Imperial College London

Dr Paraskevi Seferidi

Faculty of MedicineSchool of Public Health

Research Fellow
 
 
 
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Contact

 

paraskevi.seferidi14

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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25 results found

Bijlani C, Vrinten C, Junghans C, Chang K, Lewis E, Mulla U, Seferidi P, Vamos EP, Gill Cet al., 2024, Changes in diet and physical activity following a community-wide pilot intervention to tackle childhood obesity in a deprived inner-London ward, BMC Public Health, ISSN: 1471-2458

Journal article

Quinteros-Reyes C, Seferidi P, Guzman-Abello L, Millett C, Bernabé-Ortiz A, Ballard Eet al., 2024, Mapping food system drivers of the double burden of malnutrition using community-based system dynamics: a case study in Peru, BMC Global and Public Health, Vol: 2, Pages: 1-14, ISSN: 2731-913X

BackgroundPeru is facing a double burden of malnutrition (DBM), characterized by the co-existence of undernutrition and overnutrition. Double-duty actions that concurrently target common drivers of undernutrition and overnutrition, while ensuring no unintended side effects, are recommended to effectively address the DBM. To understand these complex common mechanisms and design context-specific double-duty actions, there is a need for participatory systems approaches. This paper provides a case study of applying a community-based system dynamics approach to capture stakeholder perspectives of food system drivers of the DBM in two regions in Peru.MethodsWe implemented a multi-stage community-based system dynamics approach, which included processes for research capacity building for systems approaches, and the designing, piloting, and implementation of stakeholder workshops. A total of 36 stakeholders, representing diverse perspectives, participated in five group model building workshops. Stakeholder views are presented in a causal loop diagram that showcases the feedback mechanisms between key food system drivers of overweight and stunting in Peru.ResultsThe causal loop diagram highlights that prioritization of undernutrition over overnutrition in the policymaking process, due to Peru’s historically high levels of undernutrition, may undermine action against the DBM. It also describes potential mechanisms of unintended impacts of undernutrition policies on the DBM in Peru, including impacts related to within-family distribution and quality of food provided through food assistance programs, and unintended impacts due to regional dynamics.ConclusionsThis paper highlights the importance of a participatory approach to understand local needs and priorities when recommending double-duty actions in Peru and shares practical methodological guidance on applying participatory systems approaches in public health.

Journal article

Escher N, Calixto Andrade G, Ghosh-Jerath S, Millett C, Seferidi Pet al., 2024, The effect of nutrition-specific and nutrition-sensitiveinterventions on the double burden of malnutrition in lowincome and middle-income countries: a systematic review, The Lancet Global Health, Vol: 12, Pages: E419-E432, ISSN: 2214-109X

Background:Low- and middle-income countries (LMICs) experiencing nutrition transition face an increasing double burden of malnutrition (DBM). The World Health Organization has urged the identification of risks and opportunities in nutrition interventions to mitigate the DBM, but robust evidence is missing. This review summarises the impact of nutrition-specific and nutrition-sensitive interventions on under- and overnutrition simultaneously in LMICs.Methods:We searched four major databases and grey literature for publications in English, French, Portuguese, and Spanish from January 1, 2000, to August 14, 2023. Eligible studies evaluated nutrition-specific and/or nutrition-sensitive interventions on both under- and overnutrition, employing robust study designs (individually-, cluster- and non-randomised trials, interrupted time series, controlled before-after and prospective cohort studies). Studies were synthesised narratively, and classified as DBM-beneficial, potentially DBM-beneficial, DBM-neutral, potentially DBM-harmful, and DBM-harmful, using vote counting. The review is registered with PROSPERO, CRD42022320131. Findings:We identified 26 studies evaluating 20 nutrition-specific (maternal and child health (MCH) and school-based programmes) and six nutrition-sensitive interventions (conditional cash transfers and other social policies). Seven out of eight MCH interventions providing food-based or nutritional supplements indicated possible DBM-harmful impacts, associated with increased maternal or child overweight. Most school-based programmes and behavioural change MCH interventions were considered potentially DBM-beneficial. Two evaluations of conditional cash transfers suggested DBM-beneficial impacts in children, while one indicated potentially harmful effects on maternal overweight. Evaluations of a family planning service and an education reform revealed possible long-term harmful impacts on obesity.Interpretation:There is considerable scope to repurpose ex

