92 results found
Gressier M, Sassi F, Frost G, 2021, Contribution of reformulation, product renewal, and changes in consumer behavior to the reduction of salt intakes in the UK population between 2008/2009 and 2016/2017, The American Journal of Clinical Nutrition, ISSN: 0002-9165
BackgroundThe UK salt reduction program started in 2003, consisting of education campaigns to raise awareness about the risks associated with a high-salt diet and of a reformulation strategy for food manufacturers. This program is often cited as an example of a successful public health program.ObjectivesThis study aimed to assess: 1) the impacts of changes in food composition and changes in consumer behavior on sodium intakes; and 2) whether changes were similar across socioeconomic groups.MethodsFood intakes for the UK population were derived from food diaries in the UK National Diet and Nutrition Survey for 2008/09 (year 1; n = 1334) and 2016/17 (year 9; n = 995). Year-specific sodium densities of foods were used to calculate the average sodium density of all food and beverage consumed. Changes in sodium density between the 2 years were explained by changes in food composition (change in sodium density of products) and/or changes in behavior (type and quantity of food consumed) using a decomposition approach.ResultsThe program was linked to a 16% (95% CI: −21% to −12%) decrease in sodium intake between years 1 and 9, while the sodium density of foods consumed decreased by 17% (95% CI: −21% to −12%). This decrease was largely driven by reformulation (−12.0 mg/100 g). Changes in food choices reinforced the effects of the program, but had a smaller impact (−1.6 mg/100 g). These effects were similar across socioeconomic groups, whether stratified by education or income, with a consistent effect of reformulation across groups and no differences between groups in behavioral responses to the program.ConclusionsA multi-component sodium reduction strategy deployed in the United Kingdom starting in 2003 corresponded to an important reduction in sodium intakes for the population. This reduction was mostly driven by changes in the food environment (reformulated food products to reduce the sodium density of foods) and, to a smaller extent, b
Handakas E, Keski-Rahkonen P, Chatzi L, et al., 2021, Cord blood metabolic signatures predictive of childhood overweight and rapid growth, International Journal of Obesity, ISSN: 0307-0565
INTRODUCTION:Metabolomics may identify biological pathways predisposing children to risk of overweight and obesity. In this study, we have investigated the cord blood metabolic signatures of rapid growth in infancy and overweight in early childhood in four European birth cohorts.METHODS:Untargeted liquid chromatography-mass spectrometry metabolomic profiles were measured in cord blood from 399 newborns from four European cohorts (ENVIRONAGE, Rhea, INMA and Piccolipiu). Rapid growth in the first year of life and overweight in childhood were defined with reference to WHO growth charts. Metabolome-wide association scans for rapid growth and overweight on over 4500 metabolic features were performed using multiple adjusted logistic mixed effect models and controlling the false discovery rate (FDR) at 5%. Additionally, we performed a look-up analysis of 43 pre-annotated metabolites, previously associated with birthweight or rapid growth. RESULTS:In the MWAS analysis, we identified three and eight metabolites associated with rapid growth and overweight respectively, after FDR correction. Higher levels of cholestenone, a cholesterol derivative produced by microbial catabolism, was predictive of rapid growth (p=1.6x10-3). Lower levels of the branched chain amino acid (BCAA) valine (p=8.6x10-6) was predictive of overweight in childhood. The area under the receiver operator curve for multivariate prediction models including these metabolites and traditional risk factors was 0.77 for rapid growth and 0.82 for overweight, compared to 0.69 and 0.69 respectively for models using traditional risk factors alone. Among the 43 pre-annotated metabolites, seven and five metabolites were nominally associated (P<0.05) with rapid growth and overweight respectively. The BCAA leucine, remained associated (1.6x 0-3) with overweight after FDR correction.CONCLUSION:The metabolites identified here may assist in the identification of children at risk of developing obesity and improve understa
Kusuma D, Pradeepa R, Khawaja KI, et al., 2021, Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: evidence from a large-scale multi-country surveillance programme, SSM - Population Health, Vol: 13, ISSN: 2352-8273
Background. South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians’ awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. Methods. We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. Results. Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P<0.001), and household income fell by 52% (P<0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P<0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P<0.001), during the lockdown.Conclusions. Our results identified important knowledge, access and uptake barriers to the prevention of COV
Pineda E, Bascunan J, Sassi F, 2021, Improving the school food environment for the prevention of childhood obesity: What works and what doesn't, Obesity Reviews, Vol: 22, ISSN: 1467-7881
The food environment has a significant influence on dietary choices, and interventions designed to modify the food environment could contribute to the prevention of childhood obesity. Many interventions have been implemented at the school level, but effectiveness in addressing childhood obesity remains unclear. We undertook a systematic review, a meta-analysis, and meta-regression analyses to assess the effectiveness of interventions on the food environment within and around schools to improve dietary intake and prevent childhood obesity. Estimates were pooled in a random-effects meta-analysis with stratification by anthropometric or dietary intake outcome. Risk of bias was formally assessed. One hundred papers were included. Interventions had a significant and meaningful effect on adiposity (body mass index [BMI] z score, standard mean difference: -0.12, 95% confidence interval: 0.15, 0.10) and fruit consumption (portions per day, standard mean difference: +0.19, 95% confidence interval: 0.16, 0.22) but not on vegetable intake. Risk of bias assessment indicated that n = 43 (81%) of non-randomized controlled studies presented a high risk of bias in the study design by not accounting for a control. Attrition bias (n = 34, 79%) and low protection of potential contamination (n = 41, 95%) presented the highest risk of bias for randomized controlled trials. Changes in the school food environment could improve children's dietary behavior and BMI, but policy actions are needed to improve surrounding school food environments to sustain healthy dietary intake and BMI.
