Joceline Pomerleau

The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet

OBJECTIVE We estimated the global burden of disease attributable to low consumption of fruit and vegetables, an increasingly recognized risk factor for cardiovascular disease and cancer, and compared its impact with that of other major risk factors for disease. METHODS The burden of disease attributable to suboptimal intake of fruit and vegetables was estimated using information on fruit and vegetable consumption in the population, and on its association with six health outcomes (ischaemic heart disease, stroke, stomach, oesophageal, colorectal and lung cancer). Data from both sources were stratified by sex, age and by 14 geographical regions. FINDINGS The total worldwide mortality currently attributable to inadequate consumption of fruit and vegetables is estimated to be up to 2.635 million deaths per year. Increasing individual fruit and vegetable consumption to up to 600 g per day (the baseline of choice) could reduce the total worldwide burden of disease by 1.8%, and reduce the burden of ischaemic heart disease and ischaemic stroke by 31% and 19% respectively. For stomach, oesophageal, lung and colorectal cancer, the potential reductions were 19%, 20%, 12% and 2%, respectively. CONCLUSION This study shows the potentially large impact that increasing fruit and vegetable intake could have in reducing many noncommunicable diseases. It highlights the need for much greater emphasis on dietary risk factors in public health policy in order to tackle the rise in noncommunicable diseases worldwide, and suggests that the proposed intersectoral WHO/FAO fruit and vegetable promotion initiative is a crucial component in any global diet strategy.

Prevalence of Smoking in 8 Countries of the Former Soviet Union: Results From the Living Conditions, Lifestyles and Health Study

OBJECTIVES We sought to provide comparative data on smoking habits in countries of the former Soviet Union. METHODS We conducted cross-sectional surveys in 8 former Soviet countries with representative national samples of the population 18 years or older. RESULTS Smoking rates varied among men, from 43.3% to 65.3% among the countries examined. Results showed that smoking among women remains uncommon in Armenia, Georgia, Kyrgyzstan, and Moldova (rates of 2.4%-6.3%). In Belarus, Ukraine, Kazakhstan, and Russia, rates were higher (9.3%-15.5%). Men start smoking at significantly younger ages than women, smoke more cigarettes per day, and are more likely to be nicotine dependent. CONCLUSIONS Smoking rates among men in these countries have been high for some time and remain among the highest in the world. Smoking rates among women have increased from previous years and appear to reflect transnational tobacco company activity.

Health behaviours and socio-economic status in Ontario, Canada

Data from the 1990 Ontario Health Survey were used to investigate the association of socio-economic status with the likelihood of meeting current recommendations for four health behaviours (smoking, fat intake, alcohol consumption, and physical activity level) in adults living in Ontario (Canada). Health behaviours were categorised as ‘unhealthy’ if they did not meet current recommendations in Ontario (smoking, fat intake < 30% of dietary energy, alcohol intake < 14 units per week, low level of leisure-time physical activity). Two summary variables based on the number ofÔ unhealthyÕ behaviours were also examined: the crude number of ‘unhealthy’ behaviours reported and the likelihood of reporting 3 or 4 ‘unhealthy’ behaviours. Four measures of socio-economic status were used: educational achievement, household income status, source of household income, and occupational prestige. Multiple logistic and linear regression analyses were performed to explore the association of each ‘unhealthy’ behaviour and of the summary variables with socio-economic status indicators (taken independently or simultaneously), controlling for demographic characteristics. Except for the positive relationship between income status and high alcohol intake, measures of ‘unhealthy’ behaviours were inversely associated with the socio-economic indices, suggesting that individuals in lower socio-economic groups are at an increased risk for health problems.

Hazardous alcohol drinking in the former soviet union: a cross-sectional study of eight countries

BACKGROUND Hazardous consumption of large quantities of alcohol is a major cause of ill-health in the former Soviet Union (fSU). The objective of this study was to describe episodic heavy drinking and other hazardous drinking behaviors in eight countries of the fSU. METHODS Data from national surveys of adults conducted in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2001 were used (overall sample size 18,428; response rates 71-88%). Heavy episodic drinking, high alcohol intake, drinking alcohol during the working day, and using illegally produced strong spirits were examined. RESULTS On average, 23% of men and 2% of women were defined as heavy episodic drinkers (> or = 2 l of beer or > or = 750 g bottle of wine or > or = 200 g strong spirits at least once every 2-3 weeks). This was more common in young males, women who are single or who are divorced/separated/widowed, in smokers, and in frequent alcohol drinkers. About half the respondents who drank strong spirits obtained at least some alcohol from private sources. Among drinkers, 11% of males and 7% of women usually took their first drink before the end of working day. CONCLUSIONS Heavy episodic alcohol drinking is frequent in males throughout the region--although prevalence rates may have been affected by underreporting--but is still relatively rare in women. Alcohol policies in the region should address hazardous drinking patterns and the common use of illegally produced alcohol.

