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Diet And Cardiovascular Disease Burden

Fiscal policies targeting diet can be used as a deterrent to poor dietary choices.

Poor diet is a major cause of non-communicable diseases, more than a combination of smoking, alcohol and lack of exercise. Socio-economic standing determines dietary habits and hence cardiovascular disease prevalence and mortality in the U.S. Economic improvement has been observed to lead to better dietary choices in the absence of dietary policies that affect CVD reduction and control.

The current prospective study is looking at potential reduction in CVD and socio-economic disparities between 2015 and 2030. Their evaluation included using dietary policy scenarios such as national mass media campaign advocating for inclusion of fruits and vegetables in the daily menu and reduction in consumption of sugar-sweetened beverages. They also explored the idea of a fiscal policy aimed at taxing sugar-sweetened beverages that would lead to a 10% increase in prices and subsidizing prices of fruits and vegetables by 30% for low-income consumers.

The 10% price reduction of fruits and vegetables showed the most promise with 150,500 CVD deaths postponed or prevented between 2015 and 2030. This was followed by 35,100 CVD deaths postponed or prevented using the 30% fruits and vegetables subsidy for the low-income consumers. The national mass media campaign was projected to postpone or prevent 28,500 CVD-related deaths while the 10% price increase in reduced sugar-sweetened beverages was projected to postpone or prevent 31,000 CVD-related deaths by the year 2030 in the U.S. When all the policies are applied together, they would result to a total of 245,100 CVD deaths postponed or prevented by the year 2030. The low-income fruits and vegetables subsidy of 30% was the only one shown to potentially reduce CVD socio-economic disparities by approximately 8% by 2030 while the combined policies were estimated to reduce CVD disparities by 6%.

In a study by Hyseni et al, potential effectiveness of policy actions to improve healthy food consumption and prevent noncommunicable diseases was examined. They looked at 58 systematic and nonsystematic reviews and analyzed data in terms of price, promotion, provision, composition, labelling, supply chain, trade/investment, and multi-component interventions. Taxes and subsidies helped to reduce consumption of sugary drinks and lead to an increase in consumption of fruit and vegetables. The larger the taxes or subsidies, the greater was the change in consumption observed.

Aggressive advertising of fast foods by fast food chains made people consume more calories. To reduce this consumption and hence obesity levels, a direct ban of advertising targeting children or coming up with deterrent policies discouraging such advertising would be an effective intervention. In this study, multi-component and price interventions were more effective at improving healthy eating.

Price intervention appear to be more effective for creating healthy eating habits and preventing noncommunicable diseases. This included increasing taxes on sugar-sweetened beverages and also taxing dietary fat. The effect of subsidies was demonstrated using fruit and vegetable intake. Imposing taxes on SSB led to a decrease in consumption and subsidies to fruits and vegetables increased their intake. Fast food companies should be barred from selling junk food and sugary drinks.

Labeling will make it possible for consumers to make informed choices as manufacturers are bound to adhere to formulation rules. This will mostly depend on individual consumers’ awareness, knowledge, and ability to interpret labels correctly. Multi-component interventions appear to be more effective dietary policy strategies than single interventions. Dietary policies that encourage fruit and vegetable consumption and discourage reduced sugar-sweetened beverages consumption can decrease CVD  incidence and mortality

Practice Pearls:

  • Suboptimal diet is a leading cause of cardiovascular disease, death, and health disparities.
  • Price intervention appear to be more effective  for creating healthy eating habits and preventing noncommunicable diseases.
  • The ability of consumers to make informed dietary choices will mostly depend on individual consumers’ awareness, knowledge, and ability to interpret labels correctly.
  • Multi-component and price interventions are more effective strategies at improving healthy eating.

References:

Pearson-Stuttard J, Bandosz P, Rehm CD, Penalvo J, Whitsel L, et al. (2017) Reducing US cardiovascular disease burden and disparities through national and targeted dietary policies: A modelling study. PLOS Medicine 14(6): e1002311. https://doi.org/10.1371/journal.pmed.1002311

Hyseni L, Atkinson M, Bromley H, et al. The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review. European Journal of Clinical Nutrition. 2017;71(6):694-711. doi:10.1038/ejcn.2016.234.

 

Josephat Macharia, PharmD candidate, Lecom School of Pharmacy class of 2018