Excessive sodium intake is a major global public health issue and the identification of dietary s... more Excessive sodium intake is a major global public health issue and the identification of dietary sources and temporal trends in its consumption are a key to effective sodium reduction policies. This study aims to update estimates of sodium intake and its dietary sources in Brazil according to the NOVA food classification system. Records of 7-day food purchases of households from the
ABSTRACTBackgroundUltra-processed foods (UPFs) are becoming dominant in the global food and suppl... more ABSTRACTBackgroundUltra-processed foods (UPFs) are becoming dominant in the global food and supply. Prospective cohort studies have found an association between UPF dietary pattern and increased risk of several non-communicable diseases and all-cause mortality. In this study, we (1) estimated the risk of all-cause mortality associated for each 10% increase in the share of UPF consumption in the total energy intake; (2) estimated the population attributable fractions (PAF) and the total number of premature deaths attributable to the consumption of UPF in adults (30-69 years) from 8 selected countries.MethodsFirst, we performed a dose-response meta-analysis of observational cohort studies assessing the association between UPFs dietary pattern and all-cause mortality. As we found evidence of linearity, we estimated the pooled RR (and its 95% CI) for all-cause mortality per each 10% increment in the % UPF. Then, we estimated the population attributable fraction (PAF) of premature all-ca...
Rationale Intake of sugary beverages has been associated with obesity and chronic non-communicabl... more Rationale Intake of sugary beverages has been associated with obesity and chronic non-communicable diseases, thereby increasing the direct health costs related to these diseases. Front-ofpackage nutrition labeling (FoPNL) aims to help consumers understand food composition, thereby improving food choices and preventing the development of such diseases. Objective To estimate, over five years, the impact of implementing FoPNL in Brazil on the prevalence of excess body weight and obesity in adults who consume sugary beverages and the direct costs related to such problems. Methods A simulation study to performed to estimate the effect of FoPNL implementation on the prevalence of excess body weight and obesity. The VIGITEL research database (2019), published in the 2020 report, was used in this study (the final sample consisted of 12,471 data points representing 14,380,032 Brazilians). The scenarios were considered: base (trend in sugary beverage intake); 1 (base scenario associated with the changes in energy content of the purchased beverages observed after the first phase of the Chilean labeling law (−9.9%);
Background Dietary risk factors have an important impact on premature deaths and disabilities due... more Background Dietary risk factors have an important impact on premature deaths and disabilities due to non-communicable diseases. In this study, we perform diet optimization to design different dietary scenarios taking into account food prices and preferences and evaluate the number of deaths that would be prevented as well as the economic burden and costs from the health system that would be saved in Brazil. Methods We used dietary intake and food prices data from the nationwide Household Budget Survey (HBS) and the National Dietary Survey (NDS) 2017-2018. Linear programming models were performed to design five scenarios which different sets of key diet modifications at the least deviation from the baseline consumption. Comparative risk assessment models were used to estimate the health impacts of optimized dietary changes on mortality and the economic impacts on morbidity (hospitalizations) and premature deaths. Results The optimized diets were, on average, more expensive than the baseline diets, varying from Int$ (international dollar) 0.02/day to 0.52/day/adult. The number of deaths prevented or postponed varied from 12,750 (10,178-15,225) to 57,341 (48,573-66,298) according to the different scenarios. The diet modifications would save from 50 to 219 million in hospitalizations and from 239 to 804 million yearly in productivity losses with the reduction of premature deaths. Conclusion A substantial number of deaths and costs due to hospitalization and productivity losses would be avoidable even with small changes in diets. However, even the cheapest
Objective: To describe the time trends and socioeconomic inequalities in infant and young child f... more Objective: To describe the time trends and socioeconomic inequalities in infant and young child feeding practices in accordance with the Brazilian deprivation index (BDI). Design: This time-series study analysed the prevalence of multiple breast-feeding and complementary feeding indicators based on data from the Brazilian Food and Nutrition Surveillance System, 2008-2019. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated. Setting: Primary health care services, Brazil. Participants: Totally, 911 735 Brazilian children under 2 years old. Results: Breast-feeding and complementary feeding practices differed between the extreme BDI quintiles. Overall, the results were more favourable in the municipalities with less deprivation (Q1). Improvements in some complementary feeding indicators were observed over time and evidenced such disparities: minimum dietary diversity (Q1:
