Investing in fruits, vegetables can save lives, reduce health care costs

Increasing the consumption of fruits and vegetables could save more than 100,000 lives and $17 billion in health care costs from heart disease each year in the United States, according to a new report by the Union of Concerned Scientists.

The report, The $11 Trillion Dollar Reward, explains that better federal agricultural policies, designed to encourage production of healthy food instead of processed junk foods, will help reap those benefits.

If Americans consumed just one additional serving of fruits or vegetables a day, the nation would save $5 billion in health care expenditures and prevent 30,301 heart disease and stroke deaths annually. And if Americans were to go a step further and eat a full 2.5 cups of vegetables and two cups of fruit daily, as recommended by federal dietary guidelines, it could prevent 127,261 deaths each year and save $17 billion in medical costs. The economic value of the lives saved from cardiovascular diseases is an astounding $11 trillion, according to the report.

The report researchers advocate for cost-effective policies that increase access to and reduce the cost of domestically grown fruits and vegetables for consumers, especially for low-income consumers who are hardest hit by cardiovascular disease and other diet-related illnesses. Low-income neighborhoods–where some 30 million Americans reside–are often far from grocery stores and other sources of fresh produce, hindering access.

Current federal agricultural policies channel taxpayer dollars into subsidies for commodity crops, such as corn and soybeans, which are used as feed for livestock, biofuels and as processed food ingredients. These policies offer few incentives for farmers to grow fruits and vegetables–effectively discouraging production of the very foods federal dietary guidelines recommend.

A three-minute video produced by UCS summarizes how we can achieve an $11 trillion reward through forward-looking agricultural policies.

Citation:
1. O’Hara JK. The $11 Trillion Reward: How Simple Dietary Changes Can Save Lives and Money, and How We Get There. Cambridge, Mass.: Union of Concerned Scientists, 2013.

Physical activity recommendations for children

Physical activity recommendations in early childhood should be a focus of future cardiovascular disease prevention efforts, according to a study of 3,000 children age 2-9 years from eight European countries.

The age and sex of the children are important factors in determining the right physical activity requirements. Boys age six years or younger need at least 60 minutes of moderate-to-vigorous physical activity per day, whereas boys age 6-9 years need at least 80 minutes. Girls in either age group need approximately 15 minutes less. Recommendations should also include 20 minutes of vigorous physical activity per day in all children.

Clinicians should avoid using generalized physical activity guidelines and evaluate children at risk of cardiovascular disease on a case-by-case basis, the researchers said.

Citation:
1. Jiménez-Pavón D, Konstabel K, Bergman P, et al. Physical activity and clustered cardiovascular disease risk factors in young children: a cross-sectional study (the IDEFICS study). BMC Medicine 2013; 11: 172. (open access)
2. McMurray RG. Insights into physical activity and cardiovascular disease risk in young children: IDEFICS study. BMC Medicine 2013; 11: 173. (open access)

Extreme heat increasing in the Midwest United States

Extreme heat is the biggest weather-related killer in the United States, and dangerously hot weather is already occurring more frequently in the Midwest than it did 60 years ago, according to a new report by the Union of Concerned Scientists.

Heat in the Heartland: 60 Years of Warming in the Midwest, presents an original analysis of weather data for five major urban areas—Chicago, Cincinnati, Detroit, Minneapolis and St. Louis—and five smaller nearby cities.

High temperatures not only can lead to dehydration, heat exhaustion and deadly heatstroke, but can can also aggravate existing medical conditions, such as diabetes, respiratory disease, kidney disease and heart disease. Heat claims, on average, more lives each year than floods, lightning, tornadoes and hurricanes combined. From 1999-2003, exposure to excessive heat killed an estimated 3,442 U.S. residents.

The report examines how the average daytime temperatures, humidity levels and nighttime temperatures within different types of weather systems have changed over time. Key findings include:

• Heat waves lasting three days or more have become more common over the last six decades. St. Louis has approximately four more three-day heat waves each year than it did in the 1940s.
• On average, hot humid days have increased more rapidly in frequency, while hot dry days have increased in temperature more rapidly across the Midwest since the 1940s and 1950s.
• In general, hot air masses have become hotter and more humid during nighttime hours.
• In some cities, average nighttime temperatures within some air mass types have increased as much as 4-5 degrees Fahrenheit (˚F) over the six decades.
• Relief from heat is harder to find—all of the cities studied now have fewer cool, dry days in the summer.
• The results are not due solely to an urban heat island effect on major cities. Less urban neighboring locations showed similar increases in hot summer air masses.

