiling scheme endorsed by the Australian Government. Differences in the content of in idual nutrients were explored in secondary analyses. A total of 3213 food products across ten food categories were included. On average, GF plain dry pasta scored nearly 0·5 stars less ( P 0·001) compared with non-GF products however, there were no significant differences in the mean HSR for breads or ready-to-eat breakfast cereals ( P ≥ 0·42 for both). Relative to non-GF foods, GF products had consistently lower average protein content across all the three core food groups, in particular for pasta and breads (52 and 32 % less, P 0·001 for both). A substantial proportion of foods in discretionary categories carried GF labels (e.g. 87 % of processed meats), and the average HSR of GF discretionary foods were not systematically superior to those of non-GF products. The consumption of GF products is unlikely to confer health benefits, unless there is clear evidence of gluten intolerance.
Publisher: Oxford University Press (OUP)
Date: 07-2006
DOI: 10.1373/CLINCHEM.2006.068692
Abstract: Background: Vitamin E supplementation has been recommended for persons with familial hypobetalipoproteinemia (FHBL), a rare disorder of lipoprotein metabolism that leads to low serum α-tocopherol and decreased LDL-cholesterol and apolipoprotein (apo) B. We examined the effect of truncated apoB variants on vitamin E metabolism and oxidative stress in persons with FHBL. Methods: We studied 9 in iduals with heterozygous FHBL [mean (SE) age, 40 (5) years body mass index (BMI), 27 (10) kg/m2] and 7 normolipidemic controls [age, 41 (5) years BMI, 25 (2) kg/m2]. We also studied 3 children—2 with homozygous FHBL (apoB-30.9) and 1 with abetalipoproteinemia—who were receiving α-tocopherol supplementation. We used HPLC with electrochemical detection to measure α- and γ-tocopherol in serum, erythrocytes, and platelets, and gas chromatography–mass spectrometry to measure F2-isoprostanes and tocopherol metabolites in urine as markers of oxidative stress and tocopherol intake, respectively. Results: Compared with controls, persons with FHBL had significantly lower fasting plasma concentrations of total cholesterol [2.4 (0.2) vs 4.7 (0.2) mmol/L], triglycerides [0.5 (0.1) vs 0.9 (0.1) mmol/L], LDL-cholesterol [0.7 (0.1) vs 2.8 (0.3) mmol/L], apoB [0.23 (0.02) vs 0.84 (0.08) g/L], α-tocopherol [13.6 (1.0) vs 28.7 (1.4) μmol/L], and γ-tocopherol [1.0 (0.1) vs 1.8 (0.3) μmol/L] (all P & .03). Erythrocyte α-tocopherol was decreased [5.0 (0.2) vs 6.0 (0.3) μmol/L P & .005], but we observed no differences in lipid-adjusted serum tocopherols, erythrocyte γ-tocopherol, platelet α- or γ-tocopherol, urinary F2-isoprostanes, or tocopherol metabolites. Conclusion: Taken together, our findings do not support the recommendation that persons with heterozygous FHBL receive vitamin E supplementation.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.JAD.2019.11.048
Abstract: To examine prospective associations of clinically relevant depressive symptoms with cognitive functions and rates of cognitive decline among Chinese adults aged 45 years and older. Data was from the China Health and Retirement Longitudinal Study (CHARLS) with a follow-up of 4 years. Based on the Chinese version of 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), clinically relevant depressive symptoms were defined with a CESD-10 score≥10 points. Cognitive functions were measured in three domains: episodic memory, mental status and global cognition. Linear mixed models were used to assess the associations between clinically relevant depressive symptoms and cognitive functions. A total of 7335 participants (50.10% men mean age: 57.47) were included in analyses. Participants with clinically relevant depressive symptoms showed poorer episodic memory (β=-0.35 95% CI:-0.41, -0.29), mental status (β=-0.48 95% CI: -0.57, -0.39), and global cognition (β=-0.82 95% CI: -0.94, -0.70) during the follow-up. Compared with counterparts, rates of decline in episodic memory, mental status, and global cognition increased by 0.04 (β=0.04 95% CI: 0.02, 0.06), 0.06 (β=0.06 95% CI: 0.02, 0.09) and 0.11 (β=0.11 95% CI: 0.06, 0.15) units per year in participants with clinically relevant depressive symptoms. A major limitation is that clinically relevant depressive symptoms were assessed by a screening tool and the follow-up was short. More severe clinically relevant depressive symptoms were associated with poorer cognitive functions and moderately faster cognitive decline in episodic memory, mental status and global cognition in middle-aged and elderly Chinese adults.
Publisher: MDPI AG
Date: 17-09-2021
DOI: 10.3390/NU13093225
Abstract: Widespread use of reduced-sodium salts can potentially lower excessive population-level dietary sodium intake. This study aimed to identify key barriers and facilitators to implementing reduced-sodium salt as a population level intervention. Semi-structured interviews were conducted with key informants from academia, the salt manufacturing industry, and government. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to inform our interview guides and data analysis. Eighteen key informants from nine countries across five World Health Organization regions participated in the study from January 2020 to July 2020. Participants were concerned about the lack of robust evidence on safety for specific populations such as those with renal impairment. Taste and price compared to regular salt and an understanding of the potential health benefits of reduced-sodium salt were identified as critical factors influencing the adoption of reduced-sodium salts. Higher production costs, low profit return, and reduced market demand for reduced-sodium salts were key barriers for industry in implementation. Participants provided recommendations as potential strategies to enhance the uptake. There are presently substantial barriers to the widespread use of reduced-sodium salt but there are also clear opportunities to take actions that would increase uptake.
Publisher: MDPI AG
Date: 31-05-2018
DOI: 10.3390/NU10060702
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-07-2017
DOI: 10.1161/CIR.0000000000000510
Abstract: Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.
Publisher: S. Karger AG
Date: 2023
DOI: 10.1159/000530857
Abstract: b i Introduction: /i /b The consumption of gluten-free foods has continued to increase in recent years. Given their higher intake among in iduals both with and without a medically diagnosed gluten allergy or sensitivity, it is important to understand how the nutritional quality of these foods compares against non-gluten-free foods. As such, we aimed to compare the nutritional quality of gluten-free and non-gluten-free pre-packaged foods sold in Hong Kong. b i Methods: /i /b Data from 18,292 pre-packaged food and beverage items in the 2019 FoodSwitch Hong Kong database were used. These products were categorized as (1) “declared gluten-free” (2) “gluten-free by ingredient or naturally gluten-free” and (3) “non-gluten-free” according to information presented on the package. One-way ANOVA was used to compare the differences in the Australian Health Star Rating (HSR), energy, protein, fibre, total fat, saturated fat, i trans /i -fat, carbohydrates, sugars, and sodium content between products in different gluten categories, overall and by major food category (e.g., bread and bakery products) and region of origin (e.g., America, Europe). b i Results: /i /b Products declared gluten-free (mean ± SD: 2.9 ± 1.3 i n /i = 7%) had statistically significantly higher HSR than those gluten-free by ingredient or naturally gluten-free (2.7 ± 1.4 i n /i = 51.9%) and non-gluten-free (2.2 ± 1.4 i n /i = 41.2%) (all pairwise comparisons i /i & 0.001). Overall, non-gluten-free products have higher energy, protein, saturated fat, i trans /i -fat, free sugar and sodium, and less fibre compared with products in the other two gluten categories. Similar differences were observed across major food groups and by region of origin. b i Conclusions: /i /b Non-gluten-free products sold in Hong Kong were generally less healthy than gluten-free products (regardless of the presence of gluten-free declaration). Consumers should be better educated on how to identify gluten-free foods, given that many gluten-free foods do not declare this information on the label.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Springer Science and Business Media LLC
Date: 30-06-2020
DOI: 10.1186/S12889-020-09160-Z
Abstract: Institutions are a recommended setting for dietary interventions and nutrition policies as these provide an opportunity to improve health by creating healthy food environments. In Australia, state and territory governments encourage or mandate institutions in their jurisdiction to adopt nutrition policies. However, no work has analysed the policy design across settings and jurisdictions. This study aimed to compare the design and components of government-led institutional nutrition policies between Australian states and territories, determine gaps in existing policies, and assess the potential for developing stronger, more comprehensive policies. Government-led institutional nutrition policies, in schools, workplaces, health facilities and other public settings, were identified by searching health and education department websites for each Australian state and territory government. This was supplemented by data from other relevant stakeholder websites and from the Food Policy Index Australia website. A framework for monitoring and evaluating nutrition policies in publicly-funded institutions was used to extract data and a qualitative analysis of the design and content of institutional nutrition policies was performed. Comparative analyses between the jurisdictions and institution types were conducted, and policies were assessed for comprehensiveness. Twenty-seven institutional nutrition policies were identified across eight states and territories in Australia. Most policies in health facilities and public schools were mandatory, though most workplace policies were voluntary. Twenty-four included nutrient criteria, and 22 included guidelines for catering/fundraising/advertising. While most included implementation guides or tools and additional supporting resources, less than half included tools/timelines for monitoring and evaluation. The policy design, components and nutrient criteria varied between jurisdictions and institution types, though all were based on the Australian Dietary Guidelines. Nutrition policies in institutions present an opportunity to create healthy eating environments and improve population health in Australia. However, the design of these policies, including lack of key components such as accountability mechanisms, and jurisdictional differences, may be a barrier to implementation and prevent the policies having their intended impact.
Publisher: BMJ
Date: 09-08-2022
DOI: 10.1136/HEARTJNL-2022-321332
Abstract: The Salt Substitute and Stroke Study (SSaSS) recently reported blood pressure-mediated benefits of a potassium-enriched salt substitute on cardiovascular outcomes and death. This study assessed the effects of salt substitutes on a breadth of outcomes to quantify the consistency of the findings and understand the likely generalisability of the SSaSS results. We searched PubMed, Embase and the Cochrane Library up to 31 August 2021. Parallel group, step-wedge or cluster randomised controlled trials reporting the effect of salt substitute on blood pressure or clinical outcomes were included. Meta-analyses and metaregressions were used to define the consistency of findings across trials, geographies and patient groups. There were 21 trials and 31 949 participants included, with 19 reporting effects on blood pressure and 5 reporting effects on clinical outcomes. Overall reduction of systolic blood pressure (SBP) was −4.61 mm Hg (95% CI −6.07 to −3.14) and of diastolic blood pressure (DBP) was −1.61 mm Hg (95% CI −2.42 to −0.79). Reductions in blood pressure appeared to be consistent across geographical regions and population subgroups defined by age, sex, history of hypertension, body mass index, baseline blood pressure, baseline 24-hour urinary sodium and baseline 24-hour urinary potassium (all p homogeneity .05). Metaregression showed that each 10% lower proportion of sodium choloride in the salt substitute was associated with a −1.53 mm Hg (95% CI −3.02 to −0.03, p=0.045) greater reduction in SBP and a −0.95 mm Hg (95% CI −1.78 to −0.12, p=0.025) greater reduction in DBP. There were clear protective effects of salt substitute on total mortality (risk ratio (RR) 0.89, 95% CI 0.85 to 0.94), cardiovascular mortality (RR 0.87, 95% CI 0. 81 to 0.94) and cardiovascular events (RR 0.89, 95% CI 0.85 to 0.94). The beneficial effects of salt substitutes on blood pressure across geographies and populations were consistent. Blood pressure-mediated protective effects on clinical outcomes are likely to be generalisable across population subgroups and to countries worldwide. CRD42020161077.
Publisher: American Diabetes Association
Date: 03-03-2021
DOI: 10.2337/DC20-2426
Abstract: Prospective associations between n-3 fatty acid biomarkers and type 2 diabetes (T2D) risk are not consistent in in idual studies. We aimed to summarize the prospective associations of biomarkers of α-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with T2D risk through an in idual participant-level pooled analysis. For our analysis we incorporated data from a global consortium of 20 prospective studies from 14 countries. We included 65,147 participants who had blood measurements of ALA, EPA, DPA, or DHA and were free of diabetes at baseline. De novo harmonized analyses were performed in each cohort following a prespecified protocol, and cohort-specific associations were pooled using inverse variance–weighted meta-analysis. A total of 16,693 incident T2D cases were identified during follow-up (median follow-up ranging from 2.5 to 21.2 years). In pooled multivariable analysis, per interquintile range (difference between the 90th and 10th percentiles for each fatty acid), EPA, DPA, DHA, and their sum were associated with lower T2D incidence, with hazard ratios (HRs) and 95% CIs of 0.92 (0.87, 0.96), 0.79 (0.73, 0.85), 0.82 (0.76, 0.89), and 0.81 (0.75, 0.88), respectively (all P & 0.001). ALA was not associated with T2D (HR 0.97 [95% CI 0.92, 1.02]) per interquintile range. Associations were robust across prespecified subgroups as well as in sensitivity analyses. Higher circulating biomarkers of seafood-derived n-3 fatty acids, including EPA, DPA, DHA, and their sum, were associated with lower risk of T2D in a global consortium of prospective studies. The biomarker of plant-derived ALA was not significantly associated with T2D risk.
Publisher: Wiley
Date: 03-08-2022
DOI: 10.1002/DMRR.3487
Abstract: To prospectively examine the association between arthritis and type 2 diabetes (T2D) in the Chinese population and confirm this association through a comprehensive meta-analysis of cohort studies. Data were from the China Health and Retirement Longitudinal Study which was started in 2011-2013 and followed up in 2013-2014 and 2015-2016. Arthritis was defined as self-reported physician diagnosis at baseline, and incident T2D was determined by self-reported physician diagnosis, fasting blood glucose ≥7.0 mmol/L or glycosylated haemoglobin ≥6.5% during the follow-ups. Cox proportional hazards regression models were used to assess the association between arthritis and risk for T2D. A meta-analysis was conducted to pool our effect estimate and those from other cohort studies using a random-effects model. Eleven thousand four hundred and eight participants (47.9% men mean age: 59.3 years) were included in final analyses. During a 4-year follow-up, 981 participants reported incident T2D. Compared with in iduals without arthritis, those with arthritis at baseline had an 18% higher risk for incident T2D (multivariable-adjusted hazard ratio: 1.18 95% confidence interval: 1.04, 1.34). In the meta-analysis of 13 cohort studies including ours, a total of 2,473,514 participants were included with 121,851 incident diabetes. The pooling HR was 1.32 (95% CI: 1.21, 1.44) for the association between arthritis and diabetes. Arthritis was associated with an increased risk of incident diabetes in Chinese adults, and the positive association was confirmed in the meta-analysis of cohort studies. Our work can inform clinical trials to assess the effectiveness of arthritis treatments in reducing risk of diabetes.
Publisher: Korean Diabetes Association
Date: 2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2023
DOI: 10.1161/HYPERTENSIONAHA.122.20105
Abstract: In 2021, the World Health Organization (WHO) set sodium benchmarks for packaged foods to guide countries in setting feasible and effective sodium reformulation programs. We modeled the dietary and health impact of full compliance with the WHO’s sodium benchmarks in Australia and compared it to the potential impact of Australia’s 2020 sodium reformulation targets. We used nationally representative data on food and sodium intake, sodium levels in packaged foods, and food sales volume to estimate sodium intake pre- and post-implementation of the WHO and Australia’s sodium benchmarks for 24 age-sex groups. Using comparative risk assessment models, we then estimated the potential deaths, incidence, and disability-adjusted life years averted from cardiovascular disease, chronic kidney disease, and stomach cancer based on the reductions in sodium intake. Compliance with the WHO’s sodium benchmarks for packaged foods in Australia could lower mean adult sodium intake by 404 mg/day, corresponding to a 12% reduction. This could prevent about 1770 deaths/year (95% uncertainty interval 1168–2587), corresponding to 3% of all cardiovascular disease, chronic kidney disease, and stomach cancer deaths in Australia, and prevent some 6900 (4603–9513) new cases, and 25 700 (17 655–35 796) disability-adjusted life years/year. Compared with Australian targets, the WHO benchmarks will avert around 3 and a half times more deaths each year (1770 versus 510). Substantially greater health impact could be achieved if the Australian government strengthened its current sodium reformulation program by adopting WHO’s more stringent and comprehensive sodium benchmarks.