OBJECTIVE: to describe self-reported high sodium consumption prevalence in adults and compare res... more OBJECTIVE: to describe self-reported high sodium consumption prevalence in adults and compare results in Brazilian capitals and the Federal District based on data from the 2013 National Health Survey (PNS) and from the 2013 Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel). METHODS: this was a descriptive study using PNS and Vigitel data, estimating prevalence and confidence intervals (95%CI). RESULTS: PNS data indicates that 14.2% (95%CI:13.6%-14.7%) of adults reported high sodium consumption. It was higher in men (16.1%;95%CI:15.3-16.9), people aged 18-29 (17.7%;95%CI:16.2-19.2), those with higher education (17.3%;95%CI:15.6-19.0), living in urban areas (14.8%;95%CI:13.6-14.7), and in Southern Brazil (18.2%;95%CI:16.8-19.7). When comparing capitals, there was no statistical difference between PNS and Vigitel, although statistical difference was found in Rio Branco and Aracaju. CONCLUSION: similar rates of high prevalence were found in both studies, reinforcing Vigitel's important monitoring role.
Objective: to describe self-reported high sodium consumption prevalence in adults and compare res... more Objective: to describe self-reported high sodium consumption prevalence in adults and compare results in Brazilian capitals and the Federal District based on data from the 2013 National Health Survey (PNS) and from the 2013 Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel). Methods: this was a descriptive study using PNS and Vigitel data, estimating prevalence and confidence intervals (95%CI). Results: PNS data indicates that 14.2% (95%CI:13.6%-14.7%) of adults reported high sodium consumption. It was higher in men (16.1%;95%CI:15.3-16.9), people aged 18-29 (17.7%;95%CI:16.2-19.2), those with higher education (17.3%;95%CI:15.6-19.0), living in urban areas (14.8%;95%CI:13.6-14.7), and in Southern Brazil (18.2%;95%CI:16.8-19.7). When comparing capitals, there was no statistical difference between PNS and Vigitel, although statistical difference was found between Rio Branco and Aracaju. Conclusion: similar rates of high prevalence were found in both studies, reinforcing Vigitel's important monitoring role.
European Journal of Clinical Nutrition, Sep 20, 2021
Background: Insufficient iodine intake in pregnancy is associated with many adverse pregnancy out... more Background: Insufficient iodine intake in pregnancy is associated with many adverse pregnancy outcomes. About 90% of African countries are at risk of iodine deficiency due to poor soils and dietary goitrogens. Pregnancy predisposes to insufficient iodine nutrition secondary to increased physiological demand and increased renal loss. Iodine deficiency is re-emerging in countries thought to be replete with pregnant women being the most affected. This review seeks to identify the degree of iodine nutrition in pregnancy on the entire African continent before and after the implementation of national iodization programmes. Methods: A systematic search of published literature will be conducted for observational studies that directly determined the prevalence of insufficient iodine intake among pregnant women in Africa. Electronic databases and grey literature will be searched for baseline data before the implementation of population-based iodine supplementation and for follow-up data up to December 2018. Screening of identified articles and data extraction will be conducted independently by two investigators. Risk of bias and methodological quality of the included studies will be assessed using a risk of bias tool. Appropriate meta-analytic techniques will be used to pool prevalence estimates from studies with similar features, overall and by major characteristics including the region of the study, time period (before and after implementation of iodization programmes), sample size and age. Heterogeneity of the estimates across studies will be quantified and publication bias investigated. This protocol is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) 2015 guidelines. Discussion: This review will help ascertain the impact of national iodization programmes on the iodine nutrition status in pregnancy in Africa and advise policy on the necessity for monitoring and mitigating iodine deficiency in pregnancy in Africa. This review is part of a thesis that will be submitted to the Faculty of Health Sciences, University of Cape Town, for the award of a PhD in Medicine whose protocol has been granted ethics approval (UCT HREC 135/2018). In addition, the results will be published in a peer-reviewed journal.