The report sheds light on the importance of city-level efforts to minimize the health risks of future climate change. The findings suggest several consequences for public health, as well as implications for local preparedness and efforts to reduce the effects of a changing climate.

“We need strategies to both build climate-resilient communities and reduce the global warming emissions that are driving climate change,” the study concludes.

It is the third report in a series on Climate Change and Your Health.

Citation:
1. Perera EM, Sanford T, White-Newsome JL, et al. Heat in the Heartland: 60 Years of Warming in the Midwest. Cambridge, Mass.: Union of Concerned Scientists, 2012.

Diabetes death rates on the decline in the U.S.

Death rates among U.S. adults with diabetes has been on the decline since the late 1990s, reports a new study. The study found that between 1997 and 2006 among diabetic adults, the rate of deaths due to cardiovascular disease (CVD) declined by 40 percent and the death rate due to all causes decreased by 23 percent. There was no difference in the rates of decline between diabetic men and women.

The CVD death rate, compared with non-diabetic adults, decreased by 60 percent, while the all-cause death rate declined by 44 percent.

Although these findings are encouraging, the study points out that “diabetes prevalence is likely to rise in the future if diabetes incidence is not curtailed.”

Citation:
1. Gregg EW, Cheng YJ, Saydah S, et al. Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey. Diabetes Care 2012; 35(6): 1252-1257. (open access)

New report on urbanization and heart disease

The World Heart Federation has released a new report, Urbanization and Cardiovascular Disease: Raising Heart-healthy Children in Today’s Cities, which shows how urban life impacts heart-healthy behavior.

Although urbanization brings with it many opportunities—such as employment choices, healthcare, educational prospects, social connections and political mobilization—city life inherently comes with obstacles to adopting heart-healthy behaviors, according to the report.

For example, foods high in salt, sugar and fats are often more cheaply and readily available than fresh fruits and vegetables in urban settings. Children are particularly vulnerable to the negative health aspects associated with city life, as they have the least independence from, and are most manipulated by, their living environment. In addition, unplanned urbanization is accompanied by limitations on space for physical activity including lack of planning, crime, and heavy and dangerous traffic.

Heart disease is not just an issue of lifestyle and individual behavior choices, it is the environment around such diseases that have a major impact, the report emphasizes.

The report presents several case studies showing that informed action by governments and key stakeholders who take a whole-of-society approach can dramatically reduce the level of cardiovascular disease risk.

Download the full report or the executive summary here: www.worldheart.org/urbanization.

Citation:
1. Smith, S. et al. Urbanization and Cardiovascular Disease: Raising Heart-healthy Children in Today’s Cities. Geneva: World Heart Federation, 2012.

Food fried in olive or sunflower oil is not linked to heart disease

Eating food fried in olive or sunflower oil is not associated with an increased risk of coronary heart disease or death, according to a study of more than 40,000 adults aged 29-69 years in Spain.

The benefits of olive or sunflower oil can be attributed to the fact that they are less prone to deteriorating during frying, compared to other oils.
The oil used for frying deteriorates, especially when reused, through oxidation and hydrogenation, leading to a loss of unsaturated fats and an increase in trans fats. When food is fried it loses water and absorbs this degredated oil, increasing its energy density.

The study researchers pointed out that these results are directly applicable only to other Mediterranean countries with frying methods similar to those in Spain. For example, oil (mainly olive and sunflower) rather than solid fat is used for frying in Spain. And these oils are not likely to be reused multiple times for foods eaten at home. Finally, consumption of fried snacks high in salt is fairly low in Spain, whereas in other countries such as the United States they provide an important percentage of energy intake.

“Frying with other types of fats, reusing oils several times, or consuming fried snacks high in salt may still be harmful,” the study concluded.

Citation:
1. Guallar-Castillón P, Rodríguez-Artalejo F, Lopez-Garcia E, et al. Consumption of fried foods and risk of coronary heart disease: Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study. BMJ 2012; 344: published 24 Jan 2012. (open access)

Adults in southern China at high risk of metabolic syndrome

A study indicates that close to eight percent of adults in Guangdong, China, have the metabolic syndrome. The metabolic syndrome is the constellation of cardiovascular risk factors including abdominal obesity, raised blood-sugar and high cholesterol. The metabolic syndrome is known to increase the risk of diabetes, heart disease and subsequent death.

