Estimating the potential public health impact of fibre enrichment: a UK modelling study

Abstract For improving human health, reformulation can be a tool as it allows individuals to consume products of choice while reducing intake of less desirable nutrients, such as sugars and fats, and potentially increasing intake of beneficial nutrients such as fibre. The potential effects of reformulating foods with increased fibre on diet and on health needs to be better understood. The objective of this statistical modelling study was to understand how fibre enrichment can affect the diet and health of consumers. The UK National Diet and Nutrition Survey (NDNS) datasets from 2014 - 2015 and 2015 - 2016 were utilised to evaluate intakes of fibre and Kilocalories with a dietary intake model. Foods and beverages eligible for fibre enrichment were identified (n = 915) based on EU legislation for fibre content claims. Those people who meet Dietary Reference Values (DRVs) and fibre enrichment health outcomes such as weight, cardiovascular disease and type 2 diabetes risk reductions were quantified pre and post fibre reformulation via Reynolds et al, D’Agostino et al, and QDiabetes algorithms, respectively. The fibre enrichment intervention showed a mean fibre intake in the UK of 19.9 g/day, signifying a 2.2 g/day increase from baseline. Modelling suggested that 5.9% of subjects could achieve a weight reduction, 72.2% a reduction in cardiovascular risk, and 71.7% a reduced risk of type 2 diabetes risk with fibre fortification (all p ≤ 0.05). This study gave a good overview of the potential public health benefits of reformulating food products using a straightforward enrichment scenario.

Download Full-text

Day-Time Patterns of Carbohydrate Intake in Adults by Non-Parametric Multi-Level Latent Class Analysis—Results from the UK National Diet and Nutrition Survey (2008/09–2015/16)

Nutrients ◽

10.3390/nu11102476 ◽

2019 ◽

Vol 11 (10) ◽

pp. 2476

Author(s):

Wang ◽

Almoosawi ◽

Palla

Keyword(s):

Type 2 Diabetes ◽

Latent Class Analysis ◽

Total Energy ◽

Energy Intake ◽

Latent Class ◽

Eating Patterns ◽

Class Analysis ◽

Nutrition Survey ◽

The Uk

This study aims at combining time and quantity of carbohydrate (CH) intake in the definition of eating patterns in UK adults and investigating the association of the derived patterns with type 2 diabetes (T2D). The National Diet and Nutrition Survey (NDNS) Rolling Program included 6155 adults in the UK. Time of the day was categorized into 7 pre-defined time slots: 6–9 am, 9–12 noon, 12–2 pm, 2–5 pm, 5–8 pm, 8–10 pm, and 10 pm–6 am. Responses for CH intake were categorized into: no energy intake, CH <50% or ≥50% of total energy. Non-parametric multilevel latent class analysis (MLCA) was applied to identify eating patterns of CH consumption across day-time, as a novel method accounting for the repeated measurements of intake over 3–4 days nested within individuals. Survey-designed multivariable regression was used to assess the associations of CH eating patterns with T2D. Three CH eating day patterns (low, high CH percentage and frequent CH intake day) emerged from 24,483 observation days; based on which three classes of CH eaters were identified and characterized as: low (28.1%), moderate (28.8%) and high (43.1%) CH eaters. On average, low-CH eaters consumed the highest amount of total energy intake (7985.8 kJ) and had higher percentages of energy contributed by fat and alcohol, especially after 8 pm. Moderate-CH eaters consumed the lowest amount of total energy (7341.8 kJ) while they tended to have their meals later in the day. High-CH eaters consumed most of their carbohydrates and energy earlier in the day and within the time slots of 6–9 am, 12–2 pm and 5–8 pm, which correspond to traditional mealtimes. The high-CH eaters profile had the highest daily intake of CH and fiber and the lowest intake of protein and fat. Low-CH eaters had greater odds than high-CH eaters of having T2D in self-reported but not in previously undiagnosed diabetics. Further research using prospective longitudinal studies is warranted to ascertain the direction of causality in the association of CH patterns with type 2 diabetes.

Download Full-text

Understanding the complexity of socioeconomic disparities in type 2 diabetes risk: a study of 4.3 million people in Sweden

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000749 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000749 ◽

Cited By ~ 1

Author(s):

Maria Wemrell ◽

Louise Bennet ◽

Juan Merlo

Keyword(s):

Public Health ◽

Type 2 Diabetes ◽

Low Income ◽

Educational Achievement ◽

Absolute Risk ◽

Diabetes Risk ◽

Socioeconomic Disparities ◽

Heterogeneous Distribution ◽

Discriminatory Accuracy

ObjectiveInvestigating demographic and socioeconomic factors as intersecting rather than as separate dimensions may improve our understanding of the heterogeneous distribution of type 2 diabetes in the population. However, this complexity has scarcely been investigated and we still do not know the accuracy of these factors for predicting type 2 diabetes. Improved understanding of the demographic and socioeconomic disparities predicting type 2 diabetes risk in the population would contribute to more precise and effective public health interventions.Research design and methodsWe analyzed the risk of type 2 diabetes among 4 334 030 individuals aged 40–84 years who by 2010 had resided in Sweden for at least 5 years. We stratified the study population into 120 strata defined by categories of age, gender, income, education, and immigration status. We calculated measures of absolute risk (prevalence) and relative risk (prevalence ratio), and quantified the discriminatory accuracy of the information for predicting type 2 diabetes in the population.ResultsThe distribution of type 2 diabetes risk in the population was highly heterogeneous. For instance, immigrated men aged 70–79 years with low educational achievement and low income had a risk around 32 times higher than native women aged 40–49 years with high income and high educational achievement (ie, 17.6% vs 0.5%). The discriminatory accuracy of the information was acceptable.ConclusionA more detailed, intersectional mapping of socioeconomic and demographic distribution of type 2 diabetes can assist in public health management aiming to reduce the prevalence of the disease.

