Disparities in Health and Economic Burdens of Cancer Attributable to Suboptimal Diet in the United States, 2015‒2018

2021 ◽  
pp. e1-e11
Author(s):  
Lu Wang ◽  
Mengxi Du ◽  
Frederick Cudhea ◽  
Christina Griecci ◽  
Dominique S. Michaud ◽  
...  
Keyword(s):  
The United States ◽  
Whole Grains ◽  
Dietary Factors ◽  
Socioeconomically Disadvantaged ◽  
Economic Costs ◽  
Sugar Sweetened Beverages ◽  
Uncertainty Interval ◽  
Processed Meats ◽  
Sweetened Beverages ◽  
Racial Ethnic

Objectives. To quantify disparities in health and economic burdens of cancer attributable to suboptimal diet among US adults. Methods. Using a probabilistic cohort state-transition model, we estimated the number of new cancer cases and cancer deaths, and economic costs of 15 diet-related cancers attributable to suboptimal intake of 7 dietary factors (a low intake of fruits, vegetables, dairy, and whole grains and a high intake of red and processed meats and sugar-sweetened beverages) among a closed cohort of US adults starting in 2017. Results. Suboptimal diet was estimated to contribute to 3.04 (95% uncertainty interval [UI] = 2.88, 3.20) million new cancer cases, 1.74 (95% UI = 1.65, 1.84) million cancer deaths, and $254 (95% UI = $242, $267) billion economic costs among US adults aged 20 years or older over a lifetime. Diet-attributable cancer burdens were higher among younger adults, men, non-Hispanic Blacks, and individuals with lower education and income attainments than other population subgroups. The largest disparities were for cancers attributable to high consumption of sugar-sweetened beverages and low consumption of whole grains. Conclusions. Suboptimal diet contributes to substantial disparities in health and economic burdens of cancer among young adults, men, racial/ethnic minorities, and socioeconomically disadvantaged groups. (Am J Public Health. Published online ahead of print October 14, 2021:e1–e11. https://doi.org/10.2105/AJPH.2021.306475 )

scholarly journals The Estimated Economic Burden of Cancers Attributable to Suboptimal Diet in the United States (OR17-03-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Jaya Khushalani ◽  
Frederick Cudhea ◽  
Donatus Ekwueme ◽  
Diane Harris ◽  
Dariush Mozaffarian ◽  
...  
Keyword(s):  
Cancer Care ◽  
Medical Costs ◽  
The United States ◽  
Whole Grains ◽  
Dietary Factors ◽  
Assessment Model ◽  
Processed Meat ◽  
Sugar Sweetened Beverages ◽  
Direct Medical Costs ◽  
Sweetened Beverages

Abstract Objectives Suboptimal diet has been estimated as a major preventable cost of cancer. We aimed to quantify the 5-year direct medical costs for the estimated proportion of cancers attributed to suboptimal consumption of 7 dietary factors (fruits, vegetables, whole grains, processed meats, red meats, sodium, and sugar-sweetened beverages) among US adults. Methods A Comparative Risk Assessment model was used to estimate the population attributable fractions (PAFs) for each diet-cancer pair and joint PAFs for 15 cancers. A Markov cohort model with Monte Carlo simulations was used to compute 5-year cancer costs attributable to suboptimal diet using PAFs, phase-specific costs of cancer care, and probability of death. Data inputs include national dietary data from the 2011–14 National Health and Nutrition Examination Survey (NHANES), optimal intake from the Global Burden of Disease (GBD) estimates, cancer incidence and survival from the Surveillance, Epidemiology, and End Results (SEER) program, and phase-specific costs of cancer care and projections from published literature. Results The estimated 5-year direct medical cost of 15 cancers attributed to 7 dietary factors was $4.5 billion (95% uncertainty interval [UI]: $4.3-$4.8). Largest costs (82%) were from colorectal cancer ($2.8 billion, 95% UI: $2.6-$3.0), and due to consumption of insufficient whole grains ($1.9 billion, 95% UI: $1.7-$2.1) and excess processed meat ($1.1 billion, 95% UI: $1.0-$1.3). Total estimated 5-year direct medical costs for cancer attributable to other dietary factors included $0.8 and $0.5 billion for insufficient vegetable and fruit consumption, respectively and $0.4, $0.2 and $0.2 billion for high intake of red meat, sodium and sugar-sweetened beverages, respectively. Conclusions These novel findings highlight the opportunity to reduce cancer and associated costs via nutritional policies for the primary prevention of cancer. The results can also inform and serve as inputs for economic evaluation and design and testing of diet-related interventions to prevent cancer in the U.S. Funding Sources None. Supporting Tables, Images and/or Graphs