Journal article

Escher NA, Andrade GC, Ghosh-Jerath S, Millett C, Seferidi Pet al., 2024, The effect of nutrition-specific and nutrition-sensitive interventions on the double burden of malnutrition in low-income and middle-income countries: a systematic review., Lancet Glob Health, Vol: 12, Pages: e419-e432

BACKGROUND: Low-income and middle-income countries (LMICs) experiencing nutrition transition face an increasing double burden of malnutrition (DBM). WHO has urged the identification of risks and opportunities in nutrition interventions to mitigate the DBM, but robust evidence is missing. This review summarises the effect of nutrition-specific and nutrition-sensitive interventions on undernutrition and overnutrition in LMICs. METHODS: We searched four major databases and grey literature for publications in English, French, Portuguese, and Spanish from Jan 1, 2000, to Aug 14, 2023. Eligible studies evaluated nutrition-specific or nutrition-sensitive interventions on both undernutrition and overnutrition, employing robust study designs (individually randomised, cluster randomised, and non-randomised trials; interrupted time series; controlled before-after; and prospective cohort studies). Studies were synthesised narratively, and classified as DBM-beneficial, potentially DBM-beneficial, DBM-neutral, potentially DBM-harmful, and DBM-harmful, using vote counting. This review is registered with PROSPERO (CRD42022320131). FINDINGS: We identified 26 studies evaluating 20 nutrition-specific (maternal and child health [MCH] and school-based programmes) and six nutrition-sensitive (conditional cash transfers and other social policies) interventions. Seven of eight MCH interventions providing food-based or nutritional supplements indicated possible DBM-harmful effects, associated with increased maternal or child overweight. Most school-based programmes and MCH interventions that target behavioural change were considered potentially DBM-beneficial. Two studies of conditional cash transfers suggested DBM-beneficial effects in children, whereas one indicated potentially harmful effects on maternal overweight. A study on a family planning service and one on an education reform revealed possible long-term harmful effects on obesity. INTERPRETATION: There is considerable scope to rep

Journal article

Hone T, Gonçalves J, Seferidi P, Moreno-Serra R, Rocha R, Gupta I, Bhardwaj V, Hidayat T, Cai C, Suhrcke M, Millett Cet al., 2024, Progress towards universal health coverage and inequalities in infant mortality: An analysis of 4.1 million births from 60 low- and middle-income countries between 2000-2019, The Lancet Global Health, ISSN: 2214-109X

Background:Expanding universal health coverage (UHC) may not be inherently pro-poor without explicit targeting and prioritising of low-income populations. This study examines whether expansion of UHC is associated with reduced socio-economic inequalities in infant mortality in low- and middle-income countries (LMICs).Methods:Data on 4,065,868 live births were compiled from 177 Demographic and Health Surveys from 60 LMICs covering the period 2000-2019. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO’s UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-, mother-, and country-level variables. Findings:A one unit increase in the UHC index was associated with a 1.2% reduction in the risk of infant death (AOR: 0.988 95%CI: 0.981,0.995; absolute: 0.57 deaths per 1000 live births). An estimated 16 million infant deaths were averted between 2000-2019 due to increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (Q5: AOR: 0.983 95%CI: 0.973,0.993) than poorer quintiles (Q1: AOR: 0.991 95%CI: 0.985,0.998). In the early stages of UHC, UHC expansion was generally pro-poor (i.e. larger reductions in infant mortality for poorer households), but became less so as overall coverage increased. Interpretation:Since UHC expansion in LMICs appears to become less pro-poor as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands.Funding:NIHR: NIHR133252 and NIHR150067

Journal article

Gaines AM, Davies T, Shahid M, Taylor F, Wu JHY, Hadjikakou M, Pettigrew S, Seferidi P, Neal Bet al., 2023, A novel approach to estimate product-specific greenhouse gas emissions for 23,550 Australian packaged foods and beverages, Journal of Cleaner Production, Vol: 425, ISSN: 0959-6526