Publisher: BMJ
Date: 12-01-2021
DOI: 10.1136/BMJNPH-2020-000173
Abstract: On average, Australian adults consume 3500 mg sodium per day, almost twice the recommended maximum level of intake. The Australian government through the Healthy Food Partnership initiative has developed a voluntary reformulation programme with sodium targets for 27 food categories. We estimated the potential impact of this programme on household sodium purchases (mg/day per capita) and examined potential differences by income level. We also modelled and compared the effects of applying the existing UK reformulation programme targets in Australia. This study used 1 year of grocery purchase data (2018) from a nationally representative consumer panel of Australian households (Nielsen Homescan) that was linked with a packaged food and beverage database (FoodSwitch) that contains product-specific sodium information. Potential reductions in per capita sodium purchases were calculated and differences across income level were assessed by analysis of variance. All analyses were modelled to the Australian population in 2018. A total of 7188 households were included in the analyses. The Healthy Food Partnership targets covered 4307/26 728 (16.1%) unique products, which represented 22.3% of all packaged foods purchased by Australian households in 2018. Under the scenario that food manufacturers complied completely with the targets, sodium purchases will be reduced by 50 mg/day per capita, equivalent to 3.5% of sodium currently purchased from packaged foods. Reductions will be greater in low-income households compared with high-income households (mean difference −7 mg/day, 95% CI −4 to −11 mg/day, p .001). If Australia had adopted the UK sodium targets, this would have covered 9927 unique products, resulting in a reduction in per capita sodium purchases by 110 mg/day. The Healthy Food Partnership reformulation programme is estimated to result in a very small reduction to sodium purchases. There are opportunities to improve the programme considerably through greater coverage and more stringent targets.
Publisher: Elsevier BV
Date: 11-2017
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1093/AJCN/NQZ005
Publisher: The Endocrine Society
Date: 06-2013
DOI: 10.1210/JC.2012-3899
Publisher: BMJ
Date: 07-12-2020
Abstract: In rural China, mortality surveillance data may be an alternative to primary data collection in clinical trials SmartVA (verbal autopsy) is also a potential alternative for endpoint adjudication. The feasibility and validity of both need to be assessed. We used mortality data from the first 24 months of the China Salt Substitute and Stroke Study (SSaSS) trial and assessed the agreement between (1) mortality surveillance data and face-to-face visits for fact of death (2) mortality surveillance data and SSaSS adjudication for causes of death (3) SmartVA and SSaSS adjudication for causes of death (4) cause-specific mortality fraction of different methods. Face-to-face visits and SSaSS adjudication were taken as reference methods. The agreement was measured by sensitivity, specificity and positive predictive value (PPV) across different 10th Revision of International Statistical Classification of Diseases chapters. One thousand three hundred and sixty-five deaths were included. Mortality surveillance data had 82% sensitivity for fact of death and 81% sensitivity for causes of death, with substantial variances across different disease types and reasonable quality for circulatory death (91% sensitivity and 94% PPV). The sensitivity of SmartVA for causes of death was 61%, with reasonable quality for deaths of external causes of morbidity (90% sensitivity). The leading causes of death from different sources were the same with some variances in the fractions. Using mortality surveillance data for fact of death in clinical trials need to account for under-reporting. A face-to-face visit to all participants at the completion of trials may be warranted. Neither mortality surveillance data nor SmartVA provided valid data source for endpoint events.
Publisher: Springer Science and Business Media LLC
Date: 11-05-2016
Publisher: Cambridge University Press (CUP)
Date: 22-08-2017
DOI: 10.1017/S1368980017001987
Abstract: To estimate the proportion of products meeting Indian government labelling regulations and to examine the Na levels in packaged foods sold in India. Nutritional composition data were collected from the labels of all packaged food products sold at Indian supermarkets in between 2012 and 2014. Proportions of products compliant with the Food Safety Standards Authority of India (FSSAI) regulations and labelled with Na content, and mean Na levels were calculated. Comparisons were made against 2010 data from Hyderabad and against the UK Department of Health (DoH) 2017 Na targets. Eleven large chain retail stores in Delhi and Hyderabad, India. Packaged food products ( n 5686) categorised into fourteen food groups, thirty-three food categories and ninety sub-categories. More packaged food products (43 v . 34 % P ·001) were compliant with FSSAI regulations but less (32 v . 38 % P ·001) reported Na values compared with 2010. Food groups with the highest Na content were sauces and spreads (2217 mg/100 g) and convenience foods (1344 mg/100 g). Mean Na content in 2014 was higher in four food groups compared with 2010 and lower in none ( P ·05). Only 27 % of foods in sub-categories for which there are UK DoH benchmarks had Na levels below the targets. Compliance with nutrient labelling in India is improving but remains low. Many packaged food products have high levels of Na and there is no evidence that Indian packaged foods are becoming less salty.
Publisher: Springer Science and Business Media LLC
Date: 12-2020
DOI: 10.1186/S12966-020-01064-W
Abstract: An amendment to this paper has been published and can be accessed via the original article.
Publisher: Elsevier BV
Date: 07-2013
Publisher: JMIR Publications Inc.
Date: 21-09-2016
DOI: 10.2196/RESPROT.6282
Publisher: Springer Science and Business Media LLC
Date: 08-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-03-2017
Publisher: Elsevier BV
Date: 05-2013
Publisher: Oxford University Press (OUP)
Date: 03-2007
DOI: 10.1373/CLINCHEM.2006.076992
Abstract: Background: Vitamin E isomers may protect against atherosclerosis. The aim of this study was to compare the effects of supplementation with either α-tocopherol (αT) or mixed tocopherols rich in γ-tocopherol (γT) on markers of oxidative stress and inflammation in patients with type 2 diabetes. Methods: In a double-blind, placebo-controlled trial, 55 patients with type 2 diabetes were randomly assigned to receive (500 mg/day) (a) αT, (b) mixed tocopherols, or (c) placebo for 6 weeks. Cellular tocopherols, plasma and urine F2-isoprostanes, erythrocyte antioxidant enzyme activities, plasma inflammatory markers, and ex vivo assessment of eicosanoid synthesis were analyzed pre- and postsupplementation. Results: Neutrophil αT and γT increased (both P & .001) with mixed tocopherol supplementation, whereas αT (P & .001) increased and γT decreased (P & .005) after αT supplementation. Both αT and mixed tocopherol supplementation resulted in reduced plasma F2-isoprostanes (P & .001 and P = 0.001, respectively) but did not affect 24-h urinary F2-isoprostanes or erythrocyte antioxidant enzyme activities. Neither αT nor mixed tocopherol supplementation affected plasma C-reactive protein, interleukin 6, tumor necrosis factor-α, or monocyte chemoattractant protein-1. Stimulated neutrophil leukotriene B4 production decreased significantly in the mixed tocopherol group (P = 0.02) but not in the αT group (P = 0.15). Conclusions: The ability of tocopherols to reduce systemic oxidative stress suggests potential benefits of vitamin E supplementation in patients with type 2 diabetes. In populations with well-controlled type 2 diabetes, supplementation with either αT or mixed tocopherols rich in γT is unlikely to confer further benefits in reducing inflammation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2022
DOI: 10.1161/HYPERTENSIONAHA.122.19072
Abstract: Salt substitution (ie, replacement of table and cooking salt with potassium-enriched salt substitutes) is a promising strategy to reduce blood pressure and prevent cardiovascular disease, particularly in countries like India where there is high sodium intake, mainly from discretionary salt, and low potassium intake. Life-threatening hyperkalemia from increased potassium intake is a postulated concern for in iduals with chronic kidney disease. We used comparative risk assessment models to estimate the number of (1) cardiovascular deaths averted due to blood pressure reductions (2) potential hyperkalemia-related deaths from increased potassium intake in in iduals with advanced chronic kidney disease and (3) net averted deaths from nationwide salt substitution in India. We evaluated a conservative scenario, based on a large, long-term pragmatic trial in rural China and an optimistic scenario informed by our recent trial in India. Sensitivity analyses were conducted to assess the robustness of the findings. In the conservative scenario, a nationwide salt substitution intervention was estimated to result in ≈214 000 (95% uncertainty interval, 92 764–353 054) averted deaths from blood pressure reduction in the total population and ≈52 000 (22 961–80 211) in 28 million in iduals with advanced chronic kidney disease, while ≈22 000 (15 221–31 840) hyperkalemia-deaths might be caused by the intervention. The corresponding estimates for the optimistic scenario were ≈351 000 (130 470–546 255), ≈66 000 (24 925–105 851), and ≈9000 (4251–14 599). Net benefits were consistent across sensitivity analyses. Modeling nationwide salt substitution in India consistently estimated substantial net benefits, preventing around 8% to 14% of annual cardiovascular deaths. Even allowing for potential hyperkalemia risks there were net benefits estimated for in iduals with chronic kidney disease.
Publisher: Wiley
Date: 14-04-2019
DOI: 10.1111/JHN.12652
Abstract: The Health Star Rating (HSR) is a front-of-pack label designed to help Australian consumers identify healthier packaged foods. Price is an important determinant of food choice and yet no previous studies have examined the relationship between HSR and price. In the present study, we investigated whether (i) healthier packaged food products, as determined by HSR, are more expensive than less healthy alternatives and (ii) products displaying the HSR are more expensive than similar products that do not. Prices of three packaged foods categories (breakfast cereals, cereal-based bars and fruit juices) and nutrient data (to calculate HSR) were obtained from shopping receipts of approximately 1600 Australians between June 2014 and September 2016. Associations between HSR and price [per energy ($/100 kJ) and per unit ($/100 g)] for products of comparable package sizes were assessed by linear regression and the results are presented as differences in average price over the theoretical maximum range of HSR from 0.5 to 5 stars. The HSR of products was not consistently related to price. Small positive associations were observed for juice ($0.08/100 mL P = 0.03) and for cereal-based bars ($0.04/100 kJ P = 0.02). No other associations between HSR and price were observed (P ≥ 0.23). Products that displayed the HSR were no more expensive on average than products that received a similar HSR but did not display the HSR (P ≥ 0.16). In summary, the findings of the present study suggest that healthier packaged food products were not consistently more expensive than less healthy products and also that price is unlikely to be a barrier for consumers to use the HSR to select healthier packaged foods.
Publisher: MDPI AG
Date: 27-09-2021
DOI: 10.3390/NU13103404
Abstract: There is limited information regarding the free sugar content of pre-packaged foods in Hong Kong. This study aims to assess the free sugar content and identify the most frequently used free sugar ingredients (FSI) in pre-packaged foods in Hong Kong. Data from 18,784 products from the 2019 FoodSwitch Hong Kong database were used in this analysis. Ingredient lists were screened to identify FSI. Total sugar content was derived from nutrition labels on packaging. Free sugar content was estimated based on adaptation of a previously established systematic methodology. Descriptive statistics of the total sugar and free sugar content, as well as the mean ± SD contribution of free sugar to total sugar of the audited products were calculated, stratified by food groups. Almost two-thirds (64.5%) of the pre-packaged foods contained at least one FSI. ‘Sugar (sucrose)’ was the most popular FSI that was found in more than half (54.7%) of the products. ‘Fruit and vegetable juices’ (median 10.0 IQR 8.3–11.5 g/100 mL) were found to have a higher median free sugar content than ‘Soft drinks’ (8.0 6.0–10.6 g/100 mL). Mean ± SD contribution of free sugar to the total sugar content was 65.8 ± 43.4%, with 8 out of 14 food groups having % total sugar as free sugar. To conclude, free sugar, especially sucrose, was extensively used in a wide variety of pre-packaged products sold in Hong Kong. Further studies are needed to assess the population intake of free sugar in Hong Kong to inform public health policy on free sugar reduction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
DOI: 10.1161/CIRCGENETICS.113.000208
Abstract: Omega6 (n6) polyunsaturated fatty acids (PUFAs) and their metabolites are involved in cell signaling, inflammation, clot formation, and other crucial biological processes. Genetic components, such as variants of fatty acid desaturase ( FADS ) genes, determine the composition of n6 PUFAs. To elucidate undiscovered biological pathways that may influence n6 PUFA composition, we conducted genome-wide association studies and meta-analyses of associations of common genetic variants with 6 plasma n6 PUFAs in 8631 white adults (55% women) across 5 prospective studies. Plasma phospholipid or total plasma fatty acids were analyzed by similar gas chromatography techniques. The n6 fatty acids linoleic acid (LA), γ-linolenic acid (GLA), dihomo-GLA, arachidonic acid, and adrenic acid were expressed as percentage of total fatty acids. We performed linear regression with robust SEs to test for single-nucleotide polymorphism–fatty acid associations, with pooling using inverse-variance–weighted meta-analysis. Novel regions were identified on chromosome 10 associated with LA (rs10740118 P =8.1×10 −9 near NRBF2 ), on chromosome 16 with LA, GLA, dihomo-GLA, and arachidonic acid (rs16966952 P =1.2×10 −15 , 5.0×10 −11 , 7.6×10 −65 , and 2.4×10 −10 , respectively NTAN1 ), and on chromosome 6 with adrenic acid after adjustment for arachidonic acid (rs3134950 P =2.1×10 −10 AGPAT1 ). We confirmed previous findings of the FADS cluster on chromosome 11 with LA and arachidonic acid, and further observed novel genome-wide significant association of this cluster with GLA, dihomo-GLA, and adrenic acid ( P =2.3×10 −72 , 2.6×10 −151 , and 6.3×10 −140 , respectively). Our findings suggest that along with the FADS gene cluster, additional genes may influence n6 PUFA composition.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2007
Publisher: MDPI AG
Date: 29-05-2021
DOI: 10.3390/NU13061861
Abstract: This study aims to examine the use of non-nutritive (NNSs) and low-calorie sweeteners (LCSs) in pre-packaged foods in Hong Kong and the differences in the number of NNSs/LCSs used between products from different regions. In a cross-sectional audit, the types of NNSs/LCSs used in 19,915 pre-packaged foods in Hong Kong were examined by searching the ingredients list of the included products for keywords related to 20 common NNSs/LCSs and their respective E-numbers. Prevalence of use of NNSs and LCSs, the co-presence of NNSs/LCSs and free sugar ingredients (FSI), and the number of NNSs/LCSs used in the included foods were computed. Pearson’s χ2 test was used to compare the total number of NNSs and/or LCSs used in food items from different regions. Sucralose (E955) was the most commonly used NNS (1.9%), followed by acesulfame K (E950, 1.6%). Sorbitol was the most commonly used LCS (2.9%). Overall, the use of LCSs was less common compared with NNSs (3.7% vs. 4.5%). The use of different types of NNSs varied substantially between food types. Notably, 20.2% of potato crisps and 15.2% of other crisps or extruded snacks contained at least one NNS and/or LCS. Co-presence of FSIs and NNSs/LCSs were most common in confectionery (15.7%) and snack foods (15.5%). Asian prepackaged foods were more likely to contain NNSs/LCSs (10.1%) compared with those from other regions. To conclude, NNSs/LCSs were used in a wide range of non-diet pre-packaged products which could be a public health concern due to their higher consumption frequencies than “diet” products.
Publisher: MDPI AG
Date: 14-09-2021
DOI: 10.3390/NU13093195
Abstract: Underconsumption of dietary fiber is prevalent worldwide and is associated with multiple adverse health conditions. Despite the importance of fiber, the labeling of fiber content on packaged foods and beverages is voluntary in most countries, making it challenging for consumers and policy makers to monitor fiber consumption. Here, we developed a machine learning approach for automated and systematic prediction of fiber content using nutrient information commonly available on packaged products. An Australian packaged food dataset with known fiber content information was ided into training (n = 8986) and test datasets (n = 2455). Utilization of a k-nearest neighbors machine learning algorithm explained a greater proportion of variance in fiber content than an existing manual fiber prediction approach (R2 = 0.84 vs. R2 = 0.68). Our findings highlight the opportunity to use machine learning to efficiently predict the fiber content of packaged products on a large scale.
Publisher: JMIR Publications Inc.
