Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study.

BACKGROUND: Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. METHODS: A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs) were reported and results were tested through sensitivity analysis. RESULTS: Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings), measured against a comparator of no additional increase in fuel excise. Under "best case" assumptions, the intervention would be more cost-effective (3181 HALYs gained, AUD34.2 M in healthcare cost savings). CONCLUSIONS: Exploratory analysis suggests that an intervention to increase fuel excise taxation may deliver obesity and physical activity related benefits. Whilst such an intervention has significant potential for cost-effectiveness, potential equity and acceptability impacts would need to be minimised. A better understanding of the effectiveness and cost-effectiveness of a range of transport interventions is required in order to achieve more physically active transport environments.

Prevalence and socio-economic distribution of eating, physical activity and sedentary behaviour among South Australian children in urban and rural communities: baseline findings from the OPAL evaluation.

OBJECTIVE: To identify current prevalence and sociodemographic distribution of adherence to national diet and physical activity and sedentary behaviour guidelines among Australian primary school children. STUDY DESIGN: Cross-sectional survey of children (n = 4637, 9-11 years) participating at baseline in the South Australian Obesity Prevention and Lifestyle (OPAL) programme evaluation. METHODS: Self-reported diet, physical activity (PA) and screen time (ST) behaviours were assessed via questionnaire. Children were classified as meeting or not meeting each guideline (two or more serves of fruit, five or more serves of vegetables, two or less serves of discretionary food, ≥60 min of PA, and ≤2 h of ST per day). RESULTS: Although 65% of children met fruit recommendations, only 22% met vegetable recommendations (17% consumed no vegetables). Approximately one-quarter (28%) of children met discretionary food recommendations. Only 17% of children met the ST recommendations and 33% met PA recommendations. Less than 1% of children met all five recommendations. Rural children were more likely to meet both PA (OR = 1.45, 95% CI: 1.21-1.74, P < 0.001) and ST (OR = 1.37, 95% CI: 1.14-1.66, P < 0.01) recommendations than urban counterparts. Children at least socio-economic disadvantage performed better than those at greatest disadvantage for most behaviours. CONCLUSION: Improvement in Australian children's diet and physical activity and sedentary behaviours, particularly urban children and those at greatest socio-economic disadvantage, is urgently warranted.

Pharmacological interventions for geriatric cachexia: a narrative review of the literature.

OBJECTIVE: The objective of this review was to investigate the range of pharmacological interventions that have been studied for treatment of geriatric cachexia, and to evaluate their effect on selected clinical outcomes in this population. METHODS: Databases including Medline and Cochrane Central Register of Controlled Trials were searched up to March 2010 with search terms including "cache*", "intervention", "megestrol acetate" and "cytokine inhibitors". Studies investigating subjects with mean age <60y or disease-related cachexia were excluded. Outcomes assessed were weight or BMI, body composition, appetite and laboratory parameters indicative of cachexia. RESULTS: Fifteen publications met the selection criteria, reporting on ten studies. Seven studies investigated use of megestrol acetate (MA): two randomised controlled trials, one case control study, two pre-test/post-test studies and two retrospective chart reviews. Weight/BMI was common amongst outcomes and these studies showed an improvement in weight compared with baseline. MA studies which investigated body composition, appetite and/or laboratory parameters provided some evidence for improvement in these outcomes. Three randomised controlled trials investigated the use of other interventions: ghrelin, growth hormone and vitamin supplementations. All demonstrated a significant increase in lean body mass. The only other outcome of interest in these three trials was weight in one study with a significant increase demonstrated. CONCLUSION: Little investigation has been conducted in this population and the diagnosis of cachexia is problematic however these trials provide preliminary evidence for beneficial outcomes in older adults likely to have cachexia. Further high quality adequately powered prospective studies are necessary to provide effective treatment for geriatric cachexia.

Comparison of dietary intakes according to breakfast choice in Australian boys.