Greenhouse gas emissions (GHGe) data are predominantly available for agricultural commodities and broad dietary patterns. However, data on commonly consumed, multi-ingredient food products as sold in supermarkets and retail outlets are mostly absent. We developed a novel approach to estimate product-specific GHGe for individual packaged foods and beverages marketed in Australia in 2019. Ingredient lists for 23,550 packaged products were systematically disaggregated and a linear program was used to estimate ingredient proportions in each product. Ingredient-specific, cradle-to-farm gate GHGe values were identified from five life cycle assessment data sources. Weighted GHGe values for each ingredient were summed up to a product-specific GHGe estimate that was then additionally adjusted for processing and transport-related emissions to account for most attributable emissions from cradle-to-retail. To assess validity, GHGe for food categories, estimated as the median of product-specific GHGe estimates, were compared against existing GHGe values for analogous food groups. The included products contained 897 different ingredients for which GHGe values were determined using data from 433 life cycle assessments. The estimated median for cradle-to-retail GHGe for all products was 2.35 kg CO2eq/kg product (interquartile range, IQR, [1.24, 4.53]). Product-specific GHGe estimates varied substantially within food categories; the 25th and 75th percentile of GHGe values differed by 2-fold or more for most. ‘Meat and meat products’ had the highest median GHGe value and broadest range of estimates (6.81 kg CO2eq/kg product, IQR [5.84, 29.2]). ‘Fruit, vegetables, nuts and legumes’ had the lowest median GHGe (1.20 kg CO2eq/kg product). Median category values for product-specific GHGe estimates aligned well with values for 34 food groups previously reported (R2 = 98.6%). Our approach provides a novel method for estimating product-specific GHGe for Australian pac

Journal article

Otten H, Seferidi P, 2022, Prevalence and socioeconomic determinants of the double burden of malnutrition in mother–child pairs in Latin America and the Caribbean, BMJ Nutrition, Prevention & Health, Vol: 5, Pages: 263-270, ISSN: 2516-5542

Background: The double burden of malnutrition (DBM), which refers to the coexistence of overnutrition and undernutrition among populations, households or individuals, is a growing problem in low/middle-income countries. The Latin America and the Caribbean (LAC) region has been particularly affected by the DBM, following a nutrition transition and a rapid increase in overweight, obesity and diet-related disease, while high levels of undernutrition persist. This study aims to describe the prevalence of four different DBM definitions in mother–child pairs across nine LAC countries and investigate the socioeconomic determinants of overweight mothers with at least one stunted child (SCOM).Methods: We used cross-sectional data from the Demographic and Health Surveys for all analyses. We used descriptive statistics to obtain prevalence rates and conducted multiple logistic regression analyses to investigate the association between SCOM households and socioeconomic determinants, including wealth index, maternal education, place of residency and whether the mother was working, adjusted for a range of variables.Results: Overweight/obese mothers with at least one anaemic child were the most common type of DBM, with a prevalence of 19.39%, followed by SCOM with a prevalence of 10.44%. Statistically significant socioeconomic predictors of SCOM were households with a lower wealth index, lower maternal education and living in rural areas.Conclusion: This study showed that the overall prevalence of most DBM definitions examined was high, which points to the need for urgent interventions in the LAC region. The unique set of socioeconomic predictors of SCOM identified in this study calls for future double-duty policies that simultaneously target food affordability, nutrition education and access to healthy food.

Journal article

Bijlani C, Vrinten C, Chang K, Hrobonova E, Lewis E, Seferidi P, Laverty A, Junghans C, Vamos EPet al., 2022, Changes in diet and physical activity after a pilot intervention to tackle childhood obesity in a deprived inner-London community: an observational cohort study., The Lancet, Vol: 400, Pages: S22-S22, ISSN: 0140-6736

BACKGROUND: Local authorities in England are uniquely positioned to modify obesogenic local environments contributing to childhood obesity. Evaluating the effects of local authority-led, community-wide approaches is challenging. This study examines changes in diet and physical activity in children aged 6-11 years after a 4-year, complex, community-based, pilot intervention in Golborne, one of the most deprived areas in London. METHODS: The Go-Golborne intervention aimed to shape the local environment by building on local assets, connecting stakeholders in local government and the community, and synchronising existing activities. Activities focused on six themes to make changes to local environments and reduce the consumption of sugary snacks and beverages, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually in 2016-19, from children from six local schools. Results were compared with the data collected at baseline. We used multilevel, linear (for dietary outcomes), and logistic (for physical activity) random-slope regression models to examine changes in diet and physical activity by time on study, adjusting for baseline age, sex, ethnicity, deprivation quintile, school, and baseline weight status. Dietary outcomes were calculated by summing the total occasions a participant indicated they ate or drank a certain food or drink (reported as portions per day, expressed as a β coefficient). The physical activity outcomes were developed by creating six binary variables to distinguish those who were most active from those who were least active. FINDINGS: 1650 children (mean age 7·9 years [SD:1·6]; 808 [49%] girls and 842 [51%] boys) were included. After 3 years of follow-up, we noted reductions in sugary beverage consumption (adjusted β -0·43 portions [95% CI -0·55 to -0·32]; p<0