Date: 25-01-2021
Abstract: egular salt is about 100% sodium chloride. Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride. Low-sodium salts have a potential role in reducing the population's sodium intake levels and blood pressure, but their availability in the global market is unknown. he aim of this study is to assess the availability, formulation, labeling, and price of low-sodium salts currently available to consumers worldwide. ow-sodium salts were identified through a systematic literature review, Google search, online shopping site searches, and inquiry of key informants. The keywords “salt substitute,” “low-sodium salt,” “potassium salt,” “mineral salt,” and “sodium reduced salt” in six official languages of the United Nations were used for the search. Information about the brand, formula, labeling, and price was extracted and analyzed. total of 87 low-sodium salts were available in 47 out of 195 (24%) countries worldwide, including 28 high-income countries, 13 upper-middle-income countries, and 6 lower-middle-income countries. The proportion of sodium chloride varied from 0% (sodium-free) to 88% (as percent of weight regular salt is 100% sodium chloride). Potassium chloride was the most frequent component with levels ranging from 0% to 100% (potassium chloride salt). A total of 43 (49%) low-sodium salts had labels with the potential health risks, and 33 (38%) had labels with the potential health benefits. The median price of low-sodium salts in high-income, upper-middle-income, and lower-middle-income countries was US $15.00/kg (IQR 6.4-22.5), US $2.70/kg (IQR 1.7-5.5), and US $2.90/kg (IQR 0.50-22.2), respectively. The price of low-sodium salts was between 1.1 and 14.6 times that of regular salts. ow-sodium salts are not widely available and are commonly more expensive than regular salts. Policies that promote the availability, affordability, and labeling of low-sodium salts should increase uptake, helping populations reduce blood pressure and prevent cardiovascular diseases. R2-10.1111/jch.14054
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-04-2017
DOI: 10.1161/CIR.0000000000000482
Abstract: Multiple randomized controlled trials (RCTs) have assessed the effects of supplementation with eicosapentaenoic acid plus docosahexaenoic acid (omega-3 polyunsaturated fatty acids, commonly called fish oils) on the occurrence of clinical cardiovascular diseases. Although the effects of supplementation for the primary prevention of clinical cardiovascular events in the general population have not been examined, RCTs have assessed the role of supplementation in secondary prevention among patients with diabetes mellitus and prediabetes, patients at high risk of cardiovascular disease, and those with prevalent coronary heart disease. In this scientific advisory, we take a clinical approach and focus on common indications for omega-3 polyunsaturated fatty acid supplements related to the prevention of clinical cardiovascular events. We limited the scope of our review to large RCTs of supplementation with major clinical cardiovascular disease end points meta-analyses were considered secondarily. We discuss the features of available RCTs and provide the rationale for our recommendations. We then use existing American Heart Association criteria to assess the strength of the recommendation and the level of evidence. On the basis of our review of the cumulative evidence from RCTs designed to assess the effect of omega-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events, we update prior recommendations for patients with prevalent coronary heart disease, and we offer recommendations, when data are available, for patients with other clinical indications, including patients with diabetes mellitus and prediabetes and those with high risk of cardiovascular disease, stroke, heart failure, and atrial fibrillation.
Publisher: Elsevier BV
Date: 08-2019
Abstract: Price promotions are used to influence purchases and represent an important target for obesity prevention policy. However, no long-term contemporary data on the extent and frequency of supermarket price promotions exists. We aimed to evaluate the frequency, magnitude and weekly variation of beverage price promotions available online at two major Australian supermarket chains over 50 weeks. Beverages were categorised into four policy-relevant categories (sugar-sweetened beverages, artificially-sweetened beverages, flavoured milk and 100% juice, milk and water). The proportional contribution of each category to the total number of price proportions, the proportion of price promotions within the available product category, the mean discount, and weekly variation in price promotions were calculated. For Coles and Woolworths respectively, 26% and 30% of all beverages were price promoted in any given week. Sugar-sweetened beverages made up the greatest proportion of all price promotions (Coles: 46%, Woolworths: 49%). Within each product category, the proportion of sugar-sweetened and artificially-sweetened beverages that were price promoted was similar, higher than the other categories and reasonably constant over time. Diet drinks and sugar-sweetened soft drinks were most heavily discounted (by 29-40%). Beverage price promotions are used extensively in Australian supermarkets, undermining efforts to promote healthy population diets. Implications for public health: Policies restricting price promotions on sugar-sweetened beverages are likely to be an important part of strategies to reduce obesity and improve population nutrition.
Publisher: MDPI AG
Date: 02-02-2023
DOI: 10.3390/NU15030761
Abstract: In most African countries, the prevalence of industrially produced trans-fatty acids (iTFA) in the food supply is unknown. We estimated the number and proportion of products containing specific (any hydrogenated edible oils) and non-specific (vegetable fat, margarine, and vegetable cream) ingredients potentially indicative of iTFAs among pre-packaged foods collected in Kenya and Nigeria. We also summarized the number and proportion of products that reported trans-fatty acids levels and the range of reported trans-fatty acids levels. In total, 99 out of 5668 (1.7%) products in Kenya and 310 out of 6316 (4.9%) products in Nigeria contained specific ingredients indicative of iTFAs. Bread and bakery products and confectioneries in both countries had the most foods that contained iTFAs-indicative ingredients. A total of 656 products (12%) in Kenya and 624 products (10%) in Nigeria contained non-specific ingredients that may indicate the presence of iTFAs. The reporting of levels of trans-fatty acids was low in both Kenya and Nigeria (11% versus 26%, respectively, p 0.001). With the increasing burden of ischemic heart disease in Kenya and Nigeria, the rapid adoption of WHO best-practice policies and the mandatory declaration of trans-fatty acids are important for eliminating iTFAs.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2016
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1194/JLR.P071860
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1093/AJCN/NQX063
Abstract: The cardioprotective properties of linoleic acid (LA), a major n-6 (ω-6) polyunsaturated fatty acid (PUFA), have been recognized, but less is known about its associations with other causes of death. Relatively little is also known about how the minor n-6 PUFAs-γ-linolenic acid (GLA), dihomo-γ-linolenic acid (DGLA), and arachidonic acid (AA)-relate to mortality risk. We investigated the associations of serum n-6 PUFAs, an objective biomarker of exposure, with risk of death in middle-aged and older men and whether disease history modifies the associations. We included 2480 men from the prospective Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42-60 y at baseline in 1984-1989. The stratified analyses by baseline disease status included 1019 men with a history of cardiovascular disease (CVD), cancer, or diabetes and 1461 men without a history of disease. During the mean follow-up of 22.4 y, 1143 deaths due to disease occurred. Of these, 575 were CVD deaths, 317 were cancer deaths, and 251 were other-cause deaths. A higher serum LA concentration was associated with a lower risk of death from any cause (multivariable-adjusted HR for the highest compared with the lowest quintile: 0.57 95% CI: 0.46, 0.71 P-trend < 0.001) and with deaths due to CVD (extreme-quintile HR: 0.54 95% CI: 0.40, 0.74 P-trend 0.13). Our findings showed an inverse association of a higher biomarker of LA intake with total and CVD mortality and little concern for risk, thus supporting the current dietary recommendations to increase LA intake for CVD prevention. The finding of an inverse association of serum AA with the risk of death needs replication in other populations.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Public Library of Science (PLoS)
Date: 21-09-2021
DOI: 10.1371/JOURNAL.PMED.1003763
Abstract: We aimed to investigate the association of serum pentadecanoic acid (15:0), a biomarker of dairy fat intake, with incident cardiovascular disease (CVD) and all-cause mortality in a Swedish cohort study. We also systematically reviewed studies of the association of dairy fat biomarkers (circulating or adipose tissue levels of 15:0, heptadecanoic acid [17:0], and trans -palmitoleic acid [ t 16:1n-7]) with CVD outcomes or all-cause mortality. We measured 15:0 in serum cholesterol esters at baseline in 4,150 Swedish adults (51% female, median age 60.5 years). During a median follow-up of 16.6 years, 578 incident CVD events and 676 deaths were identified using Swedish registers. In multivariable-adjusted models, higher 15:0 was associated with lower incident CVD risk in a linear dose–response manner (hazard ratio 0.75 per interquintile range 95% confidence interval 0.61, 0.93, P = 0.009) and nonlinearly with all-cause mortality (P for nonlinearity = 0.03), with a nadir of mortality risk around median 15:0. In meta-analyses including our Swedish cohort and 17 cohort, case–cohort, or nested case–control studies, higher 15:0 and 17:0 but not t 16:1n-7 were inversely associated with total CVD, with the relative risk of highest versus lowest tertile being 0.88 (0.78, 0.99), 0.86 (0.79, 0.93), and 1.01 (0.91, 1.12), respectively. Dairy fat biomarkers were not associated with all-cause mortality in meta-analyses, although there were ≤3 studies for each biomarker. Study limitations include the inability of the biomarkers to distinguish different types of dairy foods and that most studies in the meta-analyses (including our novel cohort study) only assessed biomarkers at baseline, which may increase the risk of misclassification of exposure levels. In a meta-analysis of 18 observational studies including our new cohort study, higher levels of 15:0 and 17:0 were associated with lower CVD risk. Our findings support the need for clinical and experimental studies to elucidate the causality of these relationships and relevant biological mechanisms.
Publisher: Public Library of Science (PLoS)
Date: 29-06-2016
Publisher: Springer Science and Business Media LLC
Date: 05-03-2021
DOI: 10.1038/S41371-021-00510-X
Abstract: Sodium and potassium appear to interact with each other in their effects on blood pressure with potassium supplementation having a greater blood pressure lowering-effect when sodium intake is high. Whether the effect of sodium reduction on blood pressure varies according to potassium intake levels is unclear. We carried out a systematic review and meta-analysis to examine the impact of baseline potassium intake on blood pressure response to sodium reduction in randomized trials in adult populations, with sodium and potassium intake estimated from 24-h urine s les. We included 68 studies involving 5708 participants and conducted univariable and multivariable meta-regression. The median intake of baseline potassium was 67.7 mmol (Interquartile range: 54.6-76.4 mmol), and the mean reduction in sodium intake was 128 mmol (95% CI: 107-148). Multivariable meta-regression that included baseline 24-h urinary potassium excretion, age, ethnicity, baseline blood pressure, change in 24-h urinary sodium excretion, as well as the interaction between baseline 24-h urinary potassium excretion and change in 24-h urinary sodium excretion did not identify a significant association of baseline potassium intake levels with the blood pressure reduction achieved with a 50 mmol lowering of sodium intake (p > 0.05 for both systolic and diastolic blood pressure). A higher starting level of blood pressure was consistently associated with a greater blood pressure reduction from reduced sodium consumption. However, the nonsignificant findings may subject to the limitations of the data available. Additional studies with more varied potassium intake levels would allow a more confident exclusion of an interaction.
Publisher: Cambridge University Press (CUP)
Date: 07-02-2018
DOI: 10.1017/S1368980017004128
Abstract: To compare the nutritional content, serving size and taxation potential of supermarket beverages from four different Western countries. Cross-sectional analysis. Multivariate regression analysis and χ 2 comparisons were used to detect differences between countries. Supermarkets in New Zealand (NZ), Australia, Canada and the UK. Supermarket beverages in the following categories: fruit juices, fruit-based drinks, carbonated soda, waters and sports/energy drinks. 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 (9 %, P ·001). Differences in energy, carbohydrate and sugar content were observed between countries and within categories, with UK products generally having the lowest energy and sugar content. Up to half of all products across categories/countries exceeded the US Food and Drug Administration’s reference single serving sizes, with fruit juices contributing the greatest number. Between 47 and 83 % of beverages in the different countries were eligible for sugar taxation, the UK having the lowest proportion of products in both the low tax (5–8 % sugar) and high tax ( % sugar) categories. 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.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
DOI: 10.1161/CIRCGENETICS.112.964619
Abstract: Palmitic acid (16:0), stearic acid (18:0), palmitoleic acid (16:1n-7), and oleic acid (18:1n-9) are major saturated and monounsaturated fatty acids that affect cellular signaling and metabolic pathways. They are synthesized via de novo lipogenesis and are the main saturated and monounsaturated fatty acids in the diet. Levels of these fatty acids have been linked to diseases including type 2 diabetes mellitus and coronary heart disease. Genome-wide association studies were conducted in 5 population-based cohorts comprising 8961 participants of European ancestry to investigate the association of common genetic variation with plasma levels of these 4 fatty acids. We identified polymorphisms in 7 novel loci associated with circulating levels of ≥1 of these fatty acids. ALG14 (asparagine-linked glycosylation 14 homolog) polymorphisms were associated with higher 16:0 ( P =2.7×10 −11 ) and lower 18:0 ( P =2.2×10 −18 ). FADS1 and FADS2 (desaturases) polymorphisms were associated with higher 16:1n-7 ( P =6.6×10 −13 ) and 18:1n-9 ( P =2.2×10 −32 ) and lower 18:0 ( P =1.3×10 −20 ). LPGAT1 (lysophosphatidylglycerol acyltransferase) polymorphisms were associated with lower 18:0 ( P =2.8×10 −9 ). GCKR (glucokinase regulator P =9.8×10 −10 ) and HIF1AN (factor inhibiting hypoxia-inducible factor-1 P =5.7×10 −9 ) polymorphisms were associated with higher 16:1n-7, whereas PKD2L1 (polycystic kidney disease 2-like 1 P =5.7×10 −15 ) and a locus on chromosome 2 (not near known genes) were associated with lower 16:1n-7 ( P =4.1×10 −8 ). Our findings provide novel evidence that common variations in genes with erse functions, including protein-glycosylation, polyunsaturated fatty acid metabolism, phospholipid modeling, and glucose- and oxygen-sensing pathways, are associated with circulating levels of 4 fatty acids in the de novo lipogenesis pathway. These results expand our knowledge of genetic factors relevant to de novo lipogenesis and fatty acid biology.
Publisher: Wiley
Date: 20-11-2018
DOI: 10.1002/HPJA.218
Abstract: Improving implementation of school healthy canteen policies requires a comprehensive understanding of implementation barriers. Therefore, the aim of this study was to assess a range of barriers, as reported by canteen managers, using a quantitative survey instrument developed based on a theoretical framework. A cross sectional survey of primary school canteen managers from the Hunter New England region of New South Wales was conducted of eligible schools in the study region identified as having an operational canteen. Survey items assessed canteen manager employment status, canteen characteristics and potential barriers to healthy canteen policy implementation, aligned to the 14 domains of the theoretical domains framework via a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The mean domain scores of canteen managers were calculated, less than four indicating the canteen manager considered the domain was a barrier. Canteen managers were also asked to provide the current canteen menu for audit by a dietitian. Of the 184 participants, 20% (n = 36) were assessed as having menus compliant with the state policy. The five most common domains identified as potential barriers to policy implementation were behavioural regulation (n = 117, 65%), skills (n = 105, 57%), beliefs about capabilities (n = 100, 55%), reinforcement (n = 95, 52%) and goals (n = 95, 52%). Canteen managers who reported optimism as a barrier had significantly lower odds of having a menu compliant with the state policy (OR = 0.39 95% CI 0.16-0.95, P = 0.038). This study provides further evidence of perceived and actual barriers that canteen managers face when attempting to implement a healthy canteen policy, and highlights the need to address differences in canteen characteristics when planning implementation support. SO WHAT?: For public health benefits of nutrition policies within schools to be realised, the barriers to implementation need to be identified and used to help guide implementation support strategies.