BACKGROUND: There is little information on how breakfast choices are associated with dietary intakes in Australian boys. OBJECTIVE: (i) To determine the proportion of breakfast skippers, ready-to-eat cereal (RTEC) consumers and non-RTEC consumers at breakfast; (ii) to compare breakfast, and daily nutrient intakes and nutrient density, between the three groups; and (iii) to compare daily nutrient intakes against nutrient recommendations. SUBJECTS/METHODS: Cross-sectional analysis of 12 to 16-year-old boys (n = 781) from the 2007 Australian National Children's Nutrition and Physical Activity Survey. RESULTS: Forty-two percent of boys consumed RTEC at breakfast; 38% did not consume RTECs; and 20% skipped breakfast. Breakfast skippers had a higher body mass index and waist circumference compared with RTEC consumers (P ≤ 0.05). At breakfast, RTEC consumers had a higher intake of total sugars and a lower intake of fat and sodium versus non-RTEC consumers. Total daily nutrient density for calcium, iron, thiamin, riboflavin, zinc, dietary folate equivalents, magnesium and iodine was higher for RTEC consumers versus non-RTEC consumers and breakfast skippers (all P ≤ 0.05). Fifty-nine percent of 14 to 16-year-old RTEC consumers reached the fibre adequate intake versus 34% and 24% of non-RTEC consumers and breakfast skippers, respectively (all P ≤ 0.01). More RTEC consumers met the calcium estimated average requirements versus non-RTEC consumers and breakfast skippers (P ≤ 0.01). CONCLUSIONS: Breakfast choice, specifically RTECs and the foods consumed with them, provide valuable nutrients that may assist boys in meeting nutrient requirements. Consumption of RTECs may be one way in which intakes of key nutrients, relevant for growth and development, could be increased in older boys.

Cluster analysis and food group consumption in a national sample of Australian girls.

BACKGROUND: Food preferences develop early in life and track into later life. There is limited information on food consumption and dietary patterns in Australian girls. The present study aimed to: (i) determine the frequency of food groups consumed over 1day; (ii) identify dietary clusters based on food group consumption; and (iii) compare dietary intakes and activity variables between clusters. METHODS: A cross-sectional analysis of 9-16-year-old girls (n=1114) from the 2007 Australian National Children's Nutrition and Physical Activity Survey was performed. RESULTS: Over the whole day, 30% of all girls consumed carbonated sugar drinks, 46% consumed take-away food, 56% consumed fruit, 70% consumed at least one vegetable, and 19% and 30% consumed white and/or red meat, respectively. K-means cluster analysis derived four clusters. Approximately one-third of girls were identified in a Meat and vegetable cluster; these girls had the highest intakes of red meat and vegetables, and tended to have higher intakes of fruit, whole grain breads, low fat yoghurt, and lower intakes of take-away foods and soft drinks. They also had the highest intakes of protein, fibre and micronutrients; and tended to perform more physical activity, compared to girls in the remaining clusters. CONCLUSIONS: Girls identified in the Meat and vegetable cluster, on average, consumed more lean red meat, vegetables, fruits, and low-fat dairy products, and had a higher intakes of many nutrients. The high percentage of girls not identified in this cluster suggests the need to inform them on how to make healthy, nutrient dense food choices, and why they require increased nutrient intakes at this time.

Australian Longitudinal Study of Ageing: prospective evaluation of anthropometric indices in terms of four year mortality in community-living older adults.

The Australian Longitudinal Study of Ageing (ALSA) aims to identify factors that contribute to & predict the health & social well-being of older Australians. Analyses were performed to determine the predictive value of anthropometric measurements in older Australians for four-year mortality. Weight, height, skinfolds (triceps, abdominal, supra-spinale, sub-scapular, medial calf, and front thigh) & girth (arm, waist, hip, calf) measurements were performed on a randomly selected community-living sample of 772 men & 624 women aged>70 years. Waist: Hip, % weight loss, corrected-arm-muscle area (CAMA) & BMI were calculated. These measures were categorised into quartiles & also according to commonly adopted definitions of nutritional status. Cox regression analysis was undertaken to assess the predictive value of the independent anthropometric variables for four-year mortality, adjusting for potential confounders (age, gender, marital status, smoking, alcohol status, self-rated health, basic activities of daily living & co-morbidity). Risk of four-year mortality increased with weight loss >10% over two years (HR=2.53, CI=1.37-4.67) & CAMA <21.4cm2(M) & <21.6cm2(F) (HR=1.93, CI=1.03-3.60) independent of confounding variables. These results confirm that selected anthropometric indices (weight loss, CAMA) independently increase the risk of four-year mortality & highlights their potential use in the nutrition screening and assessment of community-living older adults.

Exercise profile and subsequent mortality in an elderly Australian population.