scholarly journals Association between plant-based diets and blood pressure in the INTERMAP study

2020 ◽  
pp. bmjnph-2020-000077
Author(s):  
Ghadeer Aljuraiban ◽  
Queenie Chan ◽  
Rachel Gibson ◽  
Jeremiah Stamler ◽  
Martha L Daviglus ◽  
...  
Keyword(s):  
Blood Pressure ◽  
International Study ◽  
The United States ◽  
Whole Grains ◽  
Dietary Guidelines ◽  
Sugar Sweetened Beverages ◽  
Cross Sectional ◽  
Refined Grains ◽  
Sweetened Beverages ◽  
Registration Number

BackgroundPlant-based diets are associated with a lower risk of cardiovascular diseases; however, little is known how the healthiness of the diet may be associated with blood pressure (BP). We aimed to modify three plant -based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) according to country-specific dietary guidelines to enable use across populations with diverse dietary patterns – and assessed their associations with BP.DesignWe used cross-sectional data including 4,680 men and women ages 40–59y in Japan, China, the United Kingdom, and the United States from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). During four visits, eight BP measurements, and four 24-h dietary recalls were collected. Multivariable regression coefficients were estimated, pooled, weighted, and adjusted extensively for lifestyle/dietary confounders.ResultsModified PDI was not associated with BP. Consumption of hPDI higher by 1SD was inversely associated with systolic (-0.82 mm Hg;95% CI:-1.32,-0.49) and diastolic BP (-0.49 mm Hg; 95% CI:-0.91, -0.28). In contrast, consumption of an uPDI was directly associated with systolic (0.77 mm Hg;95% CI:0.30,1.20). Significant associations between hPDI with BP were attenuated with separate adjustment for vegetables and whole grains; associations between uPDI and BP were attenuated after adjustment for refined grains, sugar-sweetened beverages, and meat.ConclusionAn hPDI is associated with lower BP while a uPDI is adversely related to BP. Plant-based diets rich in vegetables and whole grains and limited in refined grains, sugar-sweetened beverages, and total meat may contribute to these associations. In addition to current guidelines, the nutritional quality of consumed plant foods is as important as limiting animal-based components.Trial registration numberThe observational INTERMAP study was registered at www.clinicaltrials.gov as NCT00005271.

Should We Put a Thin Subsidy on the Policy Table in the Fight against Obesity?

2011 ◽  
Vol 14 (2) ◽  
Author(s):  
Grace Lordan ◽  
John Quiggin
Keyword(s):  
United States ◽  
Health Outcomes ◽  
The United States ◽  
Soft Drinks ◽  
Economic Effects ◽  
Sugar Sweetened Beverages ◽  
President Obama ◽  
Sweetened Beverages ◽  
The Relationship ◽  
Artificially Sweetened Beverages