Chambers T, Segal A, Sassi F, 2021, Interventions using behavioural insights to influence children's diet-related outcomes: a systematic review, Obesity Reviews, Vol: 22, ISSN: 1467-7881
The global prevalence of children with overweight and obesity continues to rise. Obesity in childhood has dire long-term consequences on health, social and economic outcomes. Promising interventions using behavioural insights to address obesity in childhood have emerged. This systematic review examines the effectiveness and health equity implications of interventions using behavioural insights to improve children's diet-related outcomes. The search strategy included searches on six electronic databases, reference lists of previous systematic reviews and backward searching of all included studies. One-hundred and eight papers describing 137 interventions were included. Interventions using behavioural insights were effective at modifying children's diet-related outcomes in 74% of all included interventions. The most promising approaches involved using incentives, changing defaults and modifying the physical environment. Information provision alone was the least effective approach. Health equity implications were rarely analysed or discussed. There was limited evidence of the sustainability of interventions-both in relation to their overall effectiveness and cost-effectiveness. The limited evidence on health equity, long-term effectiveness and the cost-effectiveness of these interventions limit what can be inferred for policymakers. This review synthesises the use of behavioural insights to improve children's diet-related outcomes, which can be used to inform future interventions.
Branca F, Chambers T, Sassi F, 2021, How to tackle childhood obesity? Evidence and policy implications from a STOP series of systematic reviews, OBESITY REVIEWS, Vol: 22, ISSN: 1467-7881
Gressier M, Swinburn B, Frost G, et al., 2021, What is the impact of food reformulation on individual’s behaviour, nutrient intakes and health status? A systematic review of empirical evidence, Obesity Reviews, Vol: 22, Pages: 1-23, ISSN: 1467-7881
Food reformulation aimed at improving the nutritional properties of food products has long been viewed as a promising public health strategy to tackle poor nutrition and obesity. This paper presents a review of the empirical evidence (i.e. modelling studies were excluded) on the impact of food reformulation on food choices, nutrient intakes and health status, based on a systematic search of Medline, Embase, Global Health, and sources of grey literature. Fifty-nine studies (in 35 papers) were included in the review. Most studies examined food choices (n=27) and dietary intakes (n=26). The nutrients most frequently studied were sodium (n=32) and trans-fatty acids (TFA, n=13). Reformulated products were generally accepted and purchased by consumers, which led to improved nutrient intakes in 73% of studies. We also conducted two meta-analyses showing, respectively, a -0.57g/day [95%CI -0.89, -0.25] reduction in salt intake, and an effect size for TFA intake reduction of -1.2, 95% [CI -1.79, -0.61]. Only six studies examined effects on health outcomes, with studies on TFA reformulation showing overall improvement in cardiovascular risk factors. For other nutrients, it remains unclear whether observed improvements in food choices or nutrient intakes may have led to an improvement in health outcomes.
