Impact of implementation of front-of-package nutrition labeling on sugary beverage consumption and consequently on the prevalence of excess body weight and obesity and related direct costs in Brazil: An estimate through a modeling study.

RATIONALE: Intake of sugary beverages has been associated with obesity and chronic non-communicable diseases, thereby increasing the direct health costs related to these diseases. Front-of-package nutrition labeling (FoPNL) aims to help consumers understand food composition, thereby improving food choices and preventing the development of such diseases. OBJECTIVE: To estimate, over five years, the impact of implementing FoPNL in Brazil on the prevalence of excess body weight and obesity in adults who consume sugary beverages and the direct costs related to such problems. METHODS: A simulation study to performed to estimate the effect of FoPNL implementation on the prevalence of excess body weight and obesity. The VIGITEL research database (2019), published in the 2020 report, was used in this study (the final sample consisted of 12,471 data points representing 14,380,032 Brazilians). The scenarios were considered: base (trend in sugary beverage intake); 1 (base scenario associated with the changes in energy content of the purchased beverages observed after the first phase of the Chilean labeling law (-9.9%); and 2 (scenario 1 associated with reformulation of beverages, total energy reduction of -1.6%). Changes in body weight were estimated using the simulation model of Hall et al. (2011) over five years. A linear trend in the prevalence of obesity and excess body weight in the Brazilian population was considered. The impact of the prevalence of obesity and excess body weight on body mass index was estimated. In addition, the direct health costs related to obesity were estimated. RESULTS: Energy consumption from sugary beverages after FoPNL implementation is expected to be reduced by approximately 28 kcal/day (95% CI, -30 to -27) considering scenario 1. In scenarios 1 and 2, without FoPNL, the prevalence of obesity and excess body weight over five years was estimated to be 25.3% and 25.2%, and 64.4% and 64.2%, respectively. By extrapolating the results to the entire Brazilian population, it was observed that the implementation of FoPNL may reduce the prevalence of obesity by -0.32 percentage points and -0.35 percentage points (scenario 1 and 2, respectively) and excess body weight by -0.42 percentage points and -0.48 percentage points (scenarios 1 and 2, respectively) in five years. It is estimated that after five years of implementation, it will be possible to save approximately US$ 5,5 millions (95% CI 4,7 to 8,8) in scenario 1, reaching approximately US$ 6,1 millions (95% CI 5,3 to 9,8) in scenario 2. CONCLUSION: The results of this modeling study indicate that FoPNL may reduce prevalence of excess body weight and obesity, representing strategic public policies for obesity prevention.

Energy Expenditure and Liver Transplantation: What We Know and Where We Are.

Patients with end-stage liver disease (ESLD) and undergoing liver transplantation (LTx) commonly present with malnutrition attributed to various etiologies. One of the causes is potential hypermetabolism resulting from increased resting energy expenditure (REE). After the surgery, it is hypothesized that these patients show a reduction in REE, which may contribute to the weight gain observed in this population. However, there have been controversial results regarding the metabolic status of ESLD patients and liver recipients, which has led us to critically review the pertinent literature. We enrolled studies with the following goals: assessment of REE of these patients either before or after surgery by using indirect calorimetry (measured REE [mREE]) and comparison of these mREE values with those of healthy controls or with REE values obtained using predictive equations (predicted REE [pREE]). For most patients, mREE and pREE values were comparable. However, ≥5.3% of patients exhibited hypermetabolism when the mREE was compared with the pREE using the Harris-Benedict formula. Three follow-up studies that were conducted postsurgery showed a progressive reduction in the mREE for ≤1 year. However, conflicting data have been published, and cross-sectional studies have not reported hypometabolic patients. In conclusion, there is no consensus regarding the metabolic status of pre-LTx and post-LTx patients, which may be due to differences in the methods used for comparison. Therefore, we highlight this aspect of LTx patient management, which impacts the quality of nutrition therapy required by these patients.