Although the importance of exercise as a public health issue is increasingly recognised, little attention has been paid to exercise in very old people. We examined exercise patterns in 1788 subjects aged 70 years and over who were participating in the Australian Longitudinal Study of Ageing. In the two weeks before interview, 39 per cent of subjects had taken no exercise and only four per cent had exercised vigorously. When compared with those who took no exercise, exercisers were more likely to be male and younger, to self-report better health, to be former smokers and regular alcohol users. Mortality rates at two years follow-up were inversely related to the level of exercise at baseline. This research indicates that exercise is important for the very old as well as younger groups.

Effect of sodium restriction and fish oil supplementation on BP and thrombotic risk factors in patients treated with ACE inhibitors.

Effects of dietary sodium restriction combined with fish oil supplementation on BP and related risk factors were assessed in hypertensives treated with angiotensin converting enzyme (ACE) inhibitors. After a four week run-in phase, a six week intervention trial was conducted in which four matched groups of 14 patients, taking either captopril or enalapril, were assigned to one of four dietary treatments: low sodium (80 mmol/day) with fish oil (5 g of omega-3 fatty acids per day); normal sodium (150 mmol/day) with fish oil; low sodium with olive oil; normal sodium with olive oil. All subjects adopted a low sodium diet and adjustments of nutrient intake were made by double-blind administration of sodium and oils in supplementary tablets and capsules. BP fell in all treatment groups during intervention. However, the reduction of SBP was 4.2 mmHg greater in subjects on a low sodium intake than in those taking normal sodium. There were no differences in BP between those taking olive oil and those taking fish oil but plasma triglycerides and serum thromboxane production were reduced by 27% and 51%, respectively in the latter. Thus the antihypertensive effect of ACE inhibitors can be augmented by sodium restriction alone but supplementing the diet with fish oil may yield additional cardiovascular benefits.

A low-sodium diet supplemented with fish oil lowers blood pressure in the elderly.

OBJECTIVE: To examine effects of dietary fish oil supplementation with sodium restriction on blood pressure in the elderly. DESIGN: In a double-blind dietary intervention lasting 4 weeks, parallel comparisons of blood pressure were made in volunteers assigned to one of four treatment groups: fish oil and low sodium; fish oil and normal sodium; sunflower oil and low sodium; or sunflower oil and normal sodium. SETTING: Subjects lived at home and attended our nutrition research clinic at fortnightly intervals for dietary counselling and blood pressure measurement. PARTICIPANTS: Health volunteers aged 60-80 years were sought by advertisement. A total of 114 men and women were enrolled in two cohorts; 106, with an initial mean blood pressure of 132/77 mmHg, satisfactorily completed the study. INTERVENTION: All subjects adopted a low-sodium diet and dietary changes were effected by double-blind administration of slow-release sodium chloride or placebo tablets, along with capsules containing either fish or sunflower oil. MAIN OUTCOME MEASURE: The primary measure was the within-subject change in blood pressure after 4 weeks of intervention in each dietary treatment group. RESULTS: Urinary sodium excretion in subjects on low-sodium diets decreased whilst potassium excretion was unaffected. Systolic blood pressure (SBP) fell in the group taking sunflower oil with low sodium, but there was only a transient fall in diastolic blood pressure (DBP). In those taking fish oil with normal sodium, the change in blood pressure was not significant, except after adjustment for initial blood pressure and weight changes. When fish oil was combined with low sodium, however, both SBP and DBP were substantially reduced; the reduction in DBP was significantly greater than in the other treatment groups. CONCLUSION: Dietary fish oil and sodium restriction can interact to lower DBP in the elderly.

Effects of dietary sodium restriction and fish oil supplements on blood pressure in the elderly.

1. The effects on blood pressure of dietary fish oil, sodium restriction and a combination of both strategies were examined in a short-term dietary intervention study of 50 healthy elderly subjects (average age 67 years) with mean initial systolic and diastolic blood pressures of 133 and 77 mmHg, respectively. 2. Subjects were allocated to one of four treatment groups: fish oil with normal sodium, fish oil with low sodium, sunflower oil with normal sodium and sunflower oil with low sodium for 4 weeks. They then crossed over to the alternative sodium treatment for a further 4 weeks whilst remaining on the same oil. 3. The combination of fish oil supplementation with dietary sodium restriction caused significant reductions of blood pressure in the first 4 weeks: systolic blood pressure (SBP) fell by 8.9 mmHg, mean arterial pressure (MAP) by 7.4 mmHg and diastolic blood pressure (DBP) by 6.0 mmHg. 4. Fish oil enhanced the effect of sodium restriction on blood pressure. In the crossover protocol, a change in sodium excretion of 92 mmol/day was accompanied by changes of 6.4, 3.3 and 2.2 mmHg for SBP, MAP and DBP, respectively, in the subjects taking fish oil. However in those taking sunflower oil, blood pressure did not change significantly. 5. The results indicate beneficial interactive effect of dietary fish oil and sodium intake on blood pressure.

