Evidence for physical activity guidelines as a public health intervention: efficacy, effectiveness and harm – a critical policy sciences approach.

BACKGROUND: Evidence for the efficacy of physical activity in conferring health benefits is unequivocal, and this has led national governments to produce guideline recommendations for physical activity levels in their populations. AIM: To evaluate how far evidence for the efficacy, effectiveness and comparative effectiveness of current physical activity guideline recommendations as a public health intervention is considered in developing guideline recommendations, including a consideration of the extent to which, in comparison to alternatives, they may result in harm. METHODS: Utilising a critical policy sciences approach, national physical activity guideline recommendations in Australia, the UK and the USA, and those of the World Health Organisation, are examined, along with their stated underlying evidence bases, to analyse what evidence has been considered, how it has been interpreted, for what purpose, and with what outcomes. RESULTS: All current guidelines recommend 150 minutes moderate physical activity per week. However, efficacy evidence shows 60 minutes is sufficient to provide some health benefits. None of the guidelines consider effectiveness evidence nor potential effectiveness. No evidence could be found for the effectiveness of a recommendation of 150 minutes in improving population health, and none of the guidelines consider whether a recommendation at a lower but still sufficient level of efficacy (e.g. 60 minutes) would be a more effective public health intervention. CONCLUSIONS: Evidence considered in drawing up physical activity guidelines relates only to the efficacy of physical activity in conferring health benefits. The lack of effectiveness evidence, the failure to consider potential effectiveness, and related un-evidenced value judgements call into question the claim that the guidelines are evidence-based. Because neither effectiveness nor comparative effectiveness is considered, it is possible that current guidelines of 150 minutes may result in net harm to population health in comparison to the opportunity cost of recommendations at alternative levels

An overview of the statistical methods reported by studies using the Canadian community health survey

BACKGROUND: The Canadian Community Health Survey (CCHS) is a cross-sectional survey that has collected information on health determinants, health status and the utilization of the health system in Canada since 2001. Several hundred articles have been written utilizing the CCHS dataset. Previous analyses of statistical methods utilized in the literature have focused on a particular journal or set of journals to understand the statistical literacy required for understanding the published research. In this study, we describe the statistical methods referenced in the published literature utilizing the CCHS dataset(s). METHODS: A descriptive study was undertaken of references published in Medline, Embase, Web of Knowledge and Scopus associated with the CCHS. These references were imported into a Java application utilizing the searchable Apache Lucene text database and screened based upon pre-defined inclusion and exclusion criteria. Full-text PDF articles that met the inclusion criteria were then used for the identification of descriptive, elementary and regression statistical methods referenced in these articles. The identification of statistical methods occurred through an automated search of key words on the full-text articles utilizing the Java application. RESULTS: We identified 4811 references from the 4 bibliographical databases for possible inclusion. After exclusions, 663 references were used for the analysis. Descriptive statistics such as means or proportions were presented in a majority of the articles (97.7%). Elementary-level statistics such as t-tests were less frequently referenced (29.7%) than descriptive statistics. Regression methods were frequently referenced in the articles: 79.8% of articles contained reference to regression in general with logistic regression appearing most frequently in 67.1% of the articles. CONCLUSIONS: Our study shows a diverse set of analysis methods being referenced in the CCHS literature, however, the literature heavily relies on only a subset of all possible statistical tools. This information can be used in identifying gaps in statistical methods that could be applied to future analysis of public health surveys, insight into training and educational programs, and also identifies the level of statistical literacy needed to understand the published literature

Poor food and nutrient intake among Indigenous and non-Indigenous rural Australian children

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to describe the food and nutrient intake of a population of rural Australian children particularly Indigenous children. Participants were aged 10 to 12 years, and living in areas of relative socio-economic disadvantage on the north coast of New South Wales.</p> <p>Methods</p> <p>In this descriptive cross-sectional study 215 children with a mean age of 11.30 (SD 0.04) years (including 82 Indigenous children and 93 boys) completed three 24-hour food recalls (including 1 weekend day), over an average of two weeks in the Australian summer of late 2005.</p> <p>Results</p> <p>A high proportion of children consumed less than the Australian Nutrient Reference Values for fibre (74-84% less than Adequate Intake (AI)), calcium (54-86% less than Estimated Average Requirement (EAR)), folate and magnesium (36% and 28% respectively less than EAR among girls), and the majority of children exceeded the upper limit for sodium (68-76% greater than Upper Limit (UL)). Energy-dense nutrient-poor (EDNP) food consumption contributed between 45% and 49% to energy. Hot chips, sugary drinks, high-fat processed meats, salty snacks and white bread were the highest contributors to key nutrients and sugary drinks were the greatest <it>per capita </it>contributor to daily food intake for all. <it>Per capita </it>intake differences were apparent by Indigenous status. Consumption of fruit and vegetables was low for all children. Indigenous boys had a higher intake of energy, macronutrients and sodium than non-Indigenous boys.</p> <p>Conclusions</p> <p>The nutrient intake and excessive EDNP food consumption levels of Australian rural children from disadvantaged areas are cause for concern regarding their future health and wellbeing, particularly for Indigenous boys. Targeted intervention strategies should address the high consumption of these foods.</p

Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries

The consumption of sugar-sweetened beverages (SSBs) is associated with type 2 diabetes (T2D) and cardiovascular diseases (CVD). However, an updated and comprehensive assessment of the global burden attributable to SSBs remains scarce. Here we estimated SSB-attributable T2D and CVD burdens across 184 countries in 1990 and 2020 globally, regionally and nationally, incorporating data from the Global Dietary Database, jointly stratified by age, sex, educational attainment and urbanicity. In 2020, 2.2 million (95% uncertainty interval 2.0–2.3) new T2D cases and 1.2 million (95% uncertainty interval 1.1–1.3) new CVD cases were attributable to SSBs worldwide, representing 9.8% and 3.1%, respectively, of all incident cases. Globally, proportional SSB-attributable burdens were higher among men versus women, younger versus older adults, higher- versus lower-educated adults, and adults in urban versus rural areas. By world region, the highest SSB-attributable percentage burdens were in Latin America and the Caribbean (T2D: 24.4%; CVD: 11.3%) and sub-Saharan Africa (T2D: 21.5%; CVD: 10.5%). From 1990 to 2020, the largest proportional increases in SSB-attributable incident T2D and CVD cases were in sub-Saharan Africa (+8.8% and +4.4%, respectively). Our study highlights the countries and subpopulations most affected by cardiometabolic disease associated with SSB consumption, assisting in shaping effective policies and interventions to reduce these burdens globally

Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the worlds child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 1519 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes. (c) 2023, The Author(s)

How prices and income influence global patterns in saturated fat intake by age, sex and world region: a cross-sectional analysis of 160 countries

Objective When considering proposals to improve diets, it is important to understand how factors like price and income can affect saturated fat (SF) intake and demand. In this study, we examine and estimate the influence of price and income on intake across 160 countries, by age and sex, and derive sensitivity measures (price elasticities) that vary by age, sex and world region. Design We econometrically estimate intake responsiveness to income and prices across countries, accounting for differences by world region, age and sex. Intake data by age, sex and country were obtained from the 2018 Global Dietary Database. These data were then linked to global price data for select food groups from the World Bank International Comparison Programme and income data from the World Development Indicators Databank (World Bank). Results Intake differences due to price were highly significant, with a 1% increase in price associated with a lower SF intake (% energy/d) of about 4.3 percentage points. We also find significant differences across regions. In high-income countries, median (age 40) intake reductions were 1.4, 0.8 and 0.2 percentage points, given a 1% increase in the price of meat, dairy, and oils and fats, respectively. Price elasticities varied with age but not sex. Intake differences due to income were insignificant when regional binary variables were included in the analysis. Conclusion The results of this study show heterogeneous associations among prices and intake within and across countries. Policymakers should consider these heterogeneous effects as they address global nutrition and health challenges. © 2024 BMJ Publishing Group. All rights reserved.The Global Dietary Database was supported by a grant from the Bill & Melina Gates Foundation: grant # OPP1176682

Fatores associados ao consumo regular de refrigerante não dietético em adultos de Pelotas, RS

OBJECTIVE: To assess factors associated with regular intake of non-diet soft drinks among adults. METHODS: Population-based cross-sectional study including 972 adults (aged 20 to 69) in the city of Pelotas, Southern Brazil, conducted in 2006. The frequency of non-diet soft drink intake in the 12 months prior to the study was evaluated by the question: "In general since lastOBJETIVO: Analizar factores asociados al consumo regular de gaseosas no dietéticas por adultos. MÉTODOS: Estudio transversal de base poblacional con 972 adultos (20 a 69 años) del municipio de Pelotas, Sur de Brasil, realizado en 2006. La frecuencia de consumo en los 12 meses anteriores a la investigación fue medida por medio de la pregunta: "en general desde elOBJETIVO: Analisar fatores associados ao consumo regular de refrigerantes não dietéticos por adultos. MÉTODOS: Estudo transversal de base populacional com 972 adultos (20 a 69 anos) do município de Pelotas, RS, realizado em 2006. A freqüência de consumo nos 12 meses anteriores à pesquisa foi medida por meio da pergunta: "em geral desde

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.814.4 million) incident T2D cases, representing 70.3% (68.871.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.027.1%)), excess refined rice and wheat intake (24.6% (22.327.2%)) and excess processed meat intake (20.3% (18.323.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.487.7%)) and Latin America and the Caribbean (81.8% (80.183.4%)); and lowest proportional burdens were in South Asia (55.4% (52.160.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally. (c) 2023, The Author(s)

Adolescents’ beverage choice at school and the impact on sugar intake

Background/Objectives: To examine students’ beverage choice in school, with reference to its contribution to students’ intake of non-milk extrinsic (NME) sugars. Subjects/Methods: Beverage and food selection data for students aged 11–18 years (n=2461) were collected from two large secondary schools in England, for a continuous period of 145 (school A) and 125 (school B) school days. Descriptive analysis followed by cluster analysis of the beverage data were performed separately for each school. Results: More than a third of all items selected by students were beverages, and juice-based beverages were students’ most popular choice (school A, 38.6%; school B, 35.2%). Mean NME sugars derived from beverages alone was high (school A, 16.7 g/student-day; school B, 12.9 g/student-day). Based on beverage purchases, six clusters of students were identified at each school (school A: ‘juice-based’, ‘assorted’, ‘water’, ‘cartoned flavoured milk’, ‘bottled flavoured milk’, ‘high volume juice-based’; school B: ‘assorted’, ‘water with juice-based’, ‘sparkling juice/juice-based’, ‘water’, ‘high volume water’, ‘high volume juice-based’). Both schools included ‘high volume juice-based’ clusters with the highest NME sugar means from beverages (school A, 28.6 g/student-day; school B, 24.4 g/student-day), and ‘water’ clusters with the lowest. A hierarchy in NME sugars was found according to cluster; students in the ‘high volume juice-based’ cluster returned significantly higher levels of NME sugars than students in other clusters. Conclusions: This study reveals the contribution that school beverages combined with students’ beverage choice behaviour is making to students’ NME sugar intake. These findings inform school food initiatives, and more generally public health policy around adolescents’ dietary intake