Journal article

Bijlani C, Vrinten C, Chang K, Hrobonova E, Lewis E, Seferidi P, Laverty A, Junghans C, Vamos EPet al., 2022, Changes in diet and physical activity after a pilot intervention to tackle childhood obesity in a deprived inner-London community: an observational cohort study., Lancet, Vol: 400 Suppl 1

BACKGROUND: Local authorities in England are uniquely positioned to modify obesogenic local environments contributing to childhood obesity. Evaluating the effects of local authority-led, community-wide approaches is challenging. This study examines changes in diet and physical activity in children aged 6-11 years after a 4-year, complex, community-based, pilot intervention in Golborne, one of the most deprived areas in London. METHODS: The Go-Golborne intervention aimed to shape the local environment by building on local assets, connecting stakeholders in local government and the community, and synchronising existing activities. Activities focused on six themes to make changes to local environments and reduce the consumption of sugary snacks and beverages, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually in 2016-19, from children from six local schools. Results were compared with the data collected at baseline. We used multilevel, linear (for dietary outcomes), and logistic (for physical activity) random-slope regression models to examine changes in diet and physical activity by time on study, adjusting for baseline age, sex, ethnicity, deprivation quintile, school, and baseline weight status. Dietary outcomes were calculated by summing the total occasions a participant indicated they ate or drank a certain food or drink (reported as portions per day, expressed as a β coefficient). The physical activity outcomes were developed by creating six binary variables to distinguish those who were most active from those who were least active. FINDINGS: 1650 children (mean age 7·9 years [SD:1·6]; 808 [49%] girls and 842 [51%] boys) were included. After 3 years of follow-up, we noted reductions in sugary beverage consumption (adjusted β -0·43 portions [95% CI -0·55 to -0·32]; p<0

Journal article

Seferidi P, Hone T, Duran AC, Bernabe-Ortiz A, Millett Cet al., 2022, Global inequalities in the double burden of malnutrition and associations with globalisation: a multilevel analysis of Demographic and Health Surveys from 55 low-income and middle-income countries, 1992-2018, The Lancet Global Health, Vol: 10, Pages: e482-e490, ISSN: 2214-109X

BACKGROUND: Low-income and middle-income countries (LMICs) face a double burden of malnutrition (DBM), whereby overnutrition and undernutrition coexist within the same individual, household, or population. This analysis investigates global inequalities in household-level DBM, expressed as a stunted child with an overweight mother, and its association with economic, social, and political globalisation across country income and household wealth. METHODS: We pooled anthropometric and demographic data for 1 132 069 children (aged <5 years) and their mothers (aged 15-49 years) from 189 Demographic and Health Surveys in 55 LMICs between 1992 and 2018. These data were combined with country-level data on economic, social, and political globalisation from the Konjunkturforschungsstelle Globalisation Index and gross national income (GNI) from the World Bank. Multivariate associations between DBM and household wealth, GNI, and globalisation and their interactions were tested using multilevel logistic regression models with country and year fixed-effects and robust standard errors clustered by country. FINDINGS: The probability of DBM was higher among richer households in poorer LMICs and poorer households in richer LMICs. Economic globalisation was associated with higher odds of DBM among the poorest households (odds ratio 1·49, 95% CI 1·20-1·86) compared with the richest households. These associations attenuated as GNI increased. Social globalisation was associated with higher odds of DBM (1·39, 95% CI 1·16-1·65), independently of household wealth or country income. No associations were identified between political globalisation and DBM. INTERPRETATION: Increases in economic and social globalisation were associated with higher DBM, although the impacts of economic globalisation were mostly realised by the world's poorest. The economic patterning of DBM observed in this study calls for subpopulation-specific double-dut

