Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States

AbstractIntroduction:The disbalanced school food environment may be a significant factor contributing to the childhood obesity epidemic observed in the last decades worldwide and in Bulgaria. Policy measures targeting to improve the food and beverage availability at the school premises, to include nutrition education in the school curriculum and to implement initiatives aiming to promote a healthy lifestyle among children and their families, all have the potential to help lowering the prevalence of childhood obesity and improve the well-being and health of the children.The aim of the present study is to assess the policy driven improvement of the school food environment for the Bulgarian first-graders within the period 2008–2016.Materials and methods:Three cross-sectional studies among 7-year-old schoolchildren in Bulgaria were carried out on nationally representative samples of about 3500 children selected from the same sample of primary schools in the years 2008, 2013 and 2016 as part of the WHO European Childhood Obesity Surveillance Initiative (COSI). The present study is based on the data collected through questionnaire on the school environment characteristics.Results:Within the nationally representative sample of schools from 2008 to 2016 there is decrease in the percentage of schools with availability at their premises of salty snacks (from 73.7% to 32.3%), sweet snacks (from 76.5% to 49.7%), cold drinks with sugar (from 68.2% to 10.1%) and fruit juices with sugar (from 69.3% to 8.7%), paralleled by increase in the proportion of schools offering vegetables (from 17.9% to 59.8%) and fresh fruits (from 36.9% to 87.4%). Most of the schools have nutrition education as a separate class or included in the curriculum (92.4% of the schools in 2008 and 91.5% in 2016). There is marked increase in the proportion of schools that have initiatives to promote healthy lifestyles (from 42.4% in 2008 to 68.3% in 2016).Discussion:The legislative and policy measures initiated within the period 2008–2016 have led to significant improvement in the profile of foods and drinks available at the school premises, as well as higher involvement of the schools in initiatives promoting healthy lifestyles. These positive changes in the school food environment have probably important role for the trend for plateauing in the prevalence of overweight and obesity among 7-year-old schoolchildren observed within the same study.

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Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis

Journal of the American Heart Association ◽

10.1161/jaha.120.019259 ◽

2021 ◽

Author(s):

Meghan O’Hearn ◽

Junxiu Liu ◽

Frederick Cudhea ◽

Renata Micha ◽

Dariush Mozaffarian

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Risk Assessment ◽

The United States ◽

Sensitivity Analyses ◽

Cardiometabolic Health ◽

Comparative Risk Assessment ◽

Surveillance Network ◽

Comparative Risk ◽

Race Ethnicity

BACKGROUND Risk of coronavirus disease 2019 (COVID‐19) hospitalization is robustly linked to cardiometabolic health. We estimated the absolute and proportional COVID‐19 hospitalizations in US adults attributable to 4 major US cardiometabolic conditions, separately and jointly, and by race/ethnicity, age, and sex. METHODS AND RESULTS We used the best available estimates of independent associations of cardiometabolic conditions with a risk of COVID‐19 hospitalization; nationally representative data on cardiometabolic conditions from the National Health and Nutrition Examination Survey 2015 to 2018; and US COVID‐19 hospitalizations stratified by age, sex, and race/ethnicity from the Centers for Disease Control and Prevention’s Coronavirus Disease 2019–Associated Hospitalization Surveillance Network database and from the COVID Tracking Project to estimate the numbers and proportions of COVID‐19 hospitalizations attributable to diabetes mellitus, obesity, hypertension, and heart failure. Inputs were combined in a comparative risk assessment framework, with probabilistic sensitivity analyses and 1000 Monte Carlo simulations to jointly incorporate stratum‐specific uncertainties in data inputs. As of November 18, 2020, an estimated 906 849 COVID‐19 hospitalizations occurred in US adults. Of these, an estimated 20.5% (95% uncertainty interval [UIs], 18.9–22.1) of COVID‐19 hospitalizations were attributable to diabetes mellitus, 30.2% (UI, 28.2–32.3) to total obesity (body mass index ≥30 kg/m 2 ), 26.2% (UI, 24.3–28.3) to hypertension, and 11.7% (UI, 9.5–14.1) to heart failure. Considered jointly, 63.5% (UI, 61.6–65.4) or 575 419 (UI, 559 072–593 412) of COVID‐19 hospitalizations were attributable to these 4 conditions. Large differences were seen in proportions of cardiometabolic risk–attributable COVID‐19 hospitalizations by age and race/ethnicity, with smaller differences by sex. CONCLUSIONS A substantial proportion of US COVID‐19 hospitalizations appear attributable to major cardiometabolic conditions. These results can help inform public health prevention strategies to reduce COVID‐19 healthcare burdens.