The idea of using 'fat taxes’ to curb obesity rates has been raised by many. In particular, the idea of taxing sugar-sweetened beverages (SSBs) has received considerable attention in the United States and has recently been discussed by President Obama. Rather less attention has been given to the alternative of 'thin subsidies’, that is, subsidies for the consumption of foods or beverages likely to be associated with reduced incidence of obesity. This commentary examines the case for a subsidy for artificially sweetened beverages (ASBs) or 'diet soft drinks’. In this commentary, we outline the evidence on the relationship between health outcomes, most notably obesity, and the consumption of SSBs and ASBs. In the light of the evidence we consider the economic effects of taxing SSBs, and the way in which those effects would be modified by the adoption of the alternative 'thin subsidy’ based on subsidising ASBs.

scholarly journals Racial/ethnic and immigrant differences in early childhood diet quality

2013 ◽  
Vol 17 (6) ◽  
pp. 1308-1317 ◽  
Author(s):  
Marieke LA de Hoog ◽  
Ken P Kleinman ◽  
Matthew W Gillman ◽  
Tanja GM Vrijkotte ◽  
Manon van Eijsden ◽  
...  
Keyword(s):  
Fast Food ◽  
Negative Binomial ◽  
Saturated Fat ◽  
Sociodemographic Factors ◽  
Snack Food ◽  
Hispanic Children ◽  
Sugar Sweetened Beverages ◽  
Explanatory Role ◽  
Sweetened Beverages ◽  
Racial Ethnic

AbstractObjectiveTo assess racial/ethnic differences in the diet in young children and the explanatory role of maternal BMI, immigrant status and perception of child's weight.DesignAmong white, black and Hispanic 3-year-olds, we used negative binomial and linear regression to examine associations of race/ethnicity with foods and nutrients assessed by a validated FFQ.SettingProject Viva, Boston (MA), USA.SubjectsChildren aged 3 years (n 898).ResultsMean age was 38·3 (sd 2·8) months; 464 (52 %) were boys and 127 mothers (14 %) were immigrants. After adjustment for sociodemographic factors, black and Hispanic children (v. white) had a higher intake of sugar-sweetened beverages (rate ratio (RR) = 2·59 (95 % CI 1·95, 3·48) and RR = 1·59 (95 % CI 1·07, 2·47), respectively) and lower intakes of skimmed/1 % milk (RR = 0·42 (95 % CI 0·33, 0·53) and RR = 0·43 (95 % CI 0·31, 0·61), respectively) and trans-fat (−0·10 (95 % CI −0·18, −0·03) % of energy and −0·15 (95 % CI −0·26, −0·04) % of energy, respectively). Among Hispanics only, a lower intake of snack food (RR = 0·83 (95 % CI 0·72, 0·98)) was found and among blacks only, a higher intake of fast food (RR = 1·28 (95 % CI 1·05, 1·55)) and lower intakes of saturated fat (−0·86 (95 % CI −1·48, −0·23) % of energy), dietary fibre (0·85 (95 % CI 0·08, 1·62) g/d) and Ca (−120 (95 % CI −175, −65) mg/d) were found. Being born outside the USA was associated with more healthful nutrient intakes and less fast food.ConclusionsThree-year-old black and Hispanic (v. white) children ate more sugar-sweetened beverages and less low-fat dairy. Total energy intake was substantially higher in Hispanic children. Snack food (Hispanic children) and fat intakes (black children) tended to be lower. Children of immigrants ate less fast food and bad fats and more fibre.

scholarly journals Should We Tax Sugar-Sweetened Beverages? An Overview of Theory and Evidence

2019 ◽  
Vol 33 (3) ◽  
pp. 202-227 ◽  
Author(s):  
Hunt Allcott ◽  
Benjamin B. Lockwood ◽  
Dmitry Taubinsky
Keyword(s):  
Financial Burden ◽  
The United States ◽  
Self Control ◽  
Sugar Sweetened Beverages ◽  
Sugar Sweetened Beverage ◽  
Tax Rate ◽  
Sweetened Beverage ◽  
Sweetened Beverages ◽  
Sugary Drinks ◽  
Poor Nutrition

