Food Taxation and the Double Burden of Malnutrition.

Dietary transition towards more animal-based and more highly processed energy-dense foods and beverages has led to sufficient or excessive intake of calories, but also a risk of insufficient intake of various essential macro- and micronutrients (the so-called double burden of malnutrition), in high-income countries, as well as in low- and middle-income countries. Taxation of energy-dense and non-essential food and beverage products has been proposed as a policy tool to reduce the intake of these foods, and such taxes have been implemented in several countries, often targeted at sugared beverages, candies, or snacks. Several studies tend to confirm an effect of such taxes on the consumption of the targeted products, but there is less knowledge as to how these taxes influence the "double burden" challenges associated with insufficient intake of important nutrients for some consumers. This paper reviews and discusses the mechanisms and experiences with taxation of unhealthy food products, as well as some implications of food taxation in light of the double burden perspective. Existing evidence suggests that taxation of unhealthy food products has the potential to reduce consumers' intake of these products and a potential to stimulate the consumption of other food products through substitution effects. However, except for the taxation of "sweets," it is not generally evident whether such substitution effects will be beneficial or harmful from a nutritional point of view. Concerns in this respect include whether individuals' sufficiency in different macro- and micronutrients will be improved or deteriorated by such effects, and whether these effects differ between population segments with currently high and low nutritional risk.

Double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases.

OBJECTIVE: This systematic examination and meta-analysis examined the scope and variation of the worldwide double burden of diseases and identified related socio-demographic factors. DESIGN: We searched PubMed for studies published in English from January 1, 2000, through September 28, 2016, that reported on double disease burden. Twenty-nine studies from 18 high-income, middle-income and low-income countries met inclusion criteria and provided 71 obesity-undernutrition ratios, which were included in meta-regression analysis. RESULTS: All high-income countries had a much higher prevalence of obesity than undernutrition (i.e. all the obesity/undernutrition ratios >1); 55% of the ratios in lower middle-income and low-income countries were <1, but only 28% in upper middle-income countries. Meta-analysis showed a pooled obesity-undernutrition ratio of 4.3 (95% CI = 3.1-5.5), which varied by country income level, subjects' age and over time. The average ratio was higher in high-income rather than that in lower middle-income and low-income countries (ß [SE] = 10.8 [2.6]), in adults versus children (7.1 [2.2]) and in data collected since 2000 versus before 2000 (5.2 [1.5]; all P values < 0.05). CONCLUSIONS: There are considerable differences in the obesity versus undernutrition ratios and in their prevalence by country income level, age groups and over time, which may be a consequence of the cumulative exposure to an obesogenic environment.

China in the period of transition from scarcity and extensive undernutrition to emerging nutrition-related non-communicable diseases, 1949-1992.

This study uses unique official data to document nutritional changes in the 1949-1992 period. In 1949, widespread famine, high mortality and low life expectancy dominated. Economic progress was uneven; however, the longer term food supply changed greatly, and hunger was conquered. Diet composition shifted greatly over this period. Cereal consumption, already high, increased from 541.2 g d(-1) (70.0% coarse grains) in 1952 to 645.9 g d(-1) (15.9% coarse grains) in 1992. Consumption of animal-source foods, half of which were pork and pork products, tripled from 30.0 to 103.0 g d(-1). The proportion of energy intake from fat tripled from 7.6% to 22.5%, and that from carbohydrates decreased from 83.0% to 65.8% over the same period. Physical activity was high in all domains, but shifts were beginning to occur (e.g. the initial mechanization of work and the expansion of biking). Nutritional improvement was uneven, including increased undernutrition in the 1959-1962 period and a remarkable rebound and continued improvement thereafter. Overweight emerged only after 1982. Shifts in diet, activity and body composition in 1949-1992 set the stage for major shifts in nutrition in the subsequent decades.

Prevalence of food insecurity in patients with diabetes in western Kenya.

AIMS: To determine the characteristics of patients with diabetes who reported food insecurity at three diabetes clinics in western Kenya. METHODS: This study includes routinely collected demographic data at the first presentation of patients with diabetes at clinics in western Kenya from 1 January 2006 to 24 September 2011. A validated questionnaire was used to assess food insecurity with descriptive and comparative statistics being used to analyse the food-secure and food-insecure populations. RESULTS: The number of patients presenting to these clinics who were food-secure and those who were food-insecure was 1179 (68.0%) and 554 (32.0%), respectively. Comparative analysis shows a statistically significant difference in weight, BMI, the presence of a caretaker, and use of insulin between the two groups. These variables were lower in the food-insecure group. The overall assessment of the clinic population revealed an abnormally high mean HbA1c concentration of 81 mmol/mol (9.6%). CONCLUSIONS: Despite the widely recognized contribution of caloric over-nutrition to the development of diabetes, this study highlights the high prevalence of food insecurity amongst patients with diabetes in rural, resource-constrained settings. Other factors, such as the lower prevalence of obesity, poor glucose control, challenges in the use of insulin because of the risk of hypoglycaemia, and varying subtypes of diabetes in this population, point to the need for additional research in understanding the aetiology, pathophysiology and optimum management of this condition, as well as understanding the effects of enhancing food security.

The U-shaped relationship between BMI and all-cause mortality contrasts with a progressive increase in medical expenditure: a prospective cohort study.

The U-shaped relationship between body mass index (BMI) and all-cause mortality has generated uncertainty about optimal BMI. For clarification, we have related BMI to both mortality and medical expenditure. The MJ Health examination cohort of 111,949 examinees established during 1994-1996 was followed with endpoint information derived from death certificates and National Health Insurance records from 1996 to 2007. Age- and gender-specific relative risks between BMI groups were estimated by Cox and logistic regressions. The BMI and all-cause mortality relationship is U-shaped with the concave regions sitting in the region of BMI 22-26, butshifted rightward for the elderly. After excluding smokers and cancer patients at baseline, the low mortality region moved leftward to BMI 20-22. Cause-specific mortalities from respiratory disease, injury, and senility increased in the underweight group (BMI <18.5). Above 18.5, BMI was negatively associated with mortality from respiratory diseases and senility, but not with others. In contrast, irrespective of age and gender, the overall median and mean medical expenditures progressively increased with BMI, particularly beyond 22. Expenditures for injury, respiratory, circulatory diseases and senility all increased with BMI. The U-shaped BMI-mortality relation was a result of elevated death rate at both ends of the BMI scale. Increased mortality at the low end did not contribute to higher medical expenditure, maybe because the lean and frail deceased tend to die abruptly before large amount of medical expenditure was consumed. Our findings suggest that current recommendations to maintain BMI at the lower end of the desirable range remain tenable for the apparently healthy general public.