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

BACKGROUND: Promising school policies to improve children’s diets include providing fresh fruits and vegetables (F&V) and competitive food restrictions on sugar-sweetened beverages (SSBs), yet the impact of national implementation of these policies in US schools on cardiometabolic disease (CMD)...

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Autores principales: Rosettie, Katherine L., Micha, Renata, Cudhea, Frederick, Peñalvo, Jose L., O’Flaherty, Martin, Pearson-Stuttard, Jonathan, Economos, Christina D., Whitsel, Laurie P., Mozaffarian, Dariush
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034872/
https://www.ncbi.nlm.nih.gov/pubmed/29979761
http://dx.doi.org/10.1371/journal.pone.0200378
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author Rosettie, Katherine L.
Micha, Renata
Cudhea, Frederick
Peñalvo, Jose L.
O’Flaherty, Martin
Pearson-Stuttard, Jonathan
Economos, Christina D.
Whitsel, Laurie P.
Mozaffarian, Dariush
author_facet Rosettie, Katherine L.
Micha, Renata
Cudhea, Frederick
Peñalvo, Jose L.
O’Flaherty, Martin
Pearson-Stuttard, Jonathan
Economos, Christina D.
Whitsel, Laurie P.
Mozaffarian, Dariush
author_sort Rosettie, Katherine L.
collection PubMed
description BACKGROUND: Promising school policies to improve children’s diets include providing fresh fruits and vegetables (F&V) and competitive food restrictions on sugar-sweetened beverages (SSBs), yet the impact of national implementation of these policies in US schools on cardiometabolic disease (CMD) risk factors and outcomes is not known. Our objective was to estimate the impact of national implementation of F&V provision and SSB restriction in US elementary, middle, and high schools on dietary intake and body mass index (BMI) in children and future CMD mortality. METHODS: We used comparative risk assessment (CRA) frameworks to model the impacts of these policies with input parameters from nationally representative surveys, randomized-controlled trials, and systematic reviews and meta-analyses. For children ages 5–18 years, this incorporated national data on current dietary intakes and BMI, impacts of these policies on diet, and estimated effects of dietary changes on BMI. In adults ages 25 and older, we further incorporated the sustainability of dietary changes to adulthood, effects of dietary changes on CMD, and national CMD death statistics, modeling effects if these policies had been in place when current US adults were children. Uncertainty across inputs was incorporated using 1000 Monte Carlo simulations. RESULTS: National F&V provision would increase daily fruit intake in children by as much as 25.0% (95% uncertainty interval (UI): 15.4, 37.7%), and would have small effects on vegetable intake. SSB restriction would decrease daily SSB intake by as much as 26.5% (95% UI: 6.4, 46.4%), and reduce BMI by as much as 0.7% (95% UI: 0.2, 1.2%). If F&V provision and SSB restriction were nationally implemented, an estimated 22,383 CMD deaths/year (95% UI: 18735, 25930) would be averted. CONCLUSION: National school F&V provision and SSB restriction policies implemented in elementary, middle, and high schools could improve diet and BMI in children and reduce CMD mortality later in life.
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spelling pubmed-60348722018-07-19 Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States Rosettie, Katherine L. Micha, Renata Cudhea, Frederick Peñalvo, Jose L. O’Flaherty, Martin Pearson-Stuttard, Jonathan Economos, Christina D. Whitsel, Laurie P. Mozaffarian, Dariush PLoS One Research Article BACKGROUND: Promising school policies to improve children’s diets include providing fresh fruits and vegetables (F&V) and competitive food restrictions on sugar-sweetened beverages (SSBs), yet the impact of national implementation of these policies in US schools on cardiometabolic disease (CMD) risk factors and outcomes is not known. Our objective was to estimate the impact of national implementation of F&V provision and SSB restriction in US elementary, middle, and high schools on dietary intake and body mass index (BMI) in children and future CMD mortality. METHODS: We used comparative risk assessment (CRA) frameworks to model the impacts of these policies with input parameters from nationally representative surveys, randomized-controlled trials, and systematic reviews and meta-analyses. For children ages 5–18 years, this incorporated national data on current dietary intakes and BMI, impacts of these policies on diet, and estimated effects of dietary changes on BMI. In adults ages 25 and older, we further incorporated the sustainability of dietary changes to adulthood, effects of dietary changes on CMD, and national CMD death statistics, modeling effects if these policies had been in place when current US adults were children. Uncertainty across inputs was incorporated using 1000 Monte Carlo simulations. RESULTS: National F&V provision would increase daily fruit intake in children by as much as 25.0% (95% uncertainty interval (UI): 15.4, 37.7%), and would have small effects on vegetable intake. SSB restriction would decrease daily SSB intake by as much as 26.5% (95% UI: 6.4, 46.4%), and reduce BMI by as much as 0.7% (95% UI: 0.2, 1.2%). If F&V provision and SSB restriction were nationally implemented, an estimated 22,383 CMD deaths/year (95% UI: 18735, 25930) would be averted. CONCLUSION: National school F&V provision and SSB restriction policies implemented in elementary, middle, and high schools could improve diet and BMI in children and reduce CMD mortality later in life. Public Library of Science 2018-07-06 /pmc/articles/PMC6034872/ /pubmed/29979761 http://dx.doi.org/10.1371/journal.pone.0200378 Text en © 2018 Rosettie et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Rosettie, Katherine L.
Micha, Renata
Cudhea, Frederick
Peñalvo, Jose L.
O’Flaherty, Martin
Pearson-Stuttard, Jonathan
Economos, Christina D.
Whitsel, Laurie P.
Mozaffarian, Dariush
Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States
title Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States
title_full Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States
title_fullStr Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States
title_full_unstemmed Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States
title_short Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States
title_sort comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the united states
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034872/
https://www.ncbi.nlm.nih.gov/pubmed/29979761
http://dx.doi.org/10.1371/journal.pone.0200378
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