Taxes on sugar-sweetened beverages are growing in popularity and have generated an active public debate. Are they a good idea? If so, how high should they be? Are such taxes regressive? People in the United States and some other countries consume remarkable quantities of sugar-sweetened beverages, and the evidence suggests that this generates significant health costs. Building on recent work, we review the basic economic principles that determine the socially optimal sugar-sweetened beverage tax. The optimal tax depends on (1) externalities, or uninternalized health system costs from diseases caused by sugary drink consumption; (2) internalities, or costs consumers impose on themselves by consuming too many sugary drinks due to poor nutrition knowledge and/or lack of self-control; and (3) regressivity, or how much the financial burden and the internality benefits from the tax fall on the poor. We summarize the empirical evidence about the key parameters that determine how large the tax should be. Our calculations suggest that sugar-sweetened beverage taxes are welfare enhancing and indeed that the optimal sugar-sweetened beverage tax rate may be higher than the 1 cent per ounce rate most commonly used in US cities. We end with seven concrete suggestions for policymakers considering a sugar-sweetened beverage tax.

scholarly journals Preventable Cancer Burden Associated With Poor Diet in the United States

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Fang Fang Zhang ◽  
Frederick Cudhea ◽  
Zhilei Shan ◽  
Dominique S Michaud ◽  
Fumiaki Imamura ◽  
...  
Keyword(s):  
United States ◽  
Ethnic Minorities ◽  
The United States ◽  
Dietary Factors ◽  
Assessment Model ◽  
Annual Number ◽  
Cancer Type ◽  
Middle Aged ◽  
Cancer Burden ◽  
Racial Ethnic

Abstract Background Diet is an important risk factor for cancer that is amenable to intervention. Estimating the cancer burden associated with diet informs evidence-based priorities for nutrition policies to reduce cancer burden in the United States. Methods Using a comparative risk assessment model that incorporated nationally representative data on dietary intake, national cancer incidence, and estimated associations of diet with cancer risk from meta-analyses of prospective cohort studies, we estimated the annual number and proportion of new cancer cases attributable to suboptimal intakes of seven dietary factors among US adults ages 20 years or older, and by population subgroups. Results An estimated 80 110 (95% uncertainty interval [UI] = 76 316 to 83 657) new cancer cases were attributable to suboptimal diet, accounting for 5.2% (95% UI = 5.0% to 5.5%) of all new cancer cases in 2015. Of these, 67 488 (95% UI = 63 583 to 70 978) and 4.4% (95% UI = 4.2% to 4.6%) were attributable to direct associations and 12 589 (95% UI = 12 156 to 13 038) and 0.82% (95% UI = 0.79% to 0.85%) to obesity-mediated associations. By cancer type, colorectal cancer had the highest number and proportion of diet-related cases (n = 52 225, 38.3%). By diet, low consumption of whole grains (n = 27 763, 1.8%) and dairy products (n = 17 692, 1.2%) and high intake of processed meats (n = 14 524, 1.0%) contributed to the highest burden. Men, middle-aged (45–64 years) and racial/ethnic minorities (non-Hispanic blacks, Hispanics, and others) had the highest proportion of diet-associated cancer burden than other age, sex, and race/ethnicity groups. Conclusions More than 80 000 new cancer cases are estimated to be associated with suboptimal diet among US adults in 2015, with middle-aged men and racial/ethnic minorities experiencing the largest proportion of diet-associated cancer burden in the United States.

scholarly journals Who is Replacing Sugar-Sweetened Beverages with Plain Water? Analyses of NHANES 2011–16 Data

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 557-557
Author(s):  
Colin Rehm ◽  
Matthieu Maillot ◽  
Florent Vieux ◽  
Pamela Barrios ◽  
Adam Drewnowski
Keyword(s):  
Drinking Water ◽  
Family Income ◽  
Tap Water ◽  
The United States ◽  
Bottled Water ◽  
Plain Water ◽  
Lower Income ◽  
Sugar Sweetened Beverages ◽  
Sweetened Beverages ◽  
Hispanic White