International Journal of Environmental Research and Public Health, Jan 13, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background Previous studies have quantified the current burden of diseases attributable to overwe... more Background Previous studies have quantified the current burden of diseases attributable to overweight in Chile. However, no study has estimated the attributable burden of overweight in the future. Herein, we estimated the potential impact of different trajectories in the prevalence of overweight on the incidence and mortality from non-communicable diseases (NCDs) in Chilean adults from 2019 to 2030. Methods A multistate life table modelling was used to estimate the business-as-usual (BAU: if the current rate of increase in BMI persist through the next 11 years; i.e., 0.4% per year from 2003 to 2017) and three counterfactual scenarios (1: the increase rate of overweight is reduced by half; 2: maintanance of the current prevalence of overweight; 3: the prevalence of overweight is reduced by 6.7%) over a 11-year simulation period for burden of NCDs attributable to overweight in Chilean adults aged 20 to 80 years. The model inputs included nationally representative data of body mass ind...
Doenças crônicas não transmissíveis correspondem à principal causa de morte no mundo e têm a alim... more Doenças crônicas não transmissíveis correspondem à principal causa de morte no mundo e têm a alimentação inadequada como um de seus principais fatores de risco modificáveis, destacando-se o consumo excessivo de sódio e sua associação com doenças cardiovasculares, mediadas pela pressão arterial. Este estudo avaliou o impacto de diferentes cenários de políticas para a redução do consumo de sódio com base em alimentos processados e ultraprocessados na prevenção de mortes por desfechos cardiovasculares na população adulta no Brasil. Foram utilizados dados secundários, de relatórios e bases públicas do Sistema Único de Saúde e de inquéritos populacionais. Foram analisados os impactos, até 2027, de três cenários: manutenção das atuais metas voluntárias, e dois cenários mandatórios, considerando as menores metas nas Américas e as menores metas mundiais. Para a análise das mortes prevenidas ou adiadas com base no consumo de sódio em tais cenários foi utilizado o Preventable Risk Integrated ...
Excessive sodium intake is a major global public health issue and the identification of dietary s... more Excessive sodium intake is a major global public health issue and the identification of dietary sources and temporal trends in its consumption are a key to effective sodium reduction policies. This study aims to update estimates of sodium intake and its dietary sources in Brazil according to the NOVA food classification system. Records of 7-day food purchases of households from the
ABSTRACTBackgroundUltra-processed foods (UPFs) are becoming dominant in the global food and suppl... more ABSTRACTBackgroundUltra-processed foods (UPFs) are becoming dominant in the global food and supply. Prospective cohort studies have found an association between UPF dietary pattern and increased risk of several non-communicable diseases and all-cause mortality. In this study, we (1) estimated the risk of all-cause mortality associated for each 10% increase in the share of UPF consumption in the total energy intake; (2) estimated the population attributable fractions (PAF) and the total number of premature deaths attributable to the consumption of UPF in adults (30-69 years) from 8 selected countries.MethodsFirst, we performed a dose-response meta-analysis of observational cohort studies assessing the association between UPFs dietary pattern and all-cause mortality. As we found evidence of linearity, we estimated the pooled RR (and its 95% CI) for all-cause mortality per each 10% increment in the % UPF. Then, we estimated the population attributable fraction (PAF) of premature all-ca...