Journal article

Seferidi P, Millett C, Laverty AA, 2021, Industry self-regulation fails to deliver healthier diets, again Public Health England's replacement must take bolder action, BMJ: British Medical Journal, Vol: 372, Pages: 1-2, ISSN: 0959-535X

Journal article

Seferidi P, Scrinis G, Huybrechts I, Woods J, Vineis P, Millett Cet al., 2020, The neglected environmental impacts of ultra-processed foods, The Lancet Planetary Health, Vol: 4, Pages: e437-e438, ISSN: 2542-5196

Journal article

Crookes C, Palladino R, Seferidi P, Hirve R, Siskou O, Filippidis Fet al., 2020, The impact of the economic crisis on household health expenditure in Greece: an interrupted time series analysis, BMJ Open, Vol: 10, Pages: 1-11, ISSN: 2044-6055

Objectives and setting The 2008 financial crisis had a particularly severe impact onGreece. To contain spending, the government capped public health expenditure andintroduced increased cost-sharing. The Greek case is important for studying theimpact of recessions on health systems. This study analysed changes in householdhealth expenditure in Greece over the economic crisis and explored whether theimpact differed across socioeconomic groups.Participants We used data from the Greek Household Budget Survey for the years2004 and 2008-2017. The dataset comprised 51,654 households, with a total of128,111 members.Design We compared pre- and post-crisis trends in Greek household out-of-pocketpayments for healthcare from 2004-2017 using an interrupted time series analysis.This study explored spending in Euros and as a share of total household purchases.Results Our results indicated that the population level trend in household healthspending was reversed after the crisis began (pre-crisis trend:€0.040 decrease perquarter (95% CI: -0.785 to -0.022), post-crisis trend:€0.315 increase per quarter(95% CI: -0.004 to 0.635)). We also found that spending on inpatient services andpharmaceuticals has been increasing since the start of the crisis, whereas outpatientservices expenditure has been decreasing. Across all households, out-of-pocketpayments incurred a greater financial burden after the crisis relative to pre-existingtrends, but the poorest households incurred a disproportionately higher burden.Conclusions This was the first study to use an interrupted time series analysis toassess the impact of the economic crisis on household health expenditure in Greece.Our findings suggest that there was an erosion of financial protection for Greekhouseholds as a consequence of the economic crisis. This effect was particularlypronounced amongst poorer households, which is indicative of a regressivefinancing system.

Journal article

Seferidi P, Laverty AA, Collins B, Bandosz P, Capewell S, O'Flaherty M, Millett C, Pearson-Stuttard Jet al., 2020, Potential impacts of post-Brexit agricultural policy on fruit and vegetable intake and cardiovascular disease in England: a modelling study, BMJ Nutrition, Prevention & Health, Vol: 3, ISSN: 2516-5542

Background Current proposals for post-Brexit agricultural policy do not explicitly incorporate public health goals. The revised agricultural policy may be an opportunity to improve population health by supporting domestic production and consumption of fruits and vegetables (F&V). This study aims to quantify the potential impacts of a post-Brexit agricultural policy that increases land allocated to F&V on cardiovascular disease (CVD) mortality and inequalities in England, between 2021 to 2030.Methods We used the previously validated IMPACT Food Policy model and probabilistic sensitivity analysis to translate changes in land allocated to F&V into changes in F&V intake and associated CVD deaths, stratified by age, sex and Index of Multiple Deprivation. The model combined data on F&V agriculture, waste, purchases and intake, CVD mortality projections and appropriate relative risks. We modelled two scenarios, assuming that land allocated to F&V would gradually increase to 10% and 20% of land suitable for F&V production.Results We found that increasing land use for F&V production to 10% and 20% of suitable land would increase fruit intake by approximately 3.7% (95% uncertainty interval: 1.6% to 8.6%) and 17.4% (9.1% to 36.9%), and vegetable intake by approximately 7.8% (4.2% to 13.7%) and 37% (24.3% to 55.7%), respectively, in 2030. This would prevent or postpone approximately 3890 (1950 to 7080) and 18 010 (9840 to 28 870) CVD deaths between 2021 and 2030, under the first and second scenario, respectively. Both scenarios would reduce inequalities, with 16% of prevented or postponed deaths occurring among the least deprived compared with 22% among the most deprived.Conclusion Post-Brexit agricultural policy presents an important opportunity to improve dietary intake and associated cardiovascular mortality by supporting domestic production of F&V as part of a comprehensive strategy that intervenes across the supply chain.