Publisher: Wiley
Date: 28-01-2016
Abstract: Communities in rural Andhra Pradesh may be at increasing risk of diabetes. In the present study we analyzed three cross-sectional studies over 9 years to estimate the changing prevalence of dysglycemia (diabetes and prediabetes). The 2005 study s led 4535 in iduals from 20 villages, the 2010 study s led 4024 in iduals from 14 villages, and the 2014 project of 62 254 in iduals sought to include all adults aged 40-85 years from 54 villages. Blood glucose levels were estimated using a hand-held device in 2005 and 2014 and using HbA1c dried blood spots in 2010. In primary analyses restricted to assays based on fasting s les (2005, n = 3243 2014, n = 749), the prevalence estimates for dysglycemia were 53.7% (95% confidence interval [CI] 51.8%-55.7%) in 2005 and 62.0% (95% CI 58.5%-65.4%) in 2014 (P < 0.001). Over the same period, mean body mass index (BMI) increased from 22.2 to 24.3 kg/m The prevalence of dysglycemia was high at every assessment using every measurement method. Dysglycemia in this population is most likely to have risen with the rise in BMI. The decline in prevalence suggested by the secondary analyses was likely due to confounding from the different assessment methods.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2022
DOI: 10.1186/S12966-022-01389-8
Abstract: Consumption of ultra-processed foods is associated with increased risk of obesity and non-communicable diseases. Little is known about current patterns of ultra-processed foods intake in Australia. The aim of this study was to examine the amount and type of ultra-processed foods purchased by Australian households in 2019 and determine whether purchases differed by socio-economic status (SES). We also assessed whether purchases of ultra-processed foods changed between 2015 and 2019. We used grocery purchase data from a nationally representative consumer panel in Australia to assess packaged and unpackaged grocery purchases that were brought home between 2015 to 2019. Ultra-processed foods were identified according to the NOVA system, which classifies foods according to the nature, extent and purpose of industrial food processing. Purchases of ultra-processed foods were calculated per capita, using two outcomes: grams/day and percent of total energy. The top food categories contributing to purchases of ultra-processed foods in 2019 were identified, and differences in ultra-processed food purchases by SES (Index of Relative Social Advantage and Disadvantage) were assessed using survey-weighted linear regression. Changes in purchases of ultra-processed foods between 2015 to 2019 were examined overall and by SES using mixed linear models. In 2019, the mean ± SD total grocery purchases made by Australian households was 881.1 ± 511.9 g/d per capita. Of this, 424.2 ± 319.0 g/d per capita was attributable to purchases of ultra-processed foods, which represented 56.4% of total energy purchased. The largest food categories contributing to total energy purchased included mass-produced, packaged breads (8.2% of total energy purchased), chocolate and sweets (5.7%), biscuits and crackers (5.7%) and ice-cream and edible ices (4.3%). In 2019, purchases of ultra-processed foods were significantly higher for the lowest SES households compared to all other SES quintiles ( P 0.001). There were no major changes in purchases of ultra-processed foods overall or by SES over the five-year period. Between 2015 and 2019, ultra-processed foods have consistently made up the majority of groceries purchased by Australians, particularly for the lowest SES households. Policies that reduce ultra-processed food consumption may reduce diet-related health inequalities.
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.FREERADBIOMED.2005.04.001
Abstract: Gamma-tocopherol (gammaT) is one of the major forms of vitamin E consumed in the diet. Previous reports have suggested increased levels of nitrated gamma-tocopherol (5-NO2-gammaT) in smokers and in iduals with conditions associated with elevated nitrative stress. The monitoring of 5-NO2-gammaT and its possible metabolite(s) may be a useful marker of reactive nitrogen species generation in vivo. The major pathway for the metabolism of gammaT is the cytochrome P450 dependent oxidation to its water-soluble metabolite gamma-CEHC, which is excreted in urine. In order to determine if 5-NO2-gammaT could be metabolised via the same route and detected in urine we developed a sensitive gas chromatography-mass spectrometry assay for 5-NO2-gamma-CEHC. 5-NO2-gamma-CEHC was synthesised and its structure confirmed by proton nuclear magnetic resonance and mass spectrometry. While gamma-CEHC was abundant in urine from healthy volunteers, as well as patients with coronary heart disease and type 2 diabetes, 5-NO2-gamma-CEHC was undetectable (limit of detection of 5 nM). To understand this observation we examined the uptake and metabolism of gammaT and 5-NO2-gammaT by HepG2 cells. gammaT was readily incorporated into cells and metabolised to gamma-CEHC over a period of 48 hours. In contrast, 5-NO2-gammaT was poorly incorporated into HepG2 cells and not metabolised to 5-NO2-gamma-CEHC over the same time period. We conclude that nitration of gammaT prevents its incorporation into liver cells and therefore its metabolism to the water-soluble metabolite. Whether 5-NO2-gammaT could be metabolised via other pathways in vivo requires further investigation.
Publisher: Public Library of Science (PLoS)
Date: 10-10-2018
Publisher: BMJ
Date: 15-07-2020
DOI: 10.1136/BMJ.M2297
Abstract: To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease. Updated meta-analysis. Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020. Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke. A total of 129 studies were included, involving 10 069 955 in iduals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P .10). Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.
Publisher: Public Library of Science (PLoS)
Date: 08-05-2018
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1093/AJCN/NQAB242
Publisher: BMJ
Date: 10-03-2021
DOI: 10.1136/BMJ.N463
Publisher: Frontiers Media SA
Date: 21-09-2022
DOI: 10.3389/PHRS.2022.1605025
Abstract: Objectives: The potential for using routinely collected data for medical research in China remains unclear. We sought to conduct a scoping review to systematically characterise nation-wide routinely collected datasets in China that may be of value for clinical research. Methods: We searched public databases and the websites of government agencies, and non-government organizations. We included nation-wide routinely collected databases related to communicable diseases, non-communicable diseases, injuries, and maternal and child health. Database characteristics, including disease area, data custodianship, data volume, frequency of update and accessibility were extracted and summarised. Results: There were 70 databases identified, of which 46 related to communicable diseases, 20 to non-communicable diseases, 1 to injury and 3 to maternal and child health. The data volume varied from below 1000 to over 100,000 records. Over half (64%) of the databases were accessible for medical research mostly comprising communicable diseases. Conclusion: There are large quantities of routinely collected data in China. Challenges to using such data in medical research remain with various accessibility. The potential of routinely collected data may also be applicable to other low- and middle-income countries.
Publisher: MDPI AG
Date: 17-10-2017
DOI: 10.3390/NU9101128
Publisher: Frontiers Media SA
Date: 22-06-2022
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.JAND.2017.08.013
Abstract: The Australian Government has introduced a voluntary front-of-package labeling system that includes total sugar in the calculation. Our aim was to determine the effect of substituting added sugars for total sugars when calculating Health Star Ratings (HSR) and identify whether use of added sugars improves the capacity to distinguish between core and discretionary food products. This study included packaged food and beverage products available in Australian supermarkets (n=3,610). The product categories included in the analyses were breakfast cereals (n=513), fruit (n=571), milk (n=309), non-alcoholic beverages (n=1,040), vegetables (n=787), and yogurt (n=390). Added sugar values were estimated for each product using a validated method. HSRs were then estimated for every product according to the established method using total sugar, and then by substituting added sugar for total sugar. The scoring system was not modified when added sugar was used in place of total sugar in the HSR calculation. Products were classified as core or discretionary based on the Australian Dietary Guidelines. To investigate whether use of added sugar in the HSR algorithm improved the distinction between core and discretionary products as defined by the Australian Dietary Guidelines, the proportion of core products that received an HSR of ≥3.5 stars and the proportion of discretionary products that received an HSR of <3.5 stars, for algorithms based upon total vs added sugars were determined. There were 2,263 core and 1,347 discretionary foods 1,684 of 3,610 (47%) products contained added sugar (median 8.4 g/100 g, interquartile range=5.0 to 12.2 g). When the HSR was calculated with added sugar instead of total sugar, an additional 166 (7.3%) core products received an HSR of ≥3.5 stars and 103 (7.6%) discretionary products received a rating of ≥3.5 stars. The odds of correctly identifying a product as core vs discretionary were increased by 61% (odds ratio 1.61, 95% CI 1.26 to 2.06 P<0.001) when the algorithm was based on added compared to total sugars. In the six product categories examined, substitution of added sugars for total sugars better aligned the HSR with the Australian Dietary Guidelines. Future work is required to investigate the impact in other product categories.
Publisher: Elsevier BV
Date: 08-2021
Publisher: MDPI AG
Date: 18-01-2017
DOI: 10.3390/NU9010077
Publisher: MDPI AG
Date: 27-03-2023
DOI: 10.3390/NU15071623
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 c us in Sydney, Australia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2009
Publisher: Cambridge University Press (CUP)
Date: 06-03-2018
DOI: 10.1017/S1368980018000423
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 c aigns, 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.
Publisher: Cambridge University Press (CUP)
Date: 17-03-2016
DOI: 10.1017/S0007114516000799
Abstract: Despite the potential of declared serving size to encourage appropriate portion size consumption, most countries including Australia have not developed clear reference guidelines for serving size. The present study evaluated variability in manufacturer-declared serving size of discretionary food and beverage products in Australia, and how declared serving size compared with the 2013 Australian Dietary Guideline (ADG) standard serve (600 kJ). Serving sizes were obtained from the Nutrition Information Panel for 4466 packaged, discretionary products in 2013 at four large supermarkets in Sydney, Australia, and categorised into fifteen categories in line with the 2013 ADG. For unique products that were sold in multiple package sizes, the percentage difference between the minimum and the maximum serving size across different package sizes was calculated. A high variation in serving size was found within the majority of food and beverage categories – for ex le, among 347 non-alcoholic beverages (e.g. soft drinks), the median for serving size was 250 (interquartile range (IQR) 250, 355) ml (range 100–750 ml). Declared serving size for unique products that are available in multiple package sizes also showed high variation, particularly for chocolate-based confectionery, with median percentage difference between minimum and maximum serving size of 183 (IQR 150) %. Categories with a high proportion of products that exceeded the 600 kJ ADG standard serve included cakes and muffins, pastries and desserts (≥74 % for each). High variability in declared serving size may confound interpretation and understanding of consumers interested in standardising and controlling their portion selection. Future research is needed to assess if and how standardising declared serving size might affect consumer behaviour.
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.APPET.2022.106352
Abstract: We examined the prevalence and magnitude of price promotions among purchases of packaged foods and beverages in Australia, as well as the contribution of price-promoted foods and beverages to apparent energy intake. We utilized grocery purchase data from a nationally representative panel of 10 000 households in 2019 (NielsenIQ Homescan panel), combined with a food nutrition dataset (FoodSwitch). Nutritional quality was defined using the Australian and New Zealand Health Star Rating (HSR), where products with an HSR <3.5 were classified as 'less healthy' and products with an HSR ≥3.5 were classified as 'healthy'. Apparent energy intake was expressed as the total energy content of all purchased products per day per capita. Price promotions were claimed by panel members. Overall, four-in-ten packaged products (41%) were purchased on price promotion. Compared to 'healthy' products, 'less healthy' products were more frequently purchased on price promotion (33% vs 48%, respectively, p < 0.001), but had a similar mean magnitude of price discount (both 22%). Low socio-economic status (SES) households consumed 18% more energy from 'less healthy' packaged products on price promotion than high SES households (1141 vs 970 kJ/day/capita, p < 0.001). In conclusion, restricting price promotions for 'less healthy' packaged foods and beverages could potentially improve diet quality and dietary inequalities in Australia.
Publisher: MDPI AG
Date: 21-08-2015
DOI: 10.3390/NU7085321
Publisher: Cambridge University Press (CUP)
Date: 06-07-2018
Publisher: Elsevier BV
Date: 05-2019
Publisher: MDPI AG
Date: 15-02-2018
DOI: 10.3390/NU10020216
Publisher: Springer Science and Business Media LLC
Date: 09-02-2022
DOI: 10.1007/S11883-022-01004-Y
Abstract: Online grocery shopping is increasingly popular, but the extent to which these food environments encourage healthy or unhealthy purchases is unclear. This review identifies studies assessing the healthiness of real-world online supermarkets and frameworks to support future efforts. A total of 18 studies were included and 17 assessed aspects of online supermarkets. Pricing and promotional strategies were commonly applied to unhealthy products, while nutrition labelling may not meet regulated requirements or support consumer decision-making. Few studies investigated the different and specific ways online supermarkets can influence consumers. One framework for comprehensively capturing the healthiness of online supermarkets was identified, particularly highlighting the various ways retailers can tailor the environment to target in iduals. Comprehensive assessments of online supermarkets can identify the potential to support or undermine healthy choices and dietary patterns. Common, validated instruments to facilitate consistent analysis and comparison are needed, particularly to investigate the new opportunities the online setting offers to influence consumers.
Publisher: Cambridge University Press (CUP)
Date: 23-11-2023
DOI: 10.1017/S1368980022002464
Abstract: To examine the labelling status of trans -fat of pre-packaged foods sold in Hong Kong. Data from 19 027 items in the 2019 FoodSwitch Hong Kong database were used. Ingredient lists were screened to identify specific (e.g. partially hydrogenated vegetable oil, PHVO) and non-specific trans -fat ingredient indicators (e.g. hydrogenated oil). Trans -fat content was obtained from the on-pack nutrition labels, which was converted into proportion of total fat (% total fat ). Descriptive statistics were calculated for trans -fat content and the number of specific, non-specific and total trans -fat ingredients indicators found on the ingredients lists. Comparisons were made between regions using one-way ANOVA and χ 2 for continuous and categorical variables, respectively. Cross-sectional audit. Not applicable. A total of 729 items (3·8 % of all products) reported to contain industrially produced trans -fat, with a median of 0·4 g/100 g or 100 ml (interquartile range (IQR): 0·1–0·6) and 1·2 % totalfat (IQR: 0·6–2·9). ‘Bread and bakery products’ had the highest proportion of items with industrially produced trans -fat (18·9 %). ‘Non-alcoholic beverages’ had the highest proportion of products of ‘false negatives’ labelling (e.g. labelled as 0 trans -fat but contains PHVO 59·3 %). The majority of products with trans -fat indicator originated from Asia (70 %). According to the labelling ∼4 % of pre-packaged food and beverages sold in Hong Kong in 2019 contained industrially produced trans -fat, and a third of these had trans -fat % total fat . The ambiguous trans -fat labelling in Hong Kong may not effectively assist consumers in identifying products free from industrially produced trans -fat.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1093/CDN/NZZ060
Publisher: Elsevier BV
Date: 10-2021
Publisher: Public Library of Science (PLoS)
Date: 02-11-2020
Publisher: Public Library of Science (PLoS)
Date: 26-10-2021
DOI: 10.1371/JOURNAL.PMED.1003806
Abstract: The Australian Government recently established sodium targets for packaged foods to encourage voluntary reformulation to reduce population sodium consumption and related diseases. We modeled the health impact of Australia’s sodium reformulation targets and additional likely health gains if more ambitious, yet feasible sodium targets had been adopted instead. Using comparative risk assessment models, we estimated the averted deaths, incidence, and disability-adjusted life years (DALYs) from cardiovascular disease (CVD), chronic kidney disease (CKD) and stomach cancer after implementation of (a) Australia’s sodium targets (overall and by in idual companies) (b) United Kingdom’s targets (that covers more product categories) and (c) an optimistic scenario (sales-weighted 25th percentile sodium content for each food category included in the UK program). We used nationally representative data to estimate pre- and post-intervention sodium intake, and other key data sources from the Global Burden of Disease study. Full compliance with the Australian government’s sodium targets could prevent approximately 510 deaths/year (95% UI, 335 to 757), corresponding to about 1% of CVD, CKD, and stomach cancer deaths, and prevent some 1,920 (1,274 to 2,600) new cases and 7,240 (5,138 to 10,008) DALYs/year attributable to these diseases. Over half (59%) of deaths prevented is attributed to reformulation by 5 market-dominant companies. Compliance with the UK and optimistic scenario could avert approximately an additional 660 (207 to 1,227) and 1,070 (511 to 1,856) deaths/year, respectively, compared to Australia’s targets. The main limitation of this study (like other modeling studies) is that it does not prove that sodium reformulation programs will prevent deaths and disease events rather, it provides the best quantitative estimates and the corresponding uncertainty of the potential effect of the different programs to guide the design of policies. There is significant potential to strengthen Australia’s sodium reformulation targets to improve its health impact. Promoting compliance by market-dominant food companies will be critical to achieving the potential health gains.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-03-2012
DOI: 10.1161/CIRCULATIONAHA.111.062653
Abstract: Experimental studies suggest that long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) may reduce the risk of atrial fibrillation (AF). Prior studies evaluating fish or n-3 PUFA consumption from dietary questionnaires and incident AF have been conflicting. Circulating levels of n-3 PUFAs provide an objective measurement of exposure. Among 3326 US men and women ≥65 years of age and free of AF or heart failure at baseline, plasma phospholipid levels of eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid were measured at baseline by use of standardized methods. Incident AF (789 cases) was identified prospectively from hospital discharge records and study visit ECGs during 31 169 person-years of follow-up (1992–2006). In multivariable Cox models adjusted for other risk factors, the relative risk in the top versus lowest quartile of total n-3 PUFAs (eicosapentaenoic acid+docosapentaenoic acid+docosahexaenoic acid) levels was 0.71 (95% confidence interval, 0.57–0.89 P for trend=0.004) and of DHA levels was 0.77 (95% confidence interval, 0.62–0.96 P for trend=0.01). Eicosapentaenoic acid and docosapentaenoic acid levels were not significantly associated with incident AF. Evaluated nonparametrically, both total n-3 PUFAs and docosahexaenoic acid showed graded and linear inverse associations with incidence of AF. Adjustment for intervening events such as heart failure or myocardial infarction during follow-up did not appreciably alter results. In older adults, higher circulating total long-chain n-3 PUFA and docosahexaenoic acid levels were associated with lower risk of incident AF. These results highlight the need to evaluate whether increased dietary intake of these fatty acids could be effective for the primary prevention of AF.