Download Full-text

Direct healthcare costs of sedentary behaviour in the UK

Journal of Epidemiology & Community Health ◽

10.1136/jech-2018-211758 ◽

2019 ◽

Vol 73 (7) ◽

pp. 625-629 ◽

Cited By ~ 13

Author(s):

Leonie Heron ◽

Ciaran O'Neill ◽

Helen McAneney ◽

Frank Kee ◽

Mark A Tully

Keyword(s):

Public Health ◽

Lung Cancer ◽

Type 2 Diabetes ◽

Sedentary Behaviour ◽

Healthcare Costs ◽

Double Counting ◽

All Cause Mortality ◽

Direct Healthcare Costs ◽

The Uk

BackgroundGrowing evidence indicates that prolonged sedentary behaviour increases the risk of several chronic health conditions and all-cause mortality. Sedentary behaviour is prevalent among adults in the UK. Quantifying the costs associated with sedentary behaviour is an important step in the development of public health policy.MethodsNational Health Service (NHS) costs associated with prolonged sedentary behaviour (≥6 hours/day) were estimated over a 1-year period in 2016–2017 costs. We calculated a population attributable fraction (PAF) for five health outcomes (type 2 diabetes, cardiovascular disease [CVD], colon cancer, endometrial cancer and lung cancer). Adjustments were made for potential double-counting due to comorbidities. We also calculated the avoidable deaths due to prolonged sedentary behaviour using the PAF for all-cause mortality.ResultsThe total NHS costs attributable to prolonged sedentary behaviour in the UK in 2016–2017 were £0.8 billion, which included expenditure on CVD (£424 million), type 2 diabetes (£281 million), colon cancer (£30 million), lung cancer (£19 million) and endometrial cancer (£7 million). After adjustment for potential double-counting, the estimated total was £0.7 billion. If prolonged sedentary behaviour was eliminated, 69 276 UK deaths might have been avoided in 2016.ConclusionsIn this conservative estimate of direct healthcare costs, prolonged sedentary behaviour causes a considerable burden to the NHS in the UK. This estimate may be used by decision makers when prioritising healthcare resources and investing in preventative public health programmes.

Download Full-text

Healthwise, Part 5. Prevention and treatment of type 2 diabetes

British Journal of Healthcare Assistants ◽

10.12968/bjha.2022.16.1.18 ◽

2022 ◽

Vol 16 (1) ◽

pp. 18-25

Author(s):

Linda Nazarko

Keyword(s):

Public Health ◽

Risk Factors ◽

Type 2 Diabetes ◽

Hospital Treatment ◽

Death Rates ◽

Prevention And Treatment ◽

Poor Outcomes ◽

The Uk

The coronavirus (COVID-19) pandemic has highlighted the importance of public health in the UK and globally. The UK's death rates and obesity rates are related and many people in the UK experience poor health because they are overweight or obese ( Lobstein, 2021 ; Mohammad et al, 2021 ). Obesity increases the risks of developing type 2 diabetes. People with both type 1 and type 2 diabetes are at greater risk of developing severe COVID symptoms, of requiring hospital treatment and of poor outcomes and death ( Barron et al, 2020 ). This article, the fifth in a series, examines risk factors for type 2 diabetes and explains how readers can reduce their risk of developing type 2 diabetes.

Download Full-text

Cholesterol and egg intakes and the risk of type 2 diabetes: The Japan Public Health Center-based Prospective Study

British Journal Of Nutrition ◽

10.1017/s000711451400258x ◽

2014 ◽

Vol 112 (10) ◽

pp. 1636-1643 ◽

Cited By ~ 22

Author(s):

Kayo Kurotani ◽

Akiko Nanri ◽

Atsushi Goto ◽

Tetsuya Mizoue ◽

Mitsuhiko Noda ◽

...

Keyword(s):

Public Health ◽

Type 2 Diabetes ◽

Prospective Study ◽

Health Center ◽

Postmenopausal Women ◽

Dietary Cholesterol ◽

Diabetes Risk ◽

Public Health Center ◽

Cholesterol Intake

Limited and inconsistent associations between cholesterol and egg consumption and type 2 diabetes risk have been observed in Western countries. In the present study, the association of dietary cholesterol and egg intakes with type 2 diabetes risk was examined prospectively. The study subjects comprised 27 248 men and 36 218 women aged 45–75 years who participated in the second survey of the Japan Public Health Center-based Prospective Study and had no histories of type 2 diabetes or other serious diseases. Dietary cholesterol and egg intakes were estimated using a validated 147-item FFQ. The OR of self-reported, physician-diagnosed type 2 diabetes over 5 years were estimated using multiple logistic regression. A total of 1165 newly diagnosed cases of type 2 diabetes were self-reported. Although dietary cholesterol intake was not associated with type 2 diabetes risk in men, it was found to be associated with a 23 % lower odds of type 2 diabetes risk in women in the highest quartile of intake, albeit not statistically significant, compared with those in the lowest quartile (Ptrend= 0·08). Such risk reduction was somewhat greater among postmenopausal women; the multivariable-adjusted OR for the highest quartile of cholesterol intake compared with the lowest quartile was 0·68 (95 % CI 0·49, 0·94; Ptrend= 0·04). No association between egg intake and type 2 diabetes risk was found in either men or women. In conclusion, higher intake of cholesterol or eggs may not be associated with an increased risk of type 2 diabetes in Japanese populations. The observed association between decreased type 2 diabetes risk and higher dietary cholesterol intake in postmenopausal women warrants further investigation.

Download Full-text