Lipid, lipoprotein, and hemostatic effects of fish vs fish-oil n-3 fatty acids in mildly hyperlipidemic males.

The effects of fish and fish oil on lipids, hemostasis, and blood pressure were compared in 25 mildly hyperlipidemic men who received 4.5 g eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) daily for 5 wk. Six additional subjects served as controls. Fish and fish oil lowered plasma triglycerides 20% and 28% and very-low-density-lipoprotein (VLDL) triglycerides 42% and 52%, respectively (all P less than 0.05 compared with control). High-density-lipoprotein (HDL) cholesterol increased by 10% and 9%, with 34% and 32% increases in the proportion of HDL2 particles for fish and fish oil, respectively. Changes in total cholesterol, LDL cholesterol, apolipoprotein B, and blood pressure with fish and fish oil were not significantly different from changes for the control diet. The fish lowered fibrinogen (15.7%) and thromboxane (10.5%) and increased bleeding time (10.8%) (P less than 0.05 compared with control). Eating fatty fish and fish oil produced comparable lipid and lipoprotein changes, but only the fish improved hemostatic factors.

Lack of effect of short-term changes in sodium intake on blood pressure in adolescent schoolchildren.

The relationship between sodium intake and blood pressure in adolescents was examined in a dietary intervention study. One hundred schoolchildren aged 11-14 years and representing the top, middle and bottom deciles of the blood pressure range completed a crossover protocol requiring them to raise and lower their sodium intake for alternate periods of 4 weeks. Blood pressure and urinary sodium excretion were assessed weekly and diet diaries were recorded at the end of each 4-week diet period. Diet-diary analysis confirmed that sodium intake was selectively affected by the intervention. Estimates of average urinary sodium excretion at the end of each diet period differed by more than 80 mmol/day. However, there was no significant change of either systolic or diastolic blood pressure, measured supine in the whole study group, in either sex or in any of the sub-groups, even in those children representing the highest blood pressure decile. Furthermore, the blood pressure changes seen in individuals during the crossover did not correlate with their changes in sodium excretion. This lack of effect of sodium on blood pressure is consistent with other dietary intervention studies in children and supports the hypothesis that the sodium sensitivity of blood pressure is age-related. We conclude that dietary sodium restriction alone has little potential for lowering blood pressure at an early age, even in children with higher than average blood pressure.

Can eating baked beans lower plasma cholesterol?

The plasma cholesterol lowering potential of canned baked beans was examined in a cross-over comparison with canned spaghetti. The difference in total dietary non-starch polysaccharide (NSP) of 12 g daily (6.6 g difference in soluble NSP), was insufficient to alter the plasma cholesterol, HDL cholesterol, triglyceride and glucose concentrations in 20 mildly hyper-cholesterolaemic men. Thus, eating an average of six 440 g cans of this source of baked beans per week, large servings, does not lower the plasma cholesterol when dietary fat is not displaced.

Evaluation of long-term aggressive dietary management of chronic renal failure in children.

Ten children with chronic renal failure (CRF) were managed for 3 years using a strict low-protein and low-phosphorus diet supplemented by a mixture of the keto and amino forms of the essential amino acids and histidine (phase II). All of these children were previously managed for at least 2 years with a less rigorous diet of limited protein intake with no specific reduction of phosphorus (phase I). Energy, vitamin D, bicarbonate, phosphate binders and vitamin and mineral mixtures were added as required during both dietary phases. Data on dietary intake showed a significant fall in protein and phosphorus intake and a rise in calcium intake during phase II compared with phase I. Plasma calcium increased and phosphate fell, with an associated fall in intact parathyroid hormone levels. There was a marked improvement in urea creatinine ratios, which suggested an improved anabolic state. Cholesterol and triglyceride levels were improved. Height and weight velocity were increased, becoming significant after 3 years of phase II. Renal function deteriorated at a slower rate than predicted. The diet was well tolerated by the children, with fitness and school performance showing improvement. We conclude that long-term strict dietary management of children with CRF is feasible. Our data suggest an overall improvement in general health and an apparent reduction in the rate of deterioration of renal function.