Charani E, Holmes A, Bonaconsa C, et al., 2021, Investigating infection management and antimicrobial stewardship in surgery: a qualitative study from India and South Africa, Clinical Microbiology and Infection, ISSN: 1198-743X
Objectives To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high infection risk surgical pathways. Methods An qualitative study, ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCP) and patients was conducted across cardiovascular and thoracic and gastrointestinal surgical pathways in South Africa (SA) and India. Aided by Nvivo 11 software, data were coded and analysed until saturation was reached. The multiple modes of enquiry enabled cross-validation and triangulation of findings.Results Between July 2018–August 2019 data were gathered from 190 hours of non-participant observations (138 India, 72 SA); interviews with HCPs (44 India, 61 SA); patients (6 India, 8 SA), and, case studies (4 India, 2 SA). Across the surgical pathway, multiple barriers impede effective infection management and AMS. The existing, implicit roles of HCPs (including nurses, and senior surgeons) are overlooked as interventions target junior doctors, bypassing the opportunity for integrating infection-related care across the surgical team. Critically, the ownership of decisions remains with the operating surgeons and entrenched hierarchies restrict the inclusion of other HCPs in decision-making. The structural foundations to enable staff to change their behaviours and participate in infection-related surgical care is lacking.ConclusionsIdentifying the implicit existing HCPs roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimised care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads is essential for integrated AMS and infection-related care. Keywords: antibiotic prescribing, infection control, ethnography, low- and middle-income country, surgery
Segal AB, Huerta MC, Aurino E, et al., 2021, The impact of childhood obesity on human capital in high-income countries: A systematic review, Obesity Reviews, Vol: 22, Pages: 1-15, ISSN: 1467-7881
Current evidence of the impact of childhood obesity on human capital development does not point in a consistent direction, and its interpretation is challenging. We carried out a systematic review of studies from high‐income countries that used robust causal inference approaches to assess the impact of childhood overweight and obesity on outcomes typically linked to human capital development in economics. Global Health, Medline and EconLit were used to search for peer‐reviewed papers. Three reviewers independently assessed study quality using the Newcastle‐Ottawa Scale. Nineteen papers representing 22 studies met the inclusion criteria. Included studies were categorized based on three components of human capital: cognitive performance (n = 18), measured through test scores; educational attainment (n = 3), through grade progression and college completion; and labour market outcomes (n = 1), through wages. We find that childhood overweight and obesity hinder education outcomes, with effects mostly observed at older ages of exposure measurement (12+ years). Girls with overweight and obesity experienced larger negative effects and more often than boys. Future research should elucidate the pathways through which childhood obesity impacts human capital development, to support policies that may mitigate those impacts, thus averting social costs that are currently widespread, increasing and unaccounted for.
Jadeja N, Zhu NJ, Lebcir RM, et al., 2020, Optimising policy analysis for AMR: A review of the capability of system dynamics for economic evaluation, Publisher: ELSEVIER SCI LTD, Pages: 215-215, ISSN: 1201-9712
Zace D, Specchia ML, Di Pilla A, et al., 2020, Implementation level of best practice policies by Italian government for healthier food environments, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Gressier M, Sassi F, Frost G, 2020, THE EFFECT OF CHANGES IN CONSUMER CHOICE AND IN FOOD COMPOSITION ON THE SODIUM DENSITY OF FOOD CONSUMED BY THE UK POPULATION BETWEEN 2008/09 AND 2016/17, Publisher: BMJ PUBLISHING GROUP, Pages: A58-A58, ISSN: 0143-005X
Gressier M, Frost G, Sassi F, 2020, Success of reformulation and health education in reducing sodium intakes across socioeconomic groups, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Segal AB, Huerta MC, Sassi F, 2020, THE EFFECT OF CHILDHOOD OBESITY AND OVERWEIGHT ON EDUCATIONAL OUTCOMES: AN INTERDISCIPLINARY SECONDARY ANALYSIS OF THREE UK COHORTS, Publisher: BMJ PUBLISHING GROUP, Pages: A71-A71, ISSN: 0143-005X
Sassi F, 2020, The STOP project, Publisher: OXFORD UNIV PRESS, Pages: V451-V451, ISSN: 1101-1262
Howe LD, Kanayalal R, Harrison S, et al., 2020, Effects of body mass index on relationship status, social contact and socio-economic position: Mendelian randomization and within-sibling study in UK Biobank, International Journal of Epidemiology, Vol: 49, Pages: 1173-1184, ISSN: 0300-5771
BackgroundWe assessed whether body mass index (BMI) affects social and socio-economic outcomes.MethodsWe used Mendelian randomization (MR), non-linear MR and non-genetic and MR within-sibling analyses, to estimate relationships of BMI with six socio-economic and four social outcomes in 378 244 people of European ancestry in UK Biobank.ResultsIn MR of minimally related individuals, higher BMI was related to higher deprivation, lower income, fewer years of education, lower odds of degree-level education and skilled employment. Non-linear MR suggested both low (bottom decile, <22 kg/m2) and high (top seven deciles, >24.6 kg/m2) BMI, increased deprivation and reduced income. Non-genetic within-sibling analysis supported an effect of BMI on socio-economic position (SEP); precision in within-sibling MR was too low to draw inference about effects of BMI on SEP. There was some evidence of pleiotropy, with MR Egger suggesting limited effects of BMI on deprivation, although precision of these estimates is also low. Non-linear MR suggested that low BMI (bottom three deciles, <23.5 kg/m2) reduces the odds of cohabiting with a partner or spouse in men, whereas high BMI (top two deciles, >30.7 kg/m2) reduces the odds of cohabitation in women. Both non-genetic and MR within-sibling analyses supported this sex-specific effect of BMI on cohabitation. In men only, higher BMI was related to lower participation in leisure and social activities. There was little evidence that BMI affects visits from friends and family or having someone to confide in.ConclusionsBMI may affect social and socio-economic outcomes, with both high and low BMI being detrimental for SEP, although larger within-family MR studies may help to test the robustness of MR results in unrelated individuals. Triangulation of evidence across MR and within-family analyses supports evidence of a sex-specific effect of BMI on cohabitation.