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Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States

Obesity Reviews ◽

10.1111/obr.13237 ◽

2021 ◽

Vol 22 (S3) ◽

Author(s):

Ana Clara Duran ◽

Melissa Mialon ◽

Eric Crosbie ◽

Melissa Lorena Jensen ◽

Jennifer L. Harris ◽

...

Keyword(s):

United States ◽

Latin America ◽

Childhood Obesity ◽

Food Environment ◽

The United States

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School Food Environment the Frontline for Childhood Obesity Prevention - A Mixed-Methods Study of Nutritional Competencies and Skills of School Nutrition Professionals in Nebraska

Journal of the Academy of Nutrition and Dietetics ◽

10.1016/j.jand.2016.06.103 ◽

2016 ◽

Vol 116 (9) ◽

pp. A31

Author(s):

Z. Rida ◽

T. Carr ◽

C. Kohnke ◽

J. Albrecht

Keyword(s):

Mixed Methods ◽

Childhood Obesity ◽

Obesity Prevention ◽

Food Environment ◽

School Nutrition ◽

Mixed Methods Study ◽

School Food ◽

Childhood Obesity Prevention ◽

School Food Environment ◽

Nutrition Professionals

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Abstract 01: The Impact of School Food Environment Policies on Child Dietary Intake and BMI and Future Cardiometabolic Outcomes in the United States

Circulation ◽

10.1161/circ.135.suppl_1.01 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Katherine L Rosettie ◽

Renata Micha ◽

Jose L Peñalvo ◽

Frederick Cudhea ◽

Dariush Mozaffarian

Keyword(s):

Food Environment ◽

Vegetable Intake ◽

The United States ◽

Dietary Factors ◽

Assessment Model ◽

Sensitivity Analyses ◽

School Food ◽

School Food Environment ◽

Meta Analyses ◽

The Impact

Introduction: Promising school food environment policies include providing fresh fruits and vegetables (F&V provision) and competitive food restrictions on sugar-sweetened beverages (SSB restriction). Yet, the impact of these policies on diet and BMI in children and future cardiometabolic disease (CMD) outcomes is not established. Methods: We used a comparative risk assessment model to estimate the effects of F&V provision and SSB restriction on diet and BMI in US children age 5-18 yrs. We used national data from NHANES 2009-12 on baseline BMI and intakes of fruits, vegetables, and SSBs; impacts of these policies on diet from meta-analyses of interventions; and estimated effects of dietary changes on BMI from trials and cohorts. We also estimated the effects of these school policies on CMD in current US adults if such policies had been implemented in their childhood, based on meta-analysis of long-term within-person correlations of childhood and adult diets, meta-analyses of diet and CMD, and data on national CMD deaths. Model inputs were stratified by age, sex, and race, where appropriate. Point estimates and 95% uncertainty intervals were derived from probabilistic sensitivity analyses using 1000 Monte Carlo simulations. Results: F&V provision would increase overall fruit intake in children by ~ 14-21% and would not significantly increase vegetable intake ( Table ). SSB restriction would decrease overall SSB intake by ~ 6-11% and BMI (kg/m 2 ) by 0.2-0.3%. Among these dietary factors, reducing SSBs had the largest estimated impact on CMD (2418 deaths averted/year), followed by providing fruits (2121) and vegetables (165). If US adults had been exposed to both policies, an estimated 4703 CMD deaths/year would be averted, representing 0.67% of all CMD deaths. Conclusions: Specific US school food environment policies involving F&V provision and SSB restriction would modestly improve diet and BMI in children, and could prevent up to 0.7% of all CMD deaths.

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