Journal article

Seferidi P, Laverty AA, Pearson-Stuttard J, Collins B, Bandosz P, Capewell S, O'Flaherty M, Millett Cet al., 2019, Impacts of post-Brexit agricultural policy on fruit and vegetable intake and cardiovascular disease, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262

Conference paper

Seferidi P, Laverty AA, Pearson-Stuttard J, Collins B, Bandosz P, Capewell S, O'Flaherty M, Millett Cet al., 2019, IMPACTS OF POST-BREXIT AGRICULTURAL POLICY ON FRUIT AND VEGETABLE INTAKE AND CARDIOVASCULAR DISEASE IN ENGLAND: A MODELLING ANALYSIS, Publisher: BMJ PUBLISHING GROUP, Pages: A4-A4, ISSN: 0143-005X

Conference paper

Laverty A, Kypridemos C, Seferidi P, Vamos EP, Pearson-Stuttard J, Collins B, Capewell S, Fleming K, O'Flaherty M, Millett Cet al., 2019, IMPACT OF THE PUBLIC HEALTH RESPONSIBILITY DEAL ON SALT INTAKE, CARDIOVASCULAR DISEASE AND GASTRIC CANCER: INTERRUPTED TIME SERIES AND MICROSIMULATION STUDY, Publisher: BMJ PUBLISHING GROUP, Pages: A5-A5, ISSN: 0143-005X

Conference paper

Laverty AA, Kypridemos C, Seferidi P, Vamos EP, Pearson-Stuttard J, Collins B, Capewell S, Mwatsama M, Cairney P, Fleming K, O'Flaherty M, Millett Cet al., 2019, Quantifying the impact of the Public Health Responsibility Deal on salt intake, cardiovascular disease and gastric cancer burdens: interrupted time series and microsimulation study, Journal of Epidemiology and Community Health, Vol: 73, Pages: 881-887, ISSN: 0143-005X

Background In 2011, England introduced the PublicHealth Responsibility Deal (RD), a public-privatepartnership (PPP) which gave greater freedom to thefood industry to set and monitor targets for salt intakes.We estimated the impact of the RD on trends in saltintake and associated changes in cardiovascular disease(CVD) and gastric cancer (GCa) incidence, mortality andeconomic costs in England from 2011–2025.Methods We used interrupted time series modelswith 24 hours’ urine sample data and the IMPACTNCDmicrosimulation model to estimate impacts of changes insalt consumption on CVD and GCa incidence, mortalityand economic impacts, as well as equity impacts.Results Between 2003 and 2010 mean salt intake wasfalling annually by 0.20 grams/day among men and 0.12g/d among women (P-value for trend both < 0.001).After RD implementation in 2011, annual declines insalt intake slowed statistically significantly to 0.11 g/damong men and 0.07 g/d among women (P-values fordifferences in trend both P < 0.001). We estimated thatthe RD has been responsible for approximately 9900(interquartile quartile range (IQR): 6700 to 13,000)additional cases of CVD and 1500 (IQR: 510 to 2300)additional cases of GCa between 2011 and 2018. Ifthe RD continues unchanged between 2019 and 2025,approximately 26 000 (IQR: 20 000 to 31,000) additionalcases of CVD and 3800 (IQR: 2200 to 5300) cases ofGCa may occur.Interpretation Public-private partnerships such as theRD which lack robust and independent target setting,monitoring and enforcement are unlikely to produceoptimal health gains.