Gressier M, Frost G, Sassi F, 2020, Healthy foods and healthy diets. how government policies can steer food reformulation, Nutrients, Vol: 12, Pages: 1-9, ISSN: 2072-6643
Food reformulation policies aimed at reducing the risk of diet-related non-communicable diseases have been implemented in many countries. The degree of success of reformulation policies in changing the range of food options available to consumers has been a function of the design of these policies. Our objective was to review the different factors making the design and implementation of a food reformulation policy effective at improving populations’ diets and health. In this narrative review, we present a logic model of the action of reformulation policies on consumer behaviour, dietary intake and population health. We set out how policy design could drive outcomes, and highlight the role for governments and public health agencies in promoting food reformulation that is effective in improving diet and health. The key drivers of success for reformulation policies include strong incentives, a tight implementation strategy, a focus on the overall nutritional quality of food products, rather than on individual nutrients, and effective monitoring and evaluation. Additionally, policies should mark the distinction between product reformulation and product differentiation, which have different nutrition and health outcomes.
Adomako-Mensah V, Belloni A, Blawat A, et al., 2020, The health and social care costs of a selection of health conditions and multi-morbidities
BackgroundMultimorbidity (MM) is the presence of 2 or more long-term health conditions in a singleindividual. It impacts an individual’s quality of life, mental health and wellbeing, dailyfunction, and often results in greater healthcare utilisation the more co-existingconditions they have (1-4). MM is a big challenge facing the NHS, especially givenEngland’s ageing population, with an estimated two-thirds of individuals aged 65 andover having 2 or more long-term conditions (5-6). Yet, little is known about the resourceuse of these patients despite being the group with the largest impact on the NHS andwith the worst health outcomes (7). Existing evidence focuses on specific healthconditions and their interactions with other conditions using different methodologies,making comparisons across different conditions difficult.This work has empirically assessed the impact of multi-morbidity on NHS and socialcare costs. With the aim of answering the question: is the impact of developing acondition on health and social care costs greater for someone with no prior conditions,or for someone with an existing condition. If patients have multiple conditions, theremay be some economies of scale involved with treatment, for example they may beable to discuss multiple queries during a single GP appointment, or in some cases thetreatment provided will address multiple conditions. However, treating patients withmulti-morbidities could theoretically also be more expensive than treating 2 conditionsseparately, as patients may be more likely to experience complications.MethodologyThis work considered the individual cost of 11 health conditions with high prevalence inthe English population and their most common interactions. These were: chronicobstructive pulmonary disease (COPD), diabetes (types 1 and 2), lung cancer, breastcancer, coronary heart disease (CHD), stroke, hypertension, dementia, liver disease,depression and colorectal cancer.This project had 2 components: a lite
Cox B, Luyten LJ, Dockx Y, et al., 2020, Association between maternal prepregnancy body mass index and anthropometric parameters, blood pressure, and retinal microvasculature in children age 4 to 6 years., JAMA Network Open, Vol: 3, Pages: 1-12, ISSN: 2574-3805
Importance: Maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) has previously been associated with offspring cardiometabolic risk factors, such as fat mass, glucose and insulin levels, and blood pressure, but these associations appear to be largely mediated by offspring BMI. To our knowledge, no studies have assessed alterations in the retinal microvasculature in association with maternal prepregnancy BMI. Objective: To investigate the association between maternal prepregnancy BMI and anthropometric parameters, blood pressure, and retinal vessel parameters in children age 4 to 6 years. Design, Setting, and Participants: Participants included mother-child pairs of the population-based Environmental Influence on Early Aging (ENVIRONAGE) birth cohort study (Flanders, Belgium) who were recruited at birth from February 2010 to June 2014 and followed-up at age 4 to 6 years between October 2014 and July 2018. Data were analyzed from February 2019 to April 2019. Exposures: Maternal prepregnancy BMI based on height and weight measurements at the first antenatal visit (weeks 7-9 of gestation). Main Outcomes and Measures: Children's anthropometric, blood pressure, and retinal microcirculation measurements at age 4 to 6 years. Retinal vessel diameters and the tortuosity index, a measure for the curvature of the retinal vasculature, were obtained by fundus image analysis. Results: This study included 240 mothers and children with a mean (SD) age of 29. 9 (4.2) years and 54.8 (4.7) months, respectively. Of these, 114 children (47.5%) were boys. Maternal prepregnancy BMI was positively associated with the child's birth weight, BMI, waist circumference, blood pressure, and retinal vessel tortuosity. A 1-point increase in maternal prepregnancy BMI was associated with a 0.26-mm Hg (95% CI, 0.08-0.44) higher mean arterial pressure for their children, with similar estimates for systolic and diastolic blood pressure.