Rationale Intake of sugary beverages has been associated with obesity and chronic non-communicabl... more Rationale Intake of sugary beverages has been associated with obesity and chronic non-communicable diseases, thereby increasing the direct health costs related to these diseases. Front-ofpackage nutrition labeling (FoPNL) aims to help consumers understand food composition, thereby improving food choices and preventing the development of such diseases. Objective To estimate, over five years, the impact of implementing FoPNL in Brazil on the prevalence of excess body weight and obesity in adults who consume sugary beverages and the direct costs related to such problems. Methods A simulation study to performed to estimate the effect of FoPNL implementation on the prevalence of excess body weight and obesity. The VIGITEL research database (2019), published in the 2020 report, was used in this study (the final sample consisted of 12,471 data points representing 14,380,032 Brazilians). The scenarios were considered: base (trend in sugary beverage intake); 1 (base scenario associated with the changes in energy content of the purchased beverages observed after the first phase of the Chilean labeling law (−9.9%);
Background Dietary risk factors have an important impact on premature deaths and disabilities due... more Background Dietary risk factors have an important impact on premature deaths and disabilities due to non-communicable diseases. In this study, we perform diet optimization to design different dietary scenarios taking into account food prices and preferences and evaluate the number of deaths that would be prevented as well as the economic burden and costs from the health system that would be saved in Brazil. Methods We used dietary intake and food prices data from the nationwide Household Budget Survey (HBS) and the National Dietary Survey (NDS) 2017-2018. Linear programming models were performed to design five scenarios which different sets of key diet modifications at the least deviation from the baseline consumption. Comparative risk assessment models were used to estimate the health impacts of optimized dietary changes on mortality and the economic impacts on morbidity (hospitalizations) and premature deaths. Results The optimized diets were, on average, more expensive than the baseline diets, varying from Int$ (international dollar) 0.02/day to 0.52/day/adult. The number of deaths prevented or postponed varied from 12,750 (10,178-15,225) to 57,341 (48,573-66,298) according to the different scenarios. The diet modifications would save from 50 to 219 million in hospitalizations and from 239 to 804 million yearly in productivity losses with the reduction of premature deaths. Conclusion A substantial number of deaths and costs due to hospitalization and productivity losses would be avoidable even with small changes in diets. However, even the cheapest
Objective: To describe the time trends and socioeconomic inequalities in infant and young child f... more Objective: To describe the time trends and socioeconomic inequalities in infant and young child feeding practices in accordance with the Brazilian deprivation index (BDI). Design: This time-series study analysed the prevalence of multiple breast-feeding and complementary feeding indicators based on data from the Brazilian Food and Nutrition Surveillance System, 2008-2019. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated. Setting: Primary health care services, Brazil. Participants: Totally, 911 735 Brazilian children under 2 years old. Results: Breast-feeding and complementary feeding practices differed between the extreme BDI quintiles. Overall, the results were more favourable in the municipalities with less deprivation (Q1). Improvements in some complementary feeding indicators were observed over time and evidenced such disparities: minimum dietary diversity (Q1:
OBJECTIVE: to describe self-reported high sodium consumption prevalence in adults and compare res... more OBJECTIVE: to describe self-reported high sodium consumption prevalence in adults and compare results in Brazilian capitals and the Federal District based on data from the 2013 National Health Survey (PNS) and from the 2013 Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel). METHODS: this was a descriptive study using PNS and Vigitel data, estimating prevalence and confidence intervals (95%CI). RESULTS: PNS data indicates that 14.2% (95%CI:13.6%-14.7%) of adults reported high sodium consumption. It was higher in men (16.1%;95%CI:15.3-16.9), people aged 18-29 (17.7%;95%CI:16.2-19.2), those with higher education (17.3%;95%CI:15.6-19.0), living in urban areas (14.8%;95%CI:13.6-14.7), and in Southern Brazil (18.2%;95%CI:16.8-19.7). When comparing capitals, there was no statistical difference between PNS and Vigitel, although statistical difference was found in Rio Branco and Aracaju. CONCLUSION: similar rates of high prevalence were found in both studies, reinforcing Vigitel's important monitoring role.
Objective: to describe self-reported high sodium consumption prevalence in adults and compare res... more Objective: to describe self-reported high sodium consumption prevalence in adults and compare results in Brazilian capitals and the Federal District based on data from the 2013 National Health Survey (PNS) and from the 2013 Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel). Methods: this was a descriptive study using PNS and Vigitel data, estimating prevalence and confidence intervals (95%CI). Results: PNS data indicates that 14.2% (95%CI:13.6%-14.7%) of adults reported high sodium consumption. It was higher in men (16.1%;95%CI:15.3-16.9), people aged 18-29 (17.7%;95%CI:16.2-19.2), those with higher education (17.3%;95%CI:15.6-19.0), living in urban areas (14.8%;95%CI:13.6-14.7), and in Southern Brazil (18.2%;95%CI:16.8-19.7). When comparing capitals, there was no statistical difference between PNS and Vigitel, although statistical difference was found between Rio Branco and Aracaju. Conclusion: similar rates of high prevalence were found in both studies, reinforcing Vigitel's important monitoring role.