Publisher: Public Library of Science (PLoS)
Date: 12-06-2020
Publisher: Cambridge University Press (CUP)
Date: 06-04-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-07-2015
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 2015
DOI: 10.1194/JLR.M052456
Publisher: MDPI AG
Date: 05-06-2020
DOI: 10.3390/NU12061692
Abstract: Private-label products, products owned by supermarkets, are a growing area of the food supply. The aim of this study was to assess the effect of an intervention that provided an Australian supermarket (‘intervention supermarket’) with comparative nutrition data to improve the healthiness of their private-label range. Between 2015 and 2016, the intervention supermarket received reports that ranked the nutritional quality of their products against competitors. Changes in the nutrient content (sodium, sugar, saturated fat, energy and Health Star Rating) of products from the intervention supermarket between 2015 and 2018 were compared against changes achieved for three comparators (private-label products from two other supermarkets and branded products). The intervention supermarket achieved a significantly greater reduction in the sodium content of their products relative to all three comparators, which ranged between −104 and −52 mg/100 g (all p 0.05). Conversely, the three comparators each achieved a greater relative reduction in the sugar content of their products by between −3.5 and −1.6 g/100 g (all p 0.05). One of the comparators also had a greater relative reduction in the saturated fat and energy content of their products compared to the intervention supermarket (both p .05). There were negligible differences in the Health Star Rating of products between the intervention supermarket and comparators (all p 0.05). Providing comparative nutrition information to a supermarket may be ineffective in improving the healthiness of their private-label products, likely due to competing factors that play a role in the decision-making process behind product reformulation and product discontinuation/innovation.
Publisher: Cambridge University Press (CUP)
Date: 28-12-2021
DOI: 10.1017/S1368980020005273
Abstract: To assess the contribution of different food groups to total salt purchases and to evaluate the estimated reduction in salt purchases if mandatory maximum salt limits in South African legislation were being complied with. This study conducted a cross-sectional analysis of purchasing data from Discovery Vitality members. Data were linked to the South African FoodSwitch database to determine the salt content of each food product purchased. Food category and total annual salt purchases were determined by summing salt content (kg) per each unit purchased across a whole year. Reductions in annual salt purchases were estimated by applying legislated maximum limits to product salt content. South Africa. The study utilised purchasing data from 344 161 households, members of Discovery Vitality, collected for a whole year between January and December 2018. Vitality members purchased R12·8 billion worth of food products in 2018, representing 9562 products from which 264 583 kg of salt was purchased. The main contributors to salt purchases were bread and bakery products (23·3 %) meat and meat products (19 %) dairy (12·2 %) sauces, dressings, spreads and dips (11·8 %) and convenience foods (8·7 %). The projected total quantity of salt that would be purchased after implementation of the salt legislation was 250 346 kg, a reduction of 5·4 % from 2018 levels. A projected reduction in salt purchases of 5·4 % from 2018 levels suggests that meeting the mandatory maximum salt limits in South Africa will make a meaningful contribution to reducing salt purchases.
Publisher: Elsevier BV
Date: 12-2016
Publisher: Elsevier BV
Date: 08-2011
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.DIABRES.2018.03.027
Abstract: Sodium glucose co-transporter 2 (SGLT2) inhibitors appear to protect against increased risks of cardiovascular and kidney disease in patients with type 2 diabetes but also cause some harms. Whether effects are comparable across drug class or specific to in idual compounds is unclear. This meta-analysis assessed the class and in idual compound effects of SGLT2 inhibition versus control on cardiovascular events, death, kidney disease and safety outcomes in patients with type 2 diabetes. MEDLINE, EMBASE, the Cochrane Library and regulatory databases were systematically searched for data from randomized clinical trials that included reporting of cardiovascular events, deaths or safety outcomes. We used fixed effects models and inverse variance weighting to calculate relative risks with the 95% confidence intervals. The analyses included data from 82 trials, four overviews and six regulatory reports and there were 1,968 major cardiovascular events identified for analysis. Patients randomly assigned to SGLT2 had lower risks of major cardiovascular events (RR 0.85, 95%CI 0.77-0.93), heart failure (RR 0.67, 95%CI 0.55-0.80), all-cause death (RR 0.79, 95%CI 0.70-0.88) and serious decline in kidney function (RR 0.59, 0.49-0.71). Significant adverse effects were observed for genital infections (RR 3.06, 95%CI 2.73-4.43), volume depletion events (RR 1.24, 95%CI 1.07-1.43) and utation (RR 1.44 95%CI 1.13-1.83). There was a high likelihood of differences in the associations of the in idual compounds with cardiovascular death, hypoglycaemia and utation (all I There are strong overall associations of SGLT2 inhibition with protection against major cardiovascular events, heart failure, serious decline in kidney function and all-cause death. SGLT2 inhibitors were also associated with infections, volume depletion effects and utation. Some associations appear to differ between compounds.
Publisher: Wiley
Date: 16-03-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-09-2013
Abstract: Long‐chain polyunsaturated omega‐3 fatty acids (n‐3 PUFA ) demonstrated antiarrhythmic potential in experimental studies. In a large multinational randomized trial ( OPERA ), perioperative fish oil supplementation did not reduce the risk of postoperative atrial fibrillation ( PoAF ) in cardiac surgery patients. However, whether presupplementation habitual plasma phospholipid n‐3 PUFA , or achieved or change in n‐3 PUFA level postsupplementation are associated with lower risk of PoAF is unknown. In 564 subjects undergoing cardiac surgery between August 2010 and June 2012 in 28 centers across 3 countries, plasma phospholipid levels of eicosapentaenoic acid ( EPA ), docosapentaenoic acid ( DPA ), and docosahexaenoic acid ( DHA ) were measured at enrollment and again on the morning of cardiac surgery following fish oil or placebo supplementation (10 g over 3 to 5 days, or 8 g over 2 days). The primary endpoint was incident PoAF lasting ≥30 seconds, centrally adjudicated, and confirmed by rhythm strip or ECG . Secondary endpoints included sustained (≥1 hour), symptomatic, or treated PoAF the time to first PoAF and the number of PoAF episodes per patient. PoAF outcomes were assessed until hospital discharge or postoperative day 10, whichever occurred first. Relative to the baseline, fish oil supplementation increased phospholipid concentrations of EPA (+142%), DPA (+13%), and DHA (+22%) ( P .001 each). Substantial interin idual variability was observed for change in total n‐3 PUFA (range=−0.7% to 7.5% after 5 days of supplementation). Neither in idual nor total circulating n‐3 PUFA levels at enrollment, morning of surgery, or change between these time points were associated with risk of PoAF . The multivariable‐adjusted OR (95% CI ) across increasing quartiles of total n‐3 PUFA at enrollment were 1.0, 1.06 (0.60 to 1.90), 1.35 (0.76 to 2.38), and 1.19 (0.64 to 2.20) and for changes in n‐3 PUFA between enrollment and the morning of surgery were 1.0, 0.78 (0.44 to 1.39), 0.89 (0.51 to 1.55), and 1.01 (0.58 to 1.75). In stratified analysis, demographic, medication, and cardiac parameters did not significantly modify these associations. Findings were similar for secondary PoAF endpoints. Among patients undergoing cardiac surgery, neither higher habitual circulating n‐3 PUFA levels, nor achieved levels or changes following short‐term fish oil supplementation are associated with risk of PoAF . URL: Clinicaltrials.gov Unique identifier: NCT00970489
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
Abstract: Animal study results point to oxidative stress as a key mechanism triggering postoperative atrial fibrillation (Po AF ), yet the extent to which specific biomarkers of oxidative stress might relate to Po AF risk in humans remains speculative. We assessed the association of validated, fatty acid–derived oxidative stress biomarkers (F 2 ‐isoprostanes, isofurans, and F 3 ‐isoprostanes) in plasma and urine, with incident Po AF among 551 cardiac surgery patients. Biomarkers were measured at enrollment, the end of surgery, and postoperative day 2. Po AF lasting ≥30 seconds was confirmed with rhythm strip or electrocardiography and centrally adjudicated. Outcomes were assessed until hospital discharge or postoperative day 10, whichever occurred first. Urine level of each oxidative stress biomarker rose at the end of surgery (2‐ to 3‐fold over baseline, P .001) and subsequently declined to concentrations comparable to baseline by postoperative day 2. In contrast, plasma concentrations remained relatively stable throughout the perioperative course. Urine F 2 ‐isoprostanes and isofurans at the end of surgery were 20% and 50% higher in subjects who developed Po AF ( P ≤0.009). While baseline biomarker levels did not associate significantly with Po AF , end of surgery and postoperative day 2 isoprostanes and isofurans demonstrated relatively linear associations with Po AF . For ex le, the end of surgery extreme quartile multivariate adjusted OR (95% CI ) for urine isofurans and F 3 ‐isoprostanes were 1.95 (1.05 to 3.62 P for trend=0.01) and 2.10 (1.04 to 2.25, P for trend=0.04), respectively. The associations of biomarkers with Po AF varied little by demographics, surgery type, and medication use ( P ≥0.29 for each). These novel results add to accumulating evidence supporting the likely key pathogenic role of elevated oxidative stress in Po AF . URL: Clinicaltrials.gov Unique identifier: NCT00970489.
Publisher: Wiley
Date: 16-10-2021
DOI: 10.1111/NBU.12530
Abstract: Due to the coronavirus pandemic, online food purchases have increased. Nutrition labels and ingredients lists are important to assist in iduals in making healthy food choices, but their provision is not mandatory for online stores in Hong Kong. This study aimed to investigate the prevalence of missing nutrition labels and ingredients list information on the e‐shops of major chain supermarkets in Hong Kong. Data from the e‐shops of four major chain supermarkets were collected using a bespoke web scraper program, which extracted the product page link, product name, brand, package size, ingredient list in text and product image links of every edible product available. A total of 22 365 products which were required by law to carry a food label on their packaging were included in the analysis. Prevalence of missing nutrition label or ingredients list on the respective product page was determined. Pearson's χ 2 tests were used to test for differences in the prevalence between retailers. A two‐tailed p 0.05 was considered statistically significant. Two e‐shops provided nutrition labels and ingredients list for none or only a negligible number of products. Overall, the prevalence of missing information was higher for nutrition labels than for ingredients lists (80.5% vs. 70.2% p 0.001). Provision of information varied greatly between stores and food categories. We found a high prevalence of missing nutrition labels and ingredients lists on e‐shops of major supermarkets in Hong Kong. Regulations on nutrition labelling should be extended to cover pre‐packaged food and beverages sold online.
Publisher: MDPI AG
Date: 20-04-2021
DOI: 10.3390/NU13041385
Abstract: Increased consumption of unhealthy processed foods, particularly those high in sodium, is a major risk factor for cardiovascular diseases. Nutrition information on packaged foods can help guide consumers toward products with less sodium, however the availability of nutrition information on foods sold in Kenya is currently unknown. The aims of this study were to estimate the proportion of packaged foods and beverages displaying nutrition information for sodium and determine the amount of sodium in packaged foods available for sale in Kenya. Data was collected in 2019 from five retail supermarkets in Nairobi. The availability of sodium information provided on packaged products and the sodium content were recorded. As secondary analyses, we compared sodium content labelling of products in Kenya by manufacturing location and the sodium content of products available in Kenya and South Africa. A total of 6003 packaged products in 56 food categories were identified. Overall, 39% of products displayed sodium content, though the availability of labelling varied widely between food categories, with coverage in main categories ranging from 0% (yoghurts and yoghurt drinks) to 86% (breakfast cereals). Food categories with the highest median sodium content were herbs and spices (9120 mg/100 g), sauces (1200 mg/100 g) and meat alternatives (766 mg/100 g) although wide variabilities were often observed within categories. Imported products were more likely to provide information on sodium than locally produced products (81% compared to 26%) and reported higher median sodium levels (172 mg/100 g compared to 96 mg/100 g). Kenyan products reported a higher median sodium content than South African products in six categories while South African products had higher median sodium in 20 categories, with considerable variation in median sodium content between countries in some categories. These findings highlight considerable potential to improve the availability of sodium information on packaged products in Kenya and to introduce reformulation policies to reduce the amount of sodium in the Kenyan food supply.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.APPET.2017.06.005
Abstract: In June 2014, the Australian government agreed to the voluntary implementation of an interpretive 'Health Star Rating' (HSR) front-of-pack labelling system for packaged foods. The aim of the system is to make it easier for consumers to compare the healthiness of products based on number of stars. With many Australians consuming fast food there is a strong rationale for extending the HSR system to include fast food items. To examine the performance of the HSR system when applied to fast foods. Nutrient content data for fast food menu items were collected from the websites of 13 large Australian fast-food chains. The HSR was calculated for each menu item. Statistics describing HSR values for fast foods were calculated and compared to results for comparable packaged foods. Data for 1529 fast food products were compared to data for 3810 packaged food products across 16 of 17 fast food product categories. The mean HSR for the fast foods was 2.5 and ranged from 0.5 to 5.0 and corresponding values for the comparator packaged foods were 2.6 and 0.5 to 5.0. Visual inspection of the data showed broadly comparable distributions of HSR values across the fast food and the packaged food categories, although statistically significant differences were apparent for seven categories (all p < 0.04). In some cases these differences reflected the large s le size and the power to detect small variations across fast foods and packaged food, and in others it appeared to reflect primarily differences in the mix of product types within a category. These data support the idea that the HSR system could be extended to Australian fast foods. There are likely to be significant benefits to the community from the use of a single standardised signposting system for healthiness across all fresh, packaged and restaurant foods.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-03-2018
Publisher: Elsevier BV
Date: 12-2012
Publisher: Elsevier BV
Date: 05-2020
Publisher: Cambridge University Press (CUP)
Date: 17-05-2012
DOI: 10.1017/S0007114512001602
Abstract: The relationship between omega-3 polyunsaturated fatty acids ( n -3 PUFA) from seafood sources (eicosapentaenoic acid, EPA docosahexaenoic acid, DHA) or plant sources (alpha-linolenic acid, ALA) and risk of type 2 diabetes mellitus (DM) remains unclear. We systematically searched multiple literature databases through June 2011 to identify prospective studies examining relations of dietary n -3 PUFA, dietary fish and/or seafood, and circulating n -3 PUFA biomarkers with incidence of DM. Data were independently extracted in duplicate by 2 investigators, including multivariate-adjusted relative risk (RR) estimates and corresponding 95 % CI. Generalized least-squares trend estimation was used to assess dose–response relationships, with pooled summary estimates calculated by both fixed-effect and random-effect models. From 288 identified abstracts, 16 studies met inclusion criteria, including 18 separate cohorts comprising 540 184 in iduals and 25 670 cases of incident DM. Consumption of fish and/or seafood was not significantly associated with DM ( n = 13 studies RR per 100 g/d = 1·12, 95 % CI = 0·94, 1·34) nor were consumption of EPA+DHA ( n = 16 cohorts RR per 250 mg/d = 1·04, 95 % CI = 0·97, 1·10) nor circulating levels of EPA+DHA biomarkers ( n = 5 cohorts RR per 3 % of total fatty acids = 0·94, 95 % CI = 0·75, 1·17). Both dietary ALA ( n = 7 studies RR per 0·5 g/d = 0·93, 95 % CI = 0·83, 1·04) and circulating ALA biomarker levels ( n = 6 studies RR per 0·1 % of total fatty acid = 0·90, 95 % CI = 0·80, 1·00, P = 0·06) were associated with non-significant trend towards lower risk of DM. Substantial heterogeneity ( I 2 ~80 %) was observed among studies of fish/seafood or EPA+DHA and DM moderate heterogeneity ( 55 %) was seen for dietary and biomarker ALA and DM. In unadjusted meta-regressions, study location (Asia vs. North America/Europe), mean BMI, and duration of follow-up each modified the association between fish/seafood and EPA+DHA consumption and DM risk ( P -interaction ≤ 0·02 each). We had limited statistical power to determine the independent effect of these sources of heterogeneity due to their high collinearity. The overall pooled findings do not support either major harms or benefits of fish/seafood or EPA+DHA on development of DM, and suggest that ALA may be associated with modestly lower risk. Reasons for potential heterogeneity of effects, which could include true biologic heterogeneity, publication bias, or chance, deserve further investigation.