Journal article

Seferidi P, Laverty A, Pearson-Stuttard J, Bandosz P, Collins B, Guzman-Castillo M, Capewell S, O'Flaherty M, Millett Cet al., 2019, Impacts of Brexit on fruit and vegetable intake and cardiovascular disease in England: a modelling study, BMJ Open, Vol: 9, ISSN: 2044-6055

Objectives To estimate the potential impacts of different Brexit trade policy scenarios on the price and intake of fruits and vegetables (F&V) and consequent cardiovascular disease (CVD) deaths in England between 2021 and 2030.Design Economic and epidemiological modelling study with probabilistic sensitivity analysis.Setting The model combined publicly available data on F&V trade, published estimates of UK-specific price elasticities, national survey data on F&V intake, estimates on the relationship between F&V intake and CVD from published meta-analyses and CVD mortality projections for 2021–2030.Participants English adults aged 25 years and older.Interventions We modelled four potential post-Brexit trade scenarios: (1) free trading agreement with the EU and maintaining half of non-EU free trade partners; (2) free trading agreement with the EU but no trade deal with any non-EU countries; (3) no-deal Brexit; and (4) liberalised trade regime that eliminates all import tariffs.Outcome measures Cumulative coronary heart disease and stroke deaths attributed to the different Brexit scenarios modelled between 2021 and 2030.Results Under all Brexit scenarios modelled, prices of F&V would increase, especially for those highly dependent on imports. This would decrease intake of F&V between 2.5% (95% uncertainty interval: 1.9% to 3.1%) and 11.4% (9.5% to 14.2%) under the different scenarios. Our model suggests that a no-deal Brexit scenario would be the most harmful, generating approximately 12 400 (6690 to 23 390) extra CVD deaths between 2021 and 2030, whereas establishing a free trading agreement with the EU would have a lower impact on mortality, contributing approximately 5740 (2860 to 11 910) extra CVD deaths.Conclusions Trade policy under all modelled Brexit scenarios could increase price and decrease intake of F&V, generating substantial additional CVD mortality in England. The UK government should consider the population healt

Journal article

Seferidi P, Laverty AA, Pearson-Stuttard J, Guzman-Castillo M, Collins B, Capewell S, OFlaherty M, Millett CJet al., 2018, Implications of Brexit on the effectiveness of the UK soft drinks industry levy upon coronary heart disease in England: a modelling study, Public Health Nutrition, Vol: 21, Pages: 3431-3439, ISSN: 1368-9800

Objective:An industry levy on sugar-sweetened beverages (SSB) was implemented in the UK in 2018. One year later, Brexit is likely to change the UK trade regime with potential implications for sugar price. We modelled the effect of potential changes in sugar price due to Brexit on SSB levy impacts upon CHD mortality and inequalities.Design:We modelled a baseline SSB levy scenario; an SSB levy under ‘soft’ Brexit, where the UK establishes a free trading agreement with the EU; and an SSB levy under ‘hard’ Brexit, in which World Trade Organization tariffs are applied. We used the previously validated IMPACT Food Policy model and probabilistic sensitivity analysis to estimate the effect of each scenario on CHD deaths prevented or postponed and life-years gained, stratified by age, sex and socio-economic circumstance, in 2021.Setting:England.Subjects:Adults aged 25 years or older.Results:The SSB levy was associated with approximately 370 (95 % uncertainty interval 220, 560) fewer CHD deaths and 4490 (2690, 6710) life-years gained in 2021. Associated reductions in CHD mortality were 4 and 8 % greater under ‘soft’ and ‘hard’ Brexit scenarios, respectively. The SSB levy was associated with approximately 110 (50, 190) fewer CHD deaths in the most deprived quintile compared with 60 (20, 100) in the most affluent, under ‘hard’ Brexit.Conclusions:Our study found the SSB levy resilient to potential effects of Brexit upon sugar price. Even under ‘hard’ Brexit, the SSB levy would yield benefits for CHD mortality and inequalities. Brexit negotiations should deliver a fiscal and regulatory environment which promotes population health.

Journal article

Seferidi S, Laverty AA, Pearson-Stuttard J, Guzman-Castillo M, Collins B, Capewell S, O'Flaherty M, Millett Cet al., 2018, POTENTIAL IMPACTS OF BREXIT ON CARDIOVASCULAR DISEASE VIA CHANGES TO THE PRICE OF FRUITS AND VEGETABLES: A MODELLING ANALYSIS, Publisher: BMJ PUBLISHING GROUP, Pages: A21-A21, ISSN: 0143-005X

Conference paper

Seferidi P, Laverty AA, Pearson-Stuttard J, Guzman-Castillo M, Collins B, Capewell S, O'Flaherty M, Millett Cet al., 2017, Implications of Brexit for the effectiveness of the UK soft drinks industry levy on coronary heart disease in England: a modelling study, Public Health Science Conference, Publisher: ELSEVIER SCIENCE INC, Pages: S9-S9, ISSN: 0140-6736