Abstract Objectives In the United States, replacing sugar-sweetened beverages (SSB) with plain drinking water is recommended via by numerous public health agencies and non-governmental organizations. While declines in SSB consumption in the US are well-documented, it is not clear if consumers are replacing SSBs with other beverages, namely plain drinking water. Methods Beverage consumption data for 7453 children (4–18y) and 15,263 adults (≥19y) came from two 24 h dietary recalls in three most recent cycles of the National Health and Nutrition Examination Survey (NHANES 2011–2016). Consumption trends for water intakes (in mL/d) from SSBs and from drinking water were analyzed by gender, age group, family income, and race/ethnicity. Results Mean water intakes from SSBs declined from 322 mL/d to 262 mL/d (p-trend = 0.002) on average, whereas plain drinking water increased from 1011 mL/d to 1144 mL/d (p-trend = 0.0108). Statistically significant reductions in SSBs were observed only among men (-18%), younger participants (-26% in 4–8, -22% in 9–13, -33% in 14–19 and -30% in 20–30), those with lower incomes (family income-to-poverty ratio < 2.0), non-Hispanic whites and non-Hispanic black participants (p-trend < 0.05 for each). Within these population sub-groups, only non-Hispanic white participants, those with a family income to poverty ratio of 1–1.99, but not < 1.0, and children aged < 14y had a corresponding increase in plain water consumption. When examining types of water, non-Hispanic white participants replaced SSBs with tap water as opposed to bottled water, and the lower income group replaced SSBs with bottled water, as opposed to tap water. Conclusions The expected replacement of SSBs with plain drinking water was not uniformly observed across socio-demographic group. Only non-Hispanic Whites and lower income groups replaced SSB with water, whereas teenagers (14–19y) and non-Hispanic black participants did not. Understanding how and if specific population sub-groups are replacing a declining food/beverage category with another category has important population health implications. Funding Sources Analyses of publicly available federal NHANES databases were sponsored by PepsiCo Inc. and conducted by MS-Nutrition. The views expressed in this abstract are those of the authors and do not necessarily reflect the position or policy of PepsiCo, Inc.

scholarly journals The relationship of perceptions of tap water safety with intake of sugar-sweetened beverages and plain water among US adults

2012 ◽  
Vol 17 (1) ◽  
pp. 179-185 ◽  
Author(s):  
Stephen J Onufrak ◽  
Sohyun Park ◽  
Joseph R Sharkey ◽  
Bettylou Sherry
Keyword(s):  
Water Intake ◽  
Tap Water ◽  
Bottled Water ◽  
Plain Water ◽  
Water Safety ◽  
Sugar Sweetened Beverages ◽  
Sweetened Beverages ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Water Perceptions

AbstractObjectiveResearch is limited on whether mistrust of tap water discourages plain water intake and leads to a greater intake of sugar-sweetened beverages (SSB). The objective of the present study was to examine demographic differences in perceptions of tap water safety and determine if these perceptions are associated with intake of SSB and plain water.DesignThe study examined perceptions of tap water safety and their cross-sectional association with intake of SSB and plain water. Racial/ethnic differences in the associations of tap water perceptions with SSB and plain water intake were also examined.SettingNationally weighted data from the 2010 HealthStyles Survey (n 4184).SubjectsUS adults aged ≥18 years.ResultsOverall, 13·0 % of participants disagreed that their local tap water was safe to drink and 26·4 % of participants agreed that bottled water was safer than tap water. Both mistrust of tap water safety and favouring bottled water differed by region, age, race/ethnicity, income and education. The associations of tap water mistrust with intake of SSB and plain water were modified by race/ethnicity (P < 0·05). Non-white racial/ethnic groups who disagreed that their local tap water was safe to drink were more likely to report low intake of plain water. The odds of consuming ≥1 SSB/d among Hispanics who mistrusted their local tap water was twice that of Hispanics who did not (OR = 2·0; 95 % CI 1·2, 3·3).ConclusionsPublic health efforts to promote healthy beverages should recognize the potential impact of tap water perceptions on water and SSB intake among minority populations.