Publisher: Springer Science and Business Media LLC
Date: 28-10-2021
DOI: 10.1186/S12966-021-01208-6
Abstract: Countries around the world are putting in place sugar reformulation targets for packaged foods to reduce excess sugar consumption. The Australian government released its voluntary sugar reformulation targets for nine food categories in 2020. We estimated the potential impact of these targets on household sugar purchases and examined differences by income. For comparison, we also modelled the potential impact of the UK sugar reduction targets on per capita sugar purchases as the UK has one of the most comprehensive sugar reduction strategies in the world. Grocery purchase data from a nationally representative consumer panel ( n =7,188) in Australia was linked with a large database (FoodSwitch) with product-specific sugar content information for packaged foods ( n =25,261) both datasets were collected in 2018. Potential reductions in per capita sugar purchases were calculated overall and by food category. Differences in sugar reduction across income level were assessed by analysis of variance. In 2018, the total sugar acquired from packaged food and beverage purchases consumed at-home was 56.1 g/day per capita. Australia’s voluntary reformulation targets for sugar covered 2,471/25,261 (9.8%) unique products in the FoodSwitch dataset. Under the scenario that all food companies adhered to the voluntary targets, sugar purchases were estimated to be reduced by 0.9 g/day per capita, which represents a 1.5% reduction in sugar purchased from packaged foods. However, if Australia adopted the UK targets, over twice as many products would be covered ( n =4,667), and this would result in a more than four times greater reduction in sugar purchases (4.1 g/day per capita). It was also estimated that if all food companies complied with Australia’s voluntary sugar targets, reductions to sugar would be slightly greater in low-income households compared with high-income households by 0.3 g/day (95%CI 0.2 - 0.4 g/day, p .001). Sugar-reduction policies have the potential to substantially reduce population sugar consumption and may help to reduce health inequalities related to excess sugar consumption. However, the current reformulation targets in Australia are estimated to achieve only a small reduction to sugar intakes, particularly in comparison to the UK’s sugar reduction program.
Publisher: JMIR Publications Inc.
Date: 14-07-2021
DOI: 10.2196/27423
Abstract: Regular salt is about 100% sodium chloride. Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride. Low-sodium salts have a potential role in reducing the population's sodium intake levels and blood pressure, but their availability in the global market is unknown. The aim of this study is to assess the availability, formulation, labeling, and price of low-sodium salts currently available to consumers worldwide. Low-sodium salts were identified through a systematic literature review, Google search, online shopping site searches, and inquiry of key informants. The keywords “salt substitute,” “low-sodium salt,” “potassium salt,” “mineral salt,” and “sodium reduced salt” in six official languages of the United Nations were used for the search. Information about the brand, formula, labeling, and price was extracted and analyzed. A total of 87 low-sodium salts were available in 47 out of 195 (24%) countries worldwide, including 28 high-income countries, 13 upper-middle-income countries, and 6 lower-middle-income countries. The proportion of sodium chloride varied from 0% (sodium-free) to 88% (as percent of weight regular salt is 100% sodium chloride). Potassium chloride was the most frequent component with levels ranging from 0% to 100% (potassium chloride salt). A total of 43 (49%) low-sodium salts had labels with the potential health risks, and 33 (38%) had labels with the potential health benefits. The median price of low-sodium salts in high-income, upper-middle-income, and lower-middle-income countries was US $15.00/kg (IQR 6.4-22.5), US $2.70/kg (IQR 1.7-5.5), and US $2.90/kg (IQR 0.50-22.2), respectively. The price of low-sodium salts was between 1.1 and 14.6 times that of regular salts. Low-sodium salts are not widely available and are commonly more expensive than regular salts. Policies that promote the availability, affordability, and labeling of low-sodium salts should increase uptake, helping populations reduce blood pressure and prevent cardiovascular diseases. RR2-10.1111/jch.14054
Publisher: Oxford University Press (OUP)
Date: 21-01-2016
DOI: 10.1093/IJE/DYV313
Abstract: Estimating equations based on spot urine s les have been identified as a possible alternative approach to 24-h urine collections for determining mean population salt intake. This review compares estimates of mean population salt intake based upon spot and 24-h urine s les. We systematically searched for all studies that reported estimates of daily salt intake based upon both spot and 24-h urine s les for the same population. The associations between the two were quantified and compared overall and in subsets of studies. A total of 538 records were identified, 108 were assessed as full text and 29 were included. The included studies involved 10,414 participants from 34 countries and made 71 comparisons available for the primary analysis. Overall average population salt intake estimated from 24-h urine s les was 9.3 g/day compared with 9.0 g/day estimated from the spot urine s les. Estimates based upon spot urine s les had excellent sensitivity (97%) and specificity (100%) at classifying mean population salt intake as above or below the World Health Organization maximum target of 5 g/day. Compared with the 24-h s les, estimates based upon spot urine overestimated intake at lower levels of consumption and underestimated intake at higher levels of consumption. Estimates of mean population salt intake based upon spot urine s les can provide countries with a good indication of mean population salt intake and whether action on salt consumption is required.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Wiley
Date: 28-12-2020
DOI: 10.1111/IJPO.12766
Abstract: The respective contribution of total, daytime and nighttime sleep duration in childhood obesity remains unclear. To assess the longitudinal association between developmental trajectories of sleep duration and BMI z‐score in early childhood. Data were from the Melbourne INFANT program, a prospective cohort with 4‐month‐old infants being followed‐up until age 60 months (n = 528). Sleep duration (total, daytime, nighttime) and BMI z‐score were measured using questionnaire at ages 4, 9, 18, 43 and 60 months. Group‐based trajectory modelling was used to describe longitudinal trajectories from ages 4 to 60 months. Multivariable logistic regression was conducted to assess the association between sleep duration and BMI z‐score trajectories. Three nighttime sleep duration trajectory groups were identified: “Long stable” (10.5 to 11.0 hours, 61%), “catchup long” (8.0 to 11.5 hours, 23%) and “short stable” (8.7 to 9.8 hours, 16%) nighttime sleepers. BMI z‐score trajectory groups were classified as “low‐BMIz” (−1.5 to −0.5 unit, 21%), “mid‐BMIz” (−0.5 to 0.5 unit, 58%) and “high‐BMIz” (0.8 to 1.4 unit, 21%). With adjustment for child and maternal covariates, both “catchup long” (OR 3.69 95%CI 1.74, 7.92) and “long stable” nighttime sleepers (OR 4.27 95%CI 2.21, 8.25) revealed higher odds of being in the “mid‐BMIz” than the “high‐BMIz” group. By contrast, total or daytime sleep duration trajectories were not associated with BMI z‐score trajectories. Longer nighttime, but not total or daytime, sleep duration was associated with lower BMI z‐score trajectories in early childhood. Our findings reinforce the importance of nighttime sleep for healthy body‐weight development in early childhood.
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.MAM.2006.12.007
Abstract: The aim of this paper is to provide an overview of vitamin E metabolism. The topics covered include: major classes of vitamin E metabolites their production pathways and route of excretion possible biological activities of vitamin E metabolites and use of vitamin E metabolites as markers of oxidant generation. Recent investigations into vitamin E metabolism have also highlighted important new areas of research, such as the potential for high dose vitamin E supplementation to interfere with drug metabolism, as well as alternative methods to alter vitamin E bioavailability in vivo. These issues will also be discussed in the review.
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.AHJ.2022.06.007
Abstract: High dietary sodium intake is a leading cause of hypertension. A major source of dietary sodium is salt added to processed food products available in retail food environments. The fast-growing online grocery shopping setting provides new opportunities for salt reduction interventions that support consumers in choosing healthier options. The SaltSwitch Online Grocery Shopping randomized controlled trial is investigating the feasibility, acceptability, and effectiveness of a novel intervention for lowering salt consumption and blood pressure amongst people with hypertension who shop for groceries online. The intervention is based on a bespoke web browser extension that interfaces with a major retailer's online store to highlight and interpret product sodium content and suggest similar but lower-sodium alternatives. The primary outcome of interest is change in mean systolic blood pressure between in iduals randomized (1:1) to the intervention and control (usual online shopping) arms at 12 weeks. Secondary outcomes are diastolic blood pressure, spot urinary sodium and sodium:potassium ratio, sodium purchases, and dietary intake. Intervention implementation and lessons for future uptake will be assessed using a mixed methods process evaluation. Participants with hypertension who shop online for groceries and exhibit high sodium purchasing behavior are being recruited across Australia. A target s le size of 1,966 provides 80% power (2-sided alpha = 0.05) to detect a 2 mm Hg difference in systolic blood pressure between groups, assuming a 15 mm Hg standard deviation, after allowing for a 10% dropout rate. This trial will provide evidence on an innovative intervention to potentially reduce salt intake and blood pressure in people with hypertension. The intervention caters to in idual preferences by encouraging sustainable switches to similar but lower-salt products. If effective, the intervention will be readily scalable at low cost by interfacing with existing online retail environments.
Publisher: Springer Science and Business Media LLC
Date: 22-07-2017
Publisher: Elsevier BV
Date: 02-2015
Publisher: Springer Science and Business Media LLC
Date: 23-06-2020
DOI: 10.1186/S12966-020-00982-Z
Abstract: The Australian federal government will soon release voluntary sodium reduction targets for 30 packaged food categories through the Healthy Food Partnership. Previous assessments of voluntary targets show variable industry engagement, and little is known about the extent that major food companies and their products contribute to dietary sodium purchases among Australian households. The aim of this cross-sectional study was to identify the relative contribution that food companies and their products made to Australian household sodium purchases in 2018, and to examine differences in sodium purchases by household income level. We used 1 year of grocery purchase data from a nationally representative consumer panel of Australian households who reported their grocery purchases (the Nielsen Homescan panel), combined with database that contains product-specific sodium content for packaged foods and beverages (FoodSwitch). The top food companies and food categories were ranked according to their contribution to household sodium purchases. Differences in per capita sodium purchases by income levels were assessed by 1-factor ANOVA. All analyses were modelled to the Australian population in 2018 using s le weights. Sodium data were available from 7188 households who purchased 26,728 unique products and purchased just under 7.5 million food product units. Out of 1329 food companies, the top 10 accounted for 35% of unique products and contributed to 58% of all sodium purchased from packaged foods and beverages. The top three companies were grocery food retailers each contributing 12–15% of sodium purchases from sales of their private label products, particularly processed meat, cheese and bread. Out of the 67 food categories, the top 10 accounted for 73% of sodium purchased, particularly driven by purchases of processed meat (14%), bread (12%) and sauces (11%). Low-income Australian households purchased significantly more sodium from packaged products than high-income households per capita (452 mg/d, 95%CI: 363-540 mg/d, P 0.001). A small number of food companies and food categories account for most of the dietary sodium purchased by Australian households. Prioritizing government engagement with these groups could deliver a large reduction in population sodium intake.
Publisher: MDPI AG
Date: 24-11-2017
DOI: 10.3390/NU9121284
Publisher: Oxford University Press (OUP)
Date: 07-2021
DOI: 10.1530/EJE-21-0118
Abstract: We aimed to examine prospective associations between circulating fatty acids in early pregnancy and incident gestational diabetes mellitus (GDM) among Chinese pregnant women. Analyses were based on two prospective nested case-control studies conducted in western China (336 GDM cases and 672 matched controls) and central China (305 cases and 305 matched controls). Fasting plasma fatty acids in early pregnancy (gestational age at enrollment: 10.4 weeks( s.d. , 2.0)) and 13.2 weeks (1.0), respectively) were determined by gas chromatography-mass spectrometry, and GDM was diagnosed based on the International Association of Diabetes in Pregnancy Study Groups criteria during 24–28 weeks of gestation. Multiple metabolic biomarkers (HOMA-IR (homeostatic model assessment for insulin resistance), HbA1c, c-peptide, high-sensitivity C-reactive protein, adiponectin, leptin, and blood lipids) were additionally measured among 672 non-GDM controls at enrollment. Higher levels of saturated fatty acids (SFAs) 14:0 (pooled odds ratio, 1.41 for each 1- s.d. increase 95% CI: 1.25, 1.59) and 16:0 (1.19 1.05, 1.35) were associated with higher odds of GDM. Higher levels of n-6 polyunsaturated fatty acid (PUFA) 18:2n-6 were strongly associated with lower odds of GDM (0.69 0.60, 0.80). In non-GDM pregnant women, higher SFAs 14:0 and 16:0 but lower n-6 PUFA 18:2n-6 were generally correlated with unfavorable metabolic profiles. We documented adverse associations of 14:0 and 16:0 but a protective association of 18:2n-6 with GDM among Chinese pregnant women. Our findings highlight the distinct roles of specific fatty acids in the onset of GDM.
Publisher: MDPI AG
Date: 06-09-2017
DOI: 10.3390/NU9090983
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.JAND.2021.06.013
Abstract: The Australian Government will soon be releasing a series of sugar reformulation targets for packaged foods. To estimate the amount of added sugar purchased from packaged food and beverages and the relative contribution that food categories and food companies made to these purchases in 2018. The secondary objective was to examine differences in purchases of added sugar across income levels. Cross-sectional study. We used 1 year of grocery purchase data from a nationally representative panel of Australian households (the NielsenIQ Homescan panel), combined with a packaged food and beverage database (FoodSwitch). Added sugar purchases (grams per day per capita), purchase-weighted added sugar content (grams per 100 g) and total weight of products (with added sugar) purchased (grams per day per capita). Food categories and food companies were ranked according to their contribution to added sugar purchases. Differences in added sugar purchases by income levels were assessed by 1-factor analysis of variance. Added sugar information was available from 7188 households and across 26,291 unique foods and beverages. On average, the amount of added sugar acquired from packaged foods and beverages was (mean ± SE) 35.9 ± 0.01 g/d per capita. Low-income households purchased 11.0 g/d (95% CI: 10.9-11.0 g/d, P < .001) more added sugar from packaged products than high-income households per capita. The top 10 food categories accounted for 82.2% of added sugar purchased, largely due to purchases of chocolate and sweets, soft drinks, and ice cream and edible ices. Out of 994 food companies, the top 10 companies contributed to 62.1% of added sugar purchases. The Australian Government can strengthen their proposed sugar reduction program by adding further category-specific targets, prioritizing engagement with key food companies and considering a broader range of policies to reduce added sugar intakes across the Australian population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-01-2018
DOI: 10.1161/CIRCRESAHA.117.309008
Abstract: A growing body of nutritional science highlights the complex mechanisms and pleiotropic pathways of cardiometabolic effects of different foods. Among these, some of the most exciting advances are occurring in the area of flavonoids, bioactive phytochemicals found in plant foods and in the area of dairy, including milk, yogurt, and cheese. Many of the relevant ingredients and mechanistic pathways are now being clarified, shedding new light on both the ingredients and the pathways for how diet influences health and well-being. Flavonoids, for ex le, have effects on skeletal muscle, adipocytes, liver, and pancreas, and myocardial, renal, and immune cells, for instance, related to 5′-monophosphate-activated protein kinase phosphorylation, endothelial NO synthase activation, and suppression of NF-κB (nuclear factor-κB) and TLR4 (toll-like receptor 4). Effects of dairy are similarly complex and may be mediated by specific amino acids, medium-chain and odd-chain saturated fats, unsaturated fats, branched-chain fats, natural trans fats, probiotics, vitamin K1/K2, and calcium, as well as by processing such as fermentation and homogenization. These characteristics of dairy foods influence erse pathways including related to mammalian target of rapamycin, silent information regulator transcript-1, angiotensin-converting enzyme, peroxisome proliferator–activated receptors, osteocalcin, matrix glutamate protein, hepatic de novo lipogenesis, hepatic and adipose fatty acid oxidation and inflammation, and gut microbiome interactions such as intestinal integrity and endotoxemia. The complexity of these emerging pathways and corresponding biological responses highlights the rapid advances in nutritional science and the continued need to generate robust empirical evidence on the mechanistic and clinical effects of specific foods.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2021
DOI: 10.1186/S12937-020-00660-7
Abstract: Consumption of nuts improves cardio-metabolic risk factors in clinical trials and relates to lower risk of cardiovascular disease (CVD) in prospective observational studies. However, there has not been an adequately powered randomized controlled trial to test if nuts supplementation actually reduces incident CVD. In order to establish the feasibility of such a trial, the current study aimed to assess the acceptability and adherence to long-term nut supplementation amongst in iduals at high CVD risk in China. This protocol described a 6-month trial performed in Ningxia Province in China among participants with a history of CVD or older age (female ≥65 years, male ≥60 years) with multiple CVD risk factors. Participants were randomized to control (received non-edible gift), low dose walnut (30 g/d), or high dose walnut (60 g/d) groups in a 1:1:1 ratio. Walnuts were provided at no cost to participants and could be consumed according to personal preferences. Follow-up visits were scheduled at 2 weeks, 3 months and 6 months. The primary outcome was fasting plasma alpha linolenic acid (ALA) levels used as an indicator of walnut consumption. Secondary outcomes included self-reported walnut intake from the 24 h dietary recalls. The target s le size of 210 provided 90% statistical power with two-sided alpha of 0.05 to detect a mean difference of 0.12% (as percent of total fatty acid) in plasma ALA between randomized groups. Two hundred and ten participants were recruited and randomized during October 2019. Mean age of participants was 65 years (SD = 7.3), 47% were females, and 94% had a history of CVD at baseline. Across the three study groups, participants had similar baseline demographic and clinical characteristics. This trial will quantify acceptability and adherence to long-term walnut supplementation in a Chinese population at high risk of CVD. The findings will support the design of a future large trial to test the effect of walnut supplementation for CVD prevention. NCT04037943 Protocol version: v3.0 August 14 2019
Publisher: Public Library of Science (PLoS)
Date: 28-07-2011
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.JACC.2011.06.063
Abstract: We reviewed available evidence for cardiovascular effects of n-3 polyunsaturated fatty acid (PUFA) consumption, focusing on long chain (seafood) n-3 PUFA, including their principal dietary sources, effects on physiological risk factors, potential molecular pathways and bioactive metabolites, effects on specific clinical endpoints, and existing dietary guidelines. Major dietary sources include fatty fish and other seafood. n-3 PUFA consumption lowers plasma triglycerides, resting heart rate, and blood pressure and might also improve myocardial filling and efficiency, lower inflammation, and improve vascular function. Experimental studies demonstrate direct anti-arrhythmic effects, which have been challenging to document in humans. n-3 PUFA affect a myriad of molecular pathways, including alteration of physical and chemical properties of cellular membranes, direct interaction with and modulation of membrane channels and proteins, regulation of gene expression via nuclear receptors and transcription factors, changes in eicosanoid profiles, and conversion of n-3 PUFA to bioactive metabolites. In prospective observational studies and adequately powered randomized clinical trials, benefits of n-3 PUFA seem most consistent for coronary heart disease mortality and sudden cardiac death. Potential effects on other cardiovascular outcomes are less-well-established, including conflicting evidence from observational studies and/or randomized trials for effects on nonfatal myocardial infarction, ischemic stroke, atrial fibrillation, recurrent ventricular arrhythmias, and heart failure. Research gaps include the relative importance of different physiological and molecular mechanisms, precise dose-responses of physiological and clinical effects, whether fish oil provides all the benefits of fish consumption, and clinical effects of plant-derived n-3 PUFA. Overall, current data provide strong concordant evidence that n-3 PUFA are bioactive compounds that reduce risk of cardiac death. National and international guidelines have converged on consistent recommendations for the general population to consume at least 250 mg/day of long-chain n-3 PUFA or at least 2 servings/week of oily fish.