Conference paper

Seferidi P, Millett C, Laverty AA, 2017, Sweetened beverage intake in association to energy and sugar consumption and cardiometabolic markers in children, Pediatric Obesity, Vol: 13, Pages: 1-9, ISSN: 2047-6310

BackgroundArtificially sweetened beverages (ASBs) are promoted as healthy alternatives to sugar‐sweetened beverages (SSBs) in order to reduce sugar intake, but their effects on weight control and glycaemia have been debated. This study examines associations of SSBs and ASBs with energy and sugar intake and cardiometabolic measures.MethodsOne thousand six hundred eighty‐seven children aged 4–18 participated in the National Diet and Nutrition Survey Rolling Programme (2008/9–2011/12) in the UK. Linear regression was used to examine associations between SSBs and ASBs and energy and sugar, overall and from solid foods and beverages, and body mass index, waist‐to‐hip ratio and blood analytes. Fixed effects linear regression examined within‐person associations with energy and sugar.ResultsCompared with non‐consumption, SSB consumption was associated with higher sugar intake overall (6.1%; 4.2, 8.1) and ASB consumption with higher sugar intake from solid foods (1.7%; 0.5, 2.9) but not overall, mainly among boys. On SSB consumption days, energy and sugar intakes were higher (216 kcal; 163, 269 and 7.0%; 6.2, 7.8), and on ASB consumption days, sugar intake was lower (−1.0%; −1.8, −0.1) compared with those on non‐consumption days. SSB and ASB intakes were associated with higher levels of blood glucose (SSB: 0.30 mmol L−1; 0.11, 0.49 and ASB: 0.24 mmol L−1; 0.06, 0.43) and SSB intake with higher triglycerides (0.29 mmol L−1; 0.13, 0.46). No associations were found with other outcomes.ConclusionSugar‐sweetened beverage intake was associated with higher sugar intake and both SSBs and ASBs with a less healthy cardiometabolic profile. These findings add to evidence that health policy should discourage all sweetened beverage consumption.

Journal article

Oude Griep LM, Seferidi P, Stamler J, Van Horn L, Chan Q, Tzoulaki I, Steffen LM, Miura K, Ueshima H, Okuda N, Zhao L, Soedamah-Muthu SS, Daviglus ML, Elliott P, INTERMAP Research Groupet al., 2016, Relation of unprocessed, processed red meat and poultry consumption to blood pressure in East Asian and Western adults, Journal of Hypertension, Vol: 34, Pages: 1721-1729, ISSN: 1473-5598

Background: Epidemiologic evidence suggests that relationships of red meat consumption with risk of cardiovascular diseases depends on whether or not the meat is processed, including addition of preservatives, but evidence is limited for blood pressure (BP). Objective: To examine cross-sectional associations with BP of unprocessed and processed red meat and poultry consumption, total and by type, using data from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP).Design: INTERMAP included 4,680 men and women ages 40-59 years from 17 population samples in Japan, China, the United Kingdom, and the United States. During four visits, eight BP measurements, four multi-pass 24-hr dietary recalls, and two timed 24-hr urine samples were collected.Results: Average daily total unprocessed/processed meat consumption (g/1000 kcal) was 20/5 in East Asian and 38/21 in Western participants. Unprocessed meat intakes comprised red meat for 75% in East Asian and 50% in Western participants. In Westerners, multiple linear regression analyses showed systolic/diastolic BP differences for total unprocessed red meat consumption higher by 25 g/1000 kcal +0.74/+0.57 mmHg (P=0.03/0.01) and for unprocessed poultry of +0.79/+0.16 mmHg (P=0.02/0.50). Unprocessed red meat was not related to BP in East Asian participants. In Westerners, systolic/diastolic BP differences for processed red meat higher by 12.5 g/1000 kcal were +1.20/+0.24 mmHg (P<0.01/0.24), due to consumption of cold cuts and sausages (+1.59/+0.32 mmHg, P<0.001/0.27).Conclusion: These findings are consistent with recommendations to limit meat intake (processed and unprocessed) to maintain and improve cardiovascular health.

Journal article

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