Chambers T, Millett C, Sassi F, 2020, New Zealand's Public Services Act: a policy opportunity for cross-government action on unhealthy products, PERSPECTIVES IN PUBLIC HEALTH, Vol: 140, Pages: 144-145, ISSN: 1757-9139
Sassi F, 2020, The foreseeable toll of Covid-19 in the UK: the NHS needs more than money, now
Gressier M, Segal A, Sassi F, et al., 2020, The effect of single-nutrient reformulation initiatives on the nutrient profile of foods: a systematic review, Publisher: CAMBRIDGE UNIV PRESS, Pages: E565-E565, ISSN: 0029-6651
Chambers T, Sassi F, 2019, Unhealthy sponsorship of sport Tougher and more comprehensive regulation is long overdue, BMJ-BRITISH MEDICAL JOURNAL, Vol: 367, ISSN: 1756-1833
Segal AB, Huerta MC, Sassi F, 2019, Understanding the effect of childhood obesity and overweight on educational outcomes: an interdisciplinary secondary analysis of two UK cohorts, National Conference on Public Health Science Dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 84-84, ISSN: 0140-6736
Chambers T, Olney J, Sassi F, 2019, Use of academic funding to engage the food industry in innovations to improve public health: a descriptive analysis of applications for academic-industry partnerships, National Conference on Public Health Science Dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 9-9, ISSN: 0140-6736
Pineda E, Swinburn B, Sassi F, 2019, Effective school food environment interventions for the prevention of childhood obesity: systematic review and meta-analysis, National Conference on Public Health Science Dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 77-77, ISSN: 0140-6736
Ahmad R, Zhu NJ, Leather AJM, et al., 2019, Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review, BMJ Global Health, Vol: 4, ISSN: 2059-7908
Introduction: The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. Methods: A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. Results: 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. Conclusion: The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation eff
Sassi F, 2019, Global public health challenges, fiscal policies, and yellow vests, The Lancet, Vol: 393, Pages: 745-746, ISSN: 0140-6736
Howe LD, Kanayalal R, Beaumont RN, et al., 2019, Effects of body mass index on relationship status, social contact, and socioeconomic position: Mendelian Randomization study in UK Biobank
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To assess whether body mass index (BMI) has a causal effect on social and socioeconomic factors, including whether both high and low BMI can be detrimental.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Mendelian Randomization, using genetic variants for BMI to obtain unconfounded estimates, and non-linear Mendelian Randomization.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>UK Biobank.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>378,244 men and women of European ancestry, mean age 57 (SD 8 years).</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Townsend deprivation index, income, age completed full time education, degree level education, job class, employment status, cohabiting relationship status, participation in leisure and social activities, visits from friends and family, and having someone to confide in.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Higher BMI was causally associated with higher deprivation, lower income, fewer years of education, lower odds of degree-level education and skilled employment. For example, a 1 SD higher genetically-determined BMI (4.8kg/m<jats:sup>2</jats:sup> in UK Biobank) was associated with £1,660 less income per annum [95%CI: £950, £2,380]. Non-linear Mendelian Randomization provided evidence that both low BMI (bottom decile, <22kg/m<jats:sup>2</jats:sup>) and high BMI (top seven deciles, >24.6kg/m<jats:sup>2</jats:sup>) can increase deprivation and reduce income. In men only, higher BMI was related to lower participation in leisu
Pimpin L, Retat L, Fecht D, et al., 2018, Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035, PLoS Medicine, Vol: 15, ISSN: 1549-1277
BACKGROUND: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England. METHOD AND FINDINGS: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data. CONCLUSIONS: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.