European Journal of Clinical Nutrition, Sep 20, 2021
Background: Insufficient iodine intake in pregnancy is associated with many adverse pregnancy out... more Background: Insufficient iodine intake in pregnancy is associated with many adverse pregnancy outcomes. About 90% of African countries are at risk of iodine deficiency due to poor soils and dietary goitrogens. Pregnancy predisposes to insufficient iodine nutrition secondary to increased physiological demand and increased renal loss. Iodine deficiency is re-emerging in countries thought to be replete with pregnant women being the most affected. This review seeks to identify the degree of iodine nutrition in pregnancy on the entire African continent before and after the implementation of national iodization programmes. Methods: A systematic search of published literature will be conducted for observational studies that directly determined the prevalence of insufficient iodine intake among pregnant women in Africa. Electronic databases and grey literature will be searched for baseline data before the implementation of population-based iodine supplementation and for follow-up data up to December 2018. Screening of identified articles and data extraction will be conducted independently by two investigators. Risk of bias and methodological quality of the included studies will be assessed using a risk of bias tool. Appropriate meta-analytic techniques will be used to pool prevalence estimates from studies with similar features, overall and by major characteristics including the region of the study, time period (before and after implementation of iodization programmes), sample size and age. Heterogeneity of the estimates across studies will be quantified and publication bias investigated. This protocol is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) 2015 guidelines. Discussion: This review will help ascertain the impact of national iodization programmes on the iodine nutrition status in pregnancy in Africa and advise policy on the necessity for monitoring and mitigating iodine deficiency in pregnancy in Africa. This review is part of a thesis that will be submitted to the Faculty of Health Sciences, University of Cape Town, for the award of a PhD in Medicine whose protocol has been granted ethics approval (UCT HREC 135/2018). In addition, the results will be published in a peer-reviewed journal.
International Journal of Environmental Research and Public Health, Jan 13, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background Previous studies have quantified the current burden of diseases attributable to overwe... more Background Previous studies have quantified the current burden of diseases attributable to overweight in Chile. However, no study has estimated the attributable burden of overweight in the future. Herein, we estimated the potential impact of different trajectories in the prevalence of overweight on the incidence and mortality from non-communicable diseases (NCDs) in Chilean adults from 2019 to 2030. Methods A multistate life table modelling was used to estimate the business-as-usual (BAU: if the current rate of increase in BMI persist through the next 11 years; i.e., 0.4% per year from 2003 to 2017) and three counterfactual scenarios (1: the increase rate of overweight is reduced by half; 2: maintanance of the current prevalence of overweight; 3: the prevalence of overweight is reduced by 6.7%) over a 11-year simulation period for burden of NCDs attributable to overweight in Chilean adults aged 20 to 80 years. The model inputs included nationally representative data of body mass ind...
Doenças crônicas não transmissíveis correspondem à principal causa de morte no mundo e têm a alim... more Doenças crônicas não transmissíveis correspondem à principal causa de morte no mundo e têm a alimentação inadequada como um de seus principais fatores de risco modificáveis, destacando-se o consumo excessivo de sódio e sua associação com doenças cardiovasculares, mediadas pela pressão arterial. Este estudo avaliou o impacto de diferentes cenários de políticas para a redução do consumo de sódio com base em alimentos processados e ultraprocessados na prevenção de mortes por desfechos cardiovasculares na população adulta no Brasil. Foram utilizados dados secundários, de relatórios e bases públicas do Sistema Único de Saúde e de inquéritos populacionais. Foram analisados os impactos, até 2027, de três cenários: manutenção das atuais metas voluntárias, e dois cenários mandatórios, considerando as menores metas nas Américas e as menores metas mundiais. Para a análise das mortes prevenidas ou adiadas com base no consumo de sódio em tais cenários foi utilizado o Preventable Risk Integrated ...
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