Alcohol consumption in the Baltic Republics

STUDY OBJECTIVES Premature mortality associated with alcohol intake is of particular concern in several countries of the former Soviet Union. This study explored self reported alcohol consumption (beer, wine, spirits) and its determinants in the Baltic Republics. DESIGN Cross sectional surveys conducted in 1997. SETTINGS Estonia, Latvia and Lithuania. PARTICIPANTS Representative samples of adults age 19–64 (Estonia n=2010; Latvia n=2258; Lithuania n=2139). METHODS Between country differences in the frequency of alcohol intake were estimated. The odds of consuming alcohol weekly according to socioeconomic characteristics (age, ethnicity, rural/urban area, education, income) were calculated using multiple logistic regression analyses, adjusting for all variables simultaneously. MAIN RESULTS The proportion of respondents consuming alcohol weekly varied by country (p<0.001) (men: Estonia=61% Latvia=41% Lithuania=55%; women: Estonia=26% Latvia=8% Lithuania=14%). Within each country, this proportion decreased with age in both sexes (p<0.001), and increased with income in women (p<0.01). In Estonia, the odds of drinking alcohol weekly was significantly lower in respondents of Russian than of Estonian ethnicity (odds ratios (OR) and 95% confidence intervals (95%CI): men=0.51 (0.36, 0.71); women=0.57 (0.39, 0.81)). In Lithuania, the odds was higher in highly educated men than in those with a low education level (OR=1.48 (1.01, 2.17)). Daily alcohol intake was higher in Estonia than in the other countries, as was the percentage of respondents drinking heavily (equivalent to 80 g/day). CONCLUSIONS Approximately half the men and one in six women in the Baltic States reported consuming alcohol at least weekly. Age and income were the strongest and most consistent correlates of the likelihood of consuming alcohol weekly. Ethnic differences were observed only in Estonia.

The burden of disease attributable to nutrition in Europe.

OBJECTIVE This review examines the extent to which differences in nutrition could explain the diversity of health in Europe and how dietary patterns might contribute to the overall burden of disease in the region. SETTING Europe. DESIGN Between-country variations and time trends in dietary and health patterns in Europe are described, taking into account recent evidence on east-west mortality differentials. Existing information on the contribution of dietary factors to the overall burden of disease in Europe and to the burden of cardiovascular diseases and cancer is then reviewed, including a discussion of the methodological challenges that face those seeking to quantify this burden accurately. RESULTS While evidence from ecological data have long suggested that variations in health patterns in Europe may be at least partly attributed to differences in dietary intake, recent research into the major risks to disease, disability and death is confirming the importance of poor nutrition to major health problems and overall disease burden in Europe. Findings from the Global Burden of Disease 2000 study suggest that 4.4% of the overall burden of disease in the region could be attributed to low fruit and vegetable intake, and 7.8% to overweight and obesity. CONCLUSIONS The burden of disease attributed to poor nutrition in Europe appears to be substantial and probably underestimated. However, better quantification of the contribution of nutrition to the regions burden of disease awaits further research to assess the dietary intake of Europeans and to explore the relationship between nutritional factors and health outcomes in diverse parts of Europe.

Factors associated with obesity in South Asian, Afro-Caribbean and European women

OBJECTIVE: To investigate correlates of body mass index (BMI) and other anthropometric measurements in South Asian, Afro-Caribbean and European women in the UK.SUBJECTS: 291 South Asian, 303 Afro-Caribbean, and 559 European women aged 40–69 y in West London, UK.DESIGN: Cross-sectional survey.MAIN OUTCOME MEASURES: BMI, waist-to-height ratio (WHt), and skinfold thicknesses.RESULTS: Compared with European women, South Asian and Afro-Caribbean women were more like to be obese (odds ratios (OR) 1.83 and 3.01, respectively), but less likely to rate themselves as overweight (BMI-adjusted OR 0.19 and 0.34, respectively). The proportion of women who walked at least 2.5 km/d, excluding activity at work, was lower in South Asians (22%) than in Europeans (44%) or Afro-Caribbeans (40%). Among employed women, the proportion who were active at work was higher in South Asians (63%) and Afro-Caribbeans (70%) than in Europeans (49%). In Europeans, obesity was inversely associated with social class, education, smoking, alcohol intake, and distance walked, and positively associated with time spent watching television. Adjustment for alcohol intake, smoking, education and transport, physical activity explained over 80% of the difference in BMI between South Asians and Europeans, but not the difference between Afro-Caribbeans and Europeans.CONCLUSION: The factor that may be most amenable to intervention in South Asian women is low physical activity outside the workplace. The high prevalence of obesity in Afro-Caribbean women, however, is not accounted for by any behavioural factors measured in this study, and the reasons for high rates of obesity in this group remain to be established.

The burden of cardiovascular disease and cancer attributable to low fruit and vegetable intake in the European Union : differences between old and new Member States

OBJECTIVE To estimate the burden of disease attributable to low fruit and vegetable intake in the 15 countries that were members of the European Union (EU) before May 2004 (EU-15) and the 10 countries that then joined it (EU-10). DESIGN Data on fruit and vegetable intake, target levels of intake and estimates of relative risks, deaths and disability were combined to obtain the burden of ischaemic heart disease, ischaemic stroke and four types of cancer (lung/bronchus/trachea, stomach, oesophagus, and colon/rectum) attributable to low fruit and vegetable consumption. SETTING EU-15 and EU-10 Member States. RESULTS The number of lives potentially saved annually from the selected outcomes if fruit and vegetable intake increased to 600 g person(-1) day(-1) reached 892,000 and 423,000 in the EU-15 and EU-10, respectively; total disease burden could decrease by 1.9% and 3.6%, respectively. The burden of ischaemic heart disease and stroke could be reduced by up to 17% and 10%, respectively, in the EU-15 and by 24% and 15%, respectively, in the EU-10; potential reductions for the selected cancers varied from 1% to 12% in the EU-15 and from 2% to 17% in the EU-10. CONCLUSIONS The potential health gain of increased fruit and vegetable intake is particularly large in the new Member States, and particularly high for cardiovascular diseases, a main cause of health