The results of the study translate to a total of about four million adults age 20 years and older with the metabolic syndrome in this Chinese province of 85 million residents. More than 60 percent were found to have at least one individual component of the metabolic syndrome. Urban residence were more likely to have the syndrome than the rural population (close to 11 percent compared to four percent).

As China continues to be the fastest economic development in the world, it is expected to further increase its rate of modernization and urbanization–translating to more people consuming energy-dense diets and living increasingly sedentary lifestyles. The prevalence of the metabolic syndrome and related cardiovascular disease is therefore expected to increase enormously, according to the study.

“Urgent public health actions are needed to control this observed worsening situation in China,” the study concludes.

Citation:
1. Lao XQ, Zhang YH, Wong MCS, et al. The prevalence of metabolic syndrome and cardiovascular risk factors in adults in southern China. BMC Public Health 2012; 12: 64. (open access)

Case management guide for diabetes, heart disease and related conditions

The UK Department for International Development has made available Type 2 Diabetes, Cardiovascular Disease, Obesity and Hyperlipidaemia Care in Adults: Case Management Desk Guide. This document guides health care workers on the screening, detection and management of type 2 diabetes and its related conditions (hypertension, obesity, high cholesterol, alcoholism and smoking). The guide is currently in draft form.

Click here to access a PDF of the guide.

Mexico study: Heart disease risk determined by quality of fat

Quality, rather than quantity of fat, is the determinant of heart disease risk, according to a study conducted in Mexico. The study found that although fat intake among three-quarters of Mexicans fell within World Health Organization recommendations, their saturated fat and trans fat intake exceeded healthy diet recommendations–placing them at higher risk for heart disease.

Around 60 percent of Mexicans surveyed had a high intake of saturated fats and a low intake of polyunsaturated fats, which help reduce the risk of heart disease and promote cardiovascular health.

“Public policies should be enacted to reduce the intake of saturated fats by improving the quality of baking lard and promoting the consumption of defatted milk,” the study recommended. These two foods are among the main sources of saturated fats in the Mexican diet.

In addition, consumption of foods rich in n-3 and n-6 fatty acids (such as fish and nuts) are very low in the typical Mexican diet; thus, alternatives like promoting a larger consumption of canola or soy bean oils or addition of n-3 fatty acids to cooking oils from other sources must be considered, the study concluded.

Citation:
1. Ramírez-Silva I, Villalpando S, Moreno-Saracho JE, Bernal-Medina D. Fatty acids intake in the Mexican population. Results of the National Nutrition Survey 2006. Nutrition & Metabolism 2011; 8: 33. (open access)

Management of diabetes and associated cardiovascular risk factors in seven countries

A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries, according to a multi-country study using nationally representative health examination surveys from Colombia, England, Iran, Mexico, Scotland, Thailand and the United States.

The figures range from 24 percent of women in Scotland and the United States to 62 percent of men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure, and serum cholesterol was very low, ranging from one percent of male patients in Mexico to about 12 percent in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States.

Based on this comparison of how well these seven countries are performing in terms of population-level management of diabetes, hypertension and high cholesterol, the study researchers make the following recommendations:

1. It is critical to track diabetes care at the population level and to focus on actual outcomes, rather than on the process of care. It is also critical to study other countries with larger numbers of individuals with diabetes, such as China and India, for which nationally representative studies are not readily available.
2. It is important to prioritize the development and implementation of national guidelines and the use of new incentive programs for the management of hypertension and high cholesterol among individuals with diabetes in developing countries. The study findings suggest that such progress may be more feasible and more likely to have a larger population health impact than blood glucose control.
3. There are opportunities for innovation in providing incentives, in the technology of diabetes management and in improving financial access to care.

Real progress at the population level in the management of diabetes will likely require all three: monitoring performance in meeting treatment targets, expanding management of hypertension and high cholesterol in individuals with diabetes, and innovations in the delivery of and access to care.

The estimated global prevalence of diabetes is around 6.4 percent and more than 280 million people in the world have diabetes—the majority live in the developing world. Projections indicate that diabetes accounted for almost four million deaths worldwide in 2010. The burden of diabetes will only continue to grow, since the number of adults with diabetes in developing countries is projected to rise by more than two-thirds between 2010 and 2030.

Source:
1. Gakidou E, Mallinger L, Abbott-Klafter J, et al. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bulletin of the World Health Organization 2011; 89: 172-183. (open access)