scholarly journals Mass Media Campaign to Reduce Consumption of Sugar-Sweetened Beverages in a Rural Area of the United States

2017 ◽  
Vol 107 (6) ◽  
pp. 989-995 ◽  
Author(s):  
Thomas A. Farley ◽  
Hayli S. Halper ◽  
Anne M. Carlin ◽  
Karen M. Emmerson ◽  
Kelly N. Foster ◽  
...  
Keyword(s):  
United States ◽  
Mass Media ◽  
Rural Area ◽  
The United States ◽  
Mass Media Campaign ◽  
Media Campaign ◽  
Sugar Sweetened Beverages ◽  
Sweetened Beverages

scholarly journals Sugar-Sweetened Beverages, Fruit Juice, and Low-Calorie Beverages, and All-Cause Mortality Risk Among Dutch Adults: The Lifelines Cohort Study Within the SWEET Project

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1066-1066
Author(s):  
Novita Naomi ◽  
Elske Brouwer-Brolsma ◽  
Marion Buso ◽  
Sabita Soedamah-Muthu ◽  
Johanna Geleijnse ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Risk ◽  
Lower Risk ◽  
Fruit Juice ◽  
Cohort Analysis ◽  
Dietary Factors ◽  
Sugar Sweetened Beverages ◽  
Low Calorie ◽  
Sweetened Beverages ◽  
All Cause Mortality

Abstract Objectives To examine prospective associations between intakes of sugar-sweetened beverages (SSB), fruit juice, and low-calorie beverages (LCB), and all-cause mortality among Dutch adults participating in the Lifelines Cohort Study. Methods A total of 118,439 participants aged 45 ± 13 years (60% women) were included in a prospective cohort analysis. Dietary intake at baseline was assessed using an extensive semi-quantitative food frequency questionnaire (FFQ). Uni- and multivariate Cox proportional hazard regression analyses, including substitution analyses, were performed adjusted for demographics, self-reported diseases and lifestyle, and dietary factors. The association was modelled continuously in each 1 glass (or 150 mL)/day intake increment and in four categories of each beverages intake (no intake, ≤2 glass/week, &gt;2--&lt;7 glass/week, and ≥1 glass/day). Results Of the total participants, 63% were SSB consumers, 76% were fruit juice consumers, and 56% were LCB consumers. The median intake among consumers was 0.4 [0.2–1.0] glass/day for SSB, 0.3 [0.1–0.7] glass/day for fruit juice, and 0.5 [1.2–1.1] glass/day for LCB. During a follow-up period of 8.3 [7.5–9.3] y, 2,023 (1.8%) deaths were recorded. Compared to no intake, ≥1 glass SSB/day was associated with a higher risk of mortality (HR 1.24, 95% CI 1.05, 1.46), whereas LCB intake was not associated with all-cause mortality risk. Theoretical replacement of 1 glass/day of SSB with the same amount of LCB was associated with a lower risk of all-cause mortality (HR 0.90, 95% CI 0.83, 0.98). Finally, compared to no intake, moderate fruit juice intake (≤2 glass/week and &gt;2--&lt;7 glass/week) was inversely associated with all-cause mortality (HR 0.80, 95% CI 0.72, 0.90 and HR 0.85, 95% CI 0.76, 0.95 respectively). Conclusions SSB intake was associated with a higher risk of all-cause mortality in the general Dutch adult population, whereas moderate fruit juice intake showed the opposite. Replacing SSB with LCB was associated with a lower risk of all-cause mortality Funding Sources This EU-project under the acronym “SWEET” has received funding from the European Union's Horizon 2020 research and innovation programme. The material presented and views expressed here are the responsibility of the author(s) only. The EU Commission takes no responsibility for any use made of the information set out.

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