Publisher: American Diabetes Association
Date: 10-02-2022
DOI: 10.2337/DC21-1756
Abstract: Trans fatty acids (TFAs) have harmful biologic effects that could increase the risk of type 2 diabetes (T2D), but evidence remains uncertain. We aimed to investigate the prospective associations of TFA biomarkers and T2D by conducting an in idual participant-level pooled analysis. We included data from an international consortium of 12 prospective cohorts and nested case-control studies from six nations. TFA biomarkers were measured in blood collected between 1990 and 2008 from 25,126 participants aged ≥18 years without prevalent diabetes. Each cohort conducted de novo harmonized analyses using a prespecified protocol, and findings were pooled using inverse-variance weighted meta-analysis. Heterogeneity was explored by prespecified between-study and within-study characteristics. During a mean follow-up of 13.5 years, 2,843 cases of incident T2D were identified. In multivariable-adjusted pooled analyses, no significant associations with T2D were identified for trans/trans-18:2, relative risk (RR) 1.09 (95% CI 0.94–1.25) cis/trans-18:2, 0.89 (0.73–1.07) and trans/cis-18:2, 0.87 (0.73–1.03). Trans-16:1n-9, total trans-18:1, and total trans-18:2 were inversely associated with T2D (RR 0.81 [95% CI 0.67–0.99], 0.86 [0.75–0.99], and 0.84 [0.74–0.96], respectively). Findings were not significantly different according to prespecified sources of potential heterogeneity (each P ≥ 0.1). Circulating in idual trans-18:2 TFA biomarkers were not associated with risk of T2D, while trans-16:1n-9, total trans-18:1, and total trans-18:2 were inversely associated. Findings may reflect the influence of mixed TFA sources (industrial vs. natural ruminant), a general decline in TFA exposure due to policy changes during this period, or the relatively limited range of TFA levels.
Publisher: Elsevier BV
Date: 11-2023
Publisher: BMJ
Date: 18-01-2023
Abstract: To assess the prospective associations of circulating levels of omega 3 polyunsaturated fatty acid (n-3 PUFA) biomarkers (including plant derived α linolenic acid and seafood derived eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid) with incident chronic kidney disease (CKD). Pooled analysis. A consortium of 19 studies from 12 countries identified up to May 2020. Prospective studies with measured n-3 PUFA biomarker data and incident CKD based on estimated glomerular filtration rate. Each participating cohort conducted de novo analysis with prespecified and consistent exposures, outcomes, covariates, and models. The results were pooled across cohorts using inverse variance weighted meta-analysis. Primary outcome of incident CKD was defined as new onset estimated glomerular filtration rate mL/min/1.73 m 2 . In a sensitivity analysis, incident CKD was defined as new onset estimated glomerular filtration rate mL/min/1.73 m 2 and % of baseline rate. 25 570 participants were included in the primary outcome analysis and 4944 (19.3%) developed incident CKD during follow-up (weighted median 11.3 years). In multivariable adjusted models, higher levels of total seafood n-3 PUFAs were associated with a lower incident CKD risk (relative risk per interquintile range 0.92, 95% confidence interval 0.86 to 0.98 P=0.009, I 2 =9.9%). In categorical analyses, participants with total seafood n-3 PUFA level in the highest fifth had 13% lower risk of incident CKD compared with those in the lowest fifth (0.87, 0.80 to 0.96 P=0.005, I 2 =0.0%). Plant derived α linolenic acid levels were not associated with incident CKD (1.00, 0.94 to 1.06 P=0.94, I 2 =5.8%). Similar results were obtained in the sensitivity analysis. The association appeared consistent across subgroups by age (≥60 v years), estimated glomerular filtration rate (60-89 v ≥90 mL/min/1.73 m 2 ), hypertension, diabetes, and coronary heart disease at baseline. Higher seafood derived n-3 PUFA levels were associated with lower risk of incident CKD, although this association was not found for plant derived n-3 PUFAs. These results support a favourable role for seafood derived n-3 PUFAs in preventing CKD.
Publisher: BMJ
Date: 08-07-2019
Publisher: MDPI AG
Date: 06-06-2017
DOI: 10.3390/NU9060577
Publisher: Cambridge University Press (CUP)
Date: 19-09-2014
DOI: 10.1017/S0007114514002542
Abstract: High blood pressure (BP) variability, which may be an important determinant of hypertensive end-organ damage, is emerging as an important predictor of cardiovascular health. Dietary antioxidants can influence BP, but their effects on variability are yet to be investigated. The aim of the present study was to assess the effects of vitamin E, vitamin C and polyphenols on the rate of daytime and night-time ambulatory BP variation. To assess these effects, two randomised, double-blind, placebo-controlled trials were performed. In the first trial (vitamin E), fifty-eight in iduals with type 2 diabetes were given 500 mg/d of RRR -α-tocopherol, 500 mg/d of mixed tocopherols or placebo for 6 weeks. In the second trial (vitamin C–polyphenols), sixty-nine treated hypertensive in iduals were given 500 mg/d of vitamin C, 1000 mg/d of grape-seed polyphenols, both vitamin C and polyphenols, or neither (placebo) for 6 weeks. At baseline and at the end of the 6-week intervention, 24 h ambulatory BP and rate of measurement-to-measurement BP variation were assessed. Compared with placebo, treatment with α-tocopherol, mixed tocopherols, vitamin C and polyphenols did not significantly alter the rate of daytime or night-time systolic BP, diastolic BP or pulse pressure variation ( P ·05). Treatment with the vitamin C and polyphenol combination resulted in higher BP variation: the rate of night-time systolic BP variation ( P = 0·022) and pulse pressure variation ( P = 0·0036) were higher and the rate of daytime systolic BP variation was higher ( P = 0·056). Vitamin E, vitamin C or grape-seed polyphenols did not significantly alter the rate of BP variation. However, the increase in the rate of BP variation suggests that the combination of high doses of vitamin C and polyphenols could be detrimental to treated hypertensive in iduals.
Publisher: BMJ
Date: 23-01-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
DOI: 10.1161/HYPERTENSIONAHA.109.139352
Abstract: Sesamin, the major lignan found in sesame, has been shown to increase vitamin E levels by inhibiting its metabolism via the cytochrome P 450 isozyme CYP4F2. CYP4F2 and CYP4A11 are the predominant human isoforms that synthesize 20-hydroxyeicosatetraenoic acid (20-HETE) from arachidonic acid. Considerable evidence suggests that 20-HETE may play a role in the pathogenesis of hypertension. We hypothesized that sesamin could be an inhibitor of 20-HETE synthesis. This study investigated the effects of sesamin on 20-HETE synthesis in vitro and the effect of sesame supplementation on plasma and urinary 20-HETE concentrations in humans. Human microsomes were used to investigate the potency and selectivity of sesamin inhibition of 20-HETE synthesis. Sesamin inhibited human renal and liver microsome 20-HETE synthesis with IC 50 μmol/L. It was selective toward CYP4F2 (IC 50 : 1.9 μmol/L) and had reduced activity toward CYP4A11 (IC 50 : μmol/L), as well as cytochrome P epoxygenation of arachidonic acid (IC 50 : μmol/L). In a randomized, controlled crossover trial, overweight men and women (n=33) consumed 25 g/d of sesame (≈50 mg/d of sesame lignan) or an isocaloric matched control for 5 weeks each. Relative to control, sesame supplementation resulted in a 28% decrease in plasma and a 32% decrease in urinary 20-HETE ( P .001). Urinary sodium, potassium, and blood pressure were not affected. This study demonstrates for the first time that sesame supplementation in humans reduces the plasma and urinary levels of 20-HETE, likely via inhibition of CYP4F2 by sesame lignans. These results suggest that sesame lignans could be used for the investigation of potential roles of 20-HETE in humans.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1194/JLR.P062398
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 09-2021
Publisher: Oxford University Press (OUP)
Date: 18-10-2017
DOI: 10.1093/IJE/DYW239
Abstract: Spot urine s les are easier to collect than 24-h urine s les and have been used with estimating equations to derive the mean daily salt intake of a population. Whether equations using data from spot urine s les can also be used to estimate change in mean daily population salt intake over time is unknown. We compared estimates of change in mean daily population salt intake based upon 24-h urine collections with estimates derived using equations based on spot urine s les. Paired and unpaired 24-h urine s les and spot urine s les were collected from in iduals in two Australian populations, in 2011 and 2014. Estimates of change in daily mean population salt intake between 2011 and 2014 were obtained directly from the 24-h urine s les and by applying established estimating equations (Kawasaki, Tanaka, Mage, Toft, INTERSALT) to the data from spot urine s les. Differences between 2011 and 2014 were calculated using mixed models. A total of 1000 participants provided a 24-h urine s le and a spot urine s le in 2011, and 1012 did so in 2014 (paired s les n = 870 unpaired s les n = 1142). The participants were community-dwelling in iduals living in the State of Victoria or the town of Lithgow in the State of New South Wales, Australia, with a mean age of 55 years in 2011. The mean (95% confidence interval) difference in population salt intake between 2011 and 2014 determined from the 24-h urine s les was -0.48g/day (-0.74 to -0.21 P < 0.001). The corresponding result estimated from the spot urine s les was -0.24 g/day (-0.42 to -0.06 P = 0.01) using the Tanaka equation, -0.42 g/day (-0.70 to -0.13 p = 0.004) using the Kawasaki equation, -0.51 g/day (-1.00 to -0.01 P = 0.046) using the Mage equation, -0.26 g/day (-0.42 to -0.10 P = 0.001) using the Toft equation, -0.20 g/day (-0.32 to -0.09 P = 0.001) using the INTERSALT equation and -0.27 g/day (-0.39 to -0.15 P 0.058). Separate analysis of the unpaired and paired data showed that detection of change by the estimating equations was observed only in the paired data. All the estimating equations based upon spot urine s les identified a similar change in daily salt intake to that detected by the 24-h urine s les. Methods based upon spot urine s les may provide an approach to measuring change in mean population salt intake, although further investigation in larger and more erse population groups is required.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-04-2021
Publisher: Wiley
Date: 18-01-2023
Abstract: To assess the nutritional quality of plant‐based meat analogues in Australia, compared to equivalent meat products, and to assess levels of micronutrient fortification in meat analogues. This cross‐sectional study used nutrition composition data for products collected in 2021 from major supermarkets in Australia. Nutritional quality was assessed using the Health Star Rating, energy (kJ), protein (g), saturated fat (g), sodium (mg), total sugars (g), and fibre content (g) per 100 g, and level of food processing using the NOVA classification. Proportion of products fortified with iron, vitamin B 12 and zinc were reported. Differences in health star rating and nutrients between food categories were assessed using independent t ‐tests. Seven hundred ninety products ( n = 132 plant‐based and n = 658 meat) across eight food categories were analysed. Meat analogues had a higher health star rating (mean 1.2 stars, [95% CI: 1.0–1.4 stars], p 0.001), lower mean saturated fat (−2.4 g/100 g, [−2.9 to −1.8 g/100 g], p 0.001) and sodium content (−132 mg/100 g, [−186 to −79 mg/100 g], p 0.001), but higher total sugar content (0.7 g/100 g, [0.4–1.1 g/100 g], p 0.001). Meat analogues and meat products had a similar proportion of ultra‐processed products (84% and 89%, respectively). 12.1% of meat analogues were fortified with iron, vitamin B 12 and zinc. Meat analogues generally had a higher health star rating compared with meat equivalents, however, the nutrient content varied. Most meat analogues were also ultra‐processed and few are fortified with key micronutrients found in meat. More research is needed to understand the health impact of these foods.
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1093/JN/NXAC152
Publisher: Elsevier BV
Date: 12-2018
Publisher: Cold Spring Harbor Laboratory
Date: 08-02-2022
DOI: 10.1101/2022.02.06.22270563
Abstract: Recent evidence indicates that high numbers of cardiovascular (CV) researchers have considered leaving the research and academic sector due to lack of job security and low funding success. Thus, there is an urgent need to develop solutions to support the retention of early- and mid-career researchers (EMCRs). Here, we aimed to explore the current challenges faced by CV EMCRs, identify solutions to support their career progression and retention, and define a pathway forward to provide a thriving CV EMCR culture in Australia. Australian CV EMCRs ( years post-PhD n=34) participated in 90-minute online focus groups (n=7) to examine current CV research culture, equity in career progression and solutions (including a timeframe and level of priority) to overcome challenges to career success. Participants were purposefully grouped based on socio-demographic information, including years post-PhD, gender, ethnicity, sexual orientation and caring responsibilities. Participants identified that current metrics only rewarded a narrow set of successes and did not support a collaborative culture. The current appraisal of career disruption in grant applications was identified as inadequate to address underrepresented researchers, such as women and those from culturally- erse backgrounds. EMCRs proposed 92 solutions aimed at interpersonal, organisational or external levels, with capacity building and equitable opportunities as key focus areas. Pragmatic, cost-effective and implementable opportunities were identified to support the career progression of CV EMCRs to create a more sustainable, equitable and supportive workforce. This information can be used to strategically engage key stakeholders to enable CV EMCRs to thrive.
Publisher: Elsevier BV
Date: 12-2018
Publisher: Elsevier BV
Date: 2018
Publisher: Frontiers Media SA
Date: 08-06-2023
DOI: 10.3389/FPUBH.2023.1182132
Abstract: Dietary sodium has a dose-response relationship with cardiovascular disease, and sodium intake in Sweden exceeds national and international recommendations. Two thirds of dietary sodium intake comes from processed foods, and adults in Sweden eat more processed foods than any other European country. We hypothesized that sodium content in processed foods is higher in Sweden than in other countries. The aim of this study was to investigate sodium content in processed food items in Sweden, and how it differs from Australia, France, Hong Kong, South Africa, the United Kingdom and the United States. Data were collected from retailers by trained research staff using standardized methods. Data were categorized into 10 food categories and compared using Kruskal-Wallis test of ranks. Sodium content in the food items was compared in mg sodium per 100 g of product, based on the nutritional content labels on the packages. Compared to other countries, Sweden had among the highest sodium content in the “dairy” and “convenience foods” categories, but among the lowest in “cereal and grain products,” “seafood and seafood products” and “snack foods” categories. Australia had the overall lowest sodium content, and the US the overall highest. The highest sodium content in most analyzed countries was found in the “meat and meat products” category. The highest median sodium content in any category was found among “sauces, dips, spreads and dressings” in Hong Kong. The sodium content differed substantially between countries in all food categories, although contrary to our hypothesis, processed foods overall had lower sodium content in Sweden than in most other included countries. Sodium content in processed food was nonetheless high also in Sweden, and especially so in increasingly consumed food categories, such as “convenience foods”.
Publisher: Elsevier BV
Date: 11-2020
DOI: 10.1093/CDN/NZAA157
Publisher: Springer Science and Business Media LLC
Date: 20-01-2016
DOI: 10.1038/SREP19596
Abstract: Considerable evidence has associated increasing portion sizes with elevated obesity prevalence. This study examines typical portion sizes of commonly consumed core and discretionary foods in Australian adults and compares these data with the Australian Dietary Guidelines standard serves. Typical portion sizes are defined as the median amount of foods consumed per eating occasion. Sex- and age-specific median portion sizes of adults aged 19 years and over (n = 9341) were analysed using one day 24 hour recall data from the 2011–12 National Nutrition and Physical Activity Survey. A total of 152 food categories were examined. There were significant sex and age differences in typical portion sizes among a large proportion of food categories studied. Typical portion sizes of breads and cereals, meat and chicken cuts and starchy vegetables were 30–160% larger than the standard serves, whereas, the portion sizes of dairy products, some fruits and non-starchy vegetables were 30–90% smaller. Typical portion sizes for discretionary foods such as cakes, ice-cream, sausages, hamburgers, pizza and alcoholic drinks exceeded the standard serves by 40–400%. The findings of the present study are particularly relevant for establishing Australian-specific reference portions for dietary assessment tools, refinement of nutrition labelling and public health policies.
Publisher: Springer Science and Business Media LLC
Date: 24-06-2022
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: Springer Science and Business Media LLC
Date: 16-05-2019
DOI: 10.1038/S41569-019-0206-1
Abstract: The effect of dietary fats on cardiometabolic diseases, including cardiovascular diseases and type 2 diabetes mellitus, has generated tremendous interest. Many earlier investigations focused on total fat and conventional fat classes (such as saturated and unsaturated fats) and their influence on a limited number of risk factors. However, dietary fats comprise heterogeneous molecules with erse structures, and growing research in the past two decades supports correspondingly complex health effects of in idual dietary fats. Moreover, health effects of dietary fats might be modified by additional factors, such as accompanying nutrients and food-processing methods, emphasizing the importance of the food sources. Accordingly, the rapidly increasing scientific findings on dietary fats and cardiometabolic diseases have generated debate among scientists, caused confusion for the general public and present challenges for translation into dietary advice and policies. This Review summarizes the evidence on the effects of different dietary fats and their food sources on cell function and on risk factors and clinical events of cardiometabolic diseases. The aim is not to provide an exhaustive review but rather to focus on the most important evidence from randomized controlled trials and prospective cohort studies and to highlight current areas of controversy and the most relevant future research directions for understanding how to improve the prevention and management of cardiometabolic diseases through optimization of dietary fat intake.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2009
Publisher: Oxford University Press (OUP)
Date: 14-12-2015
Abstract: In 2011, the Danish Ministry of Food, Agriculture and Fisheries launched the Danish Organic Action Plan 2020 intending to double the organic agricultural area in Denmark. This study aims to measure experienced physical and psychological wellbeing at work along with beliefs and attitudes among kitchen workers before and after participating in educational training programmes in organic food conversion. This longitudinal study applied an online self-administered questionnaire among kitchen workers before and after the implementation of an organic food conversion programme with 1-year follow-up. The study targeted all staff members in the participating public kitchens taking part in the organic food conversion process funded by the Danish Organic Action Plan 2020. Of the 448 eligible kitchen workers, 235 completed the questionnaire at baseline (52%) and 149 at follow-up (63% of those surveyed at baseline). No substantive differences between baseline and follow-up measurements of organic food conversion were detected on physical or psychological wellbeing at work. Kitchen workers reported a significant improvement in the perceived food quality, motivation to work and application of nutritional guidelines. Reported organic food percentages for the kitchens also increased significantly (P< 0.001) and a shift from using ready-made food products to producing more food from base was indicated. Within 1 year, a significant increase in motivation to work among kitchen staff was observed with no substantive changes in physical or psychological wellbeing at work identified. The results support the Danish Organic Action Plan 2020 and initiatives of similar kind.
Publisher: Wiley
Date: 25-07-2020
DOI: 10.1111/JCH.13947
Publisher: Springer Science and Business Media LLC
Date: 16-05-2022
DOI: 10.1038/S41569-022-00700-1
Abstract: Cardiovascular disease remains the leading cause of death worldwide. Cardiovascular research has therefore never been more crucial. Cardiovascular researchers must be provided with a research environment that enables them to perform at their highest level, maximizing their opportunities to work effectively with key stakeholders to address this global issue. At present, cardiovascular researchers face a range of challenges and barriers, including a decline in funding, job insecurity and a lack of ersity at senior leadership levels. Indeed, many cardiovascular researchers, particularly women, have considered leaving the sector, highlighting a crucial need to develop strategies to support and retain researchers working in the cardiovascular field. In this Roadmap article, we present solutions to problems relevant to cardiovascular researchers worldwide that are broadly classified across three key areas: capacity building, research funding and fostering ersity and equity. This Roadmap provides opportunities for research institutions, as well as governments and funding bodies, to implement changes from policy to practice, to address the most important factors restricting the career progression of cardiovascular researchers.
Publisher: Public Library of Science (PLoS)
Date: 19-07-2016
Publisher: Springer Science and Business Media LLC
Date: 22-04-2021
DOI: 10.1038/S41467-021-22370-2
Abstract: The health effects of omega-3 fatty acids have been controversial. Here we report the results of a de novo pooled analysis conducted with data from 17 prospective cohort studies examining the associations between blood omega-3 fatty acid levels and risk for all-cause mortality. Over a median of 16 years of follow-up, 15,720 deaths occurred among 42,466 in iduals. We found that, after multivariable adjustment for relevant risk factors, risk for death from all causes was significantly lower (by 15–18%, at least p 0.003) in the highest vs the lowest quintile for circulating long chain (20–22 carbon) omega-3 fatty acids (eicosapentaenoic, docosapentaenoic, and docosahexaenoic acids). Similar relationships were seen for death from cardiovascular disease, cancer and other causes. No associations were seen with the 18-carbon omega-3, alpha-linolenic acid. These findings suggest that higher circulating levels of marine n-3 PUFA are associated with a lower risk of premature death.
Publisher: American Medical Association (AMA)
Date: 08-2016
Publisher: Springer Science and Business Media LLC
Date: 26-09-2023
Publisher: Elsevier BV
Date: 05-2016
Publisher: Springer Science and Business Media LLC
Date: 27-09-2023
DOI: 10.1038/S41430-022-01211-5
Abstract: Public support for evidence-based nutrition interventions can be an important determinant of government willingness to develop and implement such interventions. The aim of this study was to assess support for a broad range of nutrition interventions across seven countries: Australia, Canada, China, India, New Zealand, the United Kingdom, and the United States. Assessed interventions included those relating to food availability, affordability, reformulation, labelling, and promotion. Approximately 1000 adults per country (total n = 7559) completed an online survey assessing support for 35 nutrition interventions olicies. ANOVA analyses were used to identify differences between countries on overall levels of support and by intervention category. Multiple regression analyses assessed demographic and diet-related factors associated with higher levels of support across the total s le and by country. Substantial levels of public support were found for the assessed interventions across the seven countries and five intervention categories. The highest levels were found in India (Mean across all interventions of 4.16 (standard deviation (SD) 0.65) on a 5-point scale) and the lowest in the United States (Mean = 3.48, SD = 0.83). Support was strongest for interventions involving food labelling (Mean = 4.20, SD = 0.79) and food reformulation (Mean = 4.17, SD = 0.87), and weakest for fiscal interventions (Mean = 3.52, SD = 1.06). Consumer characteristics associated with stronger support were higher self-rated health, higher educational attainment, female sex, older age, and perceptions of consuming a healthy diet. The results indicate substantial support for a large range of nutrition interventions across the assessed countries, and hence governments could potentially be more proactive in developing and implementing such initiatives.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-11-2019
Abstract: Synthesized fatty acids ( FA s) from de novo lipogenesis may affect cardiometabolic health, but longitudinal associations between serially measured de novo lipogenesis–related fatty acid biomarkers and mortality or cardiovascular disease ( CVD) are not well established. We investigated longitudinal associations between de novo lipogenesis–related fatty acids with all‐cause mortality, cause‐specific mortality, and incident CVD among 3869 older US adults, mean ( SD ) age 75 (5) years and free of prevalent CVD at baseline. Levels of plasma phospholipid palmitic (16:0), palmitoleic (16:1n‐7), stearic (18:0), oleic acid (18:1n‐9), and other risk factors were serially measured at baseline, 6 years, and 13 years. All‐cause mortality, cause‐specific mortality, and incident fatal and nonfatal CVD were centrally adjudicated. Risk was assessed in multivariable‐adjusted Cox models with time‐varying FA s and covariates. During 13 years, median follow‐up (maximum 22.4 years), participants experienced 3227 deaths (1131 CVD , 2096 non‐ CVD ) and 1753 incident CVD events. After multivariable adjustment, higher cumulative levels of 16:0, 16:1n‐7, and 18:1n‐9 were associated with higher all‐cause mortality, with extreme‐quintile hazard ratios (95% CI s) of 1.35 (1.17–1.56), 1.40 (1.21–1.62), and 1.56 (1.35–1.80), respectively, whereas higher levels of 18:0 were associated with lower mortality (hazard ratio=0.76 95% CI =0.66–0.88). Associations were generally similar for CVD mortality versus non‐ CVD mortality, as well as total incident CVD . Changes in levels of 16:0 were positively, and 18:0 inversely, associated with all‐cause mortality (hazard ratio=1.23, 95% CI =1.08–1.41 and hazard ratio=0.78, 95% CI =0.68–0.90). Higher long‐term levels of 16:0, 16:1n‐7, and 18:1n‐9 and changes in 16:0 were positively, whereas long‐term levels and changes in 18:0 were inversely, associated with all‐cause mortality in older adults.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2020
DOI: 10.1161/CIRCHEARTFAILURE.120.007054
Abstract: Patients with heart failure (HF) with diabetes mellitus have distinct biomarker profiles compared with those without diabetes mellitus. SFRP5 (secreted frizzled-related protein 5) is an anti-inflammatory adipokine with an important suppressing role on the development of type 2 diabetes mellitus (T2DM). This study aimed to evaluate the prognostic value of SFRP5 in patients with HF with and without T2DM. The study included 833 consecutive patients with HF, 312 (37.5%) of whom had T2DM. Blood s les were collected at presentation, and SFRP5 levels were measured. The primary outcome was the composite end points of first occurrence of HF rehospitalization or all-cause mortality during follow-up. During median follow-up of 2.1 years, 335 (40.2%) patients in the cohort experienced the composite primary outcome. After adjustment for multiple risk factors, each doubling of SFRP5 level was associated with a 21% decreased risk of primary outcomes in the overall study population ( P .001). Subgroup analyses showed that the association between level of SFPR5 and primary outcomes may be stronger in patients with T2DM (hazard ratio, 0.69 [95% CI, 0.61–0.79]) than in patients without T2DM (hazard ratio, 0.89 [95% CI, 0.79–1.01] interaction P =0.006). Similar associations were observed when taking SFRP5 as a categorical variable. Addition of SFRP5 significantly improved discrimination and reclassification of the incident primary outcomes beyond clinical risk factors and N-terminal pro-B-type natriuretic peptide in all patients with HF and those with T2DM (all P .01). SFRP5 is an independent novel biomarker for risk stratification in HF, especially in HF with T2DM.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-11-2013
Abstract: Dietary guidelines support intake of polyunsaturated fatty acids ( PUFA s) in fish and vegetable oils. However, some controversy remains about benefits of PUFA s, and most prior studies have relied on self‐reported dietary assessment in relatively homogeneous populations. In a multiethnic cohort of 2837 US adults (whites, Hispanics, A frican A mericans, C hinese A mericans), plasma phospholipid PUFA s were measured at baseline (2000–2002) using gas chromatography and dietary PUFA s estimated using a food frequency questionnaire. Incident cardiovascular disease ( CVD ) events (including coronary heart disease and stroke n=189) were prospectively identified through 2010 during 19 778 person‐years of follow‐up. In multivariable‐adjusted Cox models, circulating n‐3 eicosapentaenoic acid and docosahexaenoic acid were inversely associated with incident CVD , with extreme‐quartile hazard ratios (95% CI s) of 0.49 for eicosapentaenoic acid (0.30 to 0.79 P trend =0.01) and 0.39 for docosahexaenoic acid (0.22 to 0.67 P trend .001). n‐3 Docosapentaenoic acid ( DPA ) was inversely associated with CVD in whites and C hinese, but not in other race/ethnicities ( P ‐interaction=0.01). No significant associations with CVD were observed for circulating n‐3 alpha‐linolenic acid or n‐6 PUFA (linoleic acid, arachidonic acid). Associations with CVD of self‐reported dietary PUFA were consistent with those of the PUFA biomarkers. All associations were similar across racial‐ethnic groups, except those of docosapentaenoic acid. Both dietary and circulating eicosapentaenoic acid and docosahexaenoic acid, but not alpha‐linolenic acid or n‐6 PUFA , were inversely associated with CVD incidence. These findings suggest that increased consumption of n‐3 PUFA from seafood may prevent CVD development in a multiethnic population.
Publisher: MDPI AG
Date: 31-05-2021
DOI: 10.3390/NU13061882
Abstract: Unhealthy diets are underpinned by the over-consumption of packaged products. Data describing the ingredient composition of these products is limited. We sought to define the ingredients used in Australian packaged foods and beverages and assess associations between the number of ingredients and existing health indicators. Statements of ingredients were disaggregated, creating separate fields for each ingredient and sub-ingredient. Ingredients were categorised and the average number of ingredients per product was calculated. Associations between number of ingredients and both the nutrient-based Health Star Rating (HSR) and the NOVA level-of-processing classification were assessed. A total of 24,229 products, listing 233,113 ingredients, were included. Products had between 1 and 62 ingredients (median (Interquartile range (IQR)): 8 (3–14)). We identified 915 unique ingredients, which we organised into 17 major and 138 minor categories. ‘Additives’ were contained in the largest proportion of products (64.6%, (15,652/24,229)). The median number of ingredients per product was significantly lower in products with the optimum 5-star HSR (when compared to all other HSR score groups, p-value 0.001) and significantly higher in products classified as ultra-processed (when compared to all other NOVA classification groups, p-value 0.001). There is a strong relationship between the number of ingredients in a product and indicators of nutritional quality and level of processing.
Publisher: Elsevier BV
Date: 03-2012
Publisher: Elsevier BV
Date: 07-2021
DOI: 10.1093/AJCN/NQAB054
Start Date: 2020
End Date: 2023
Funder: National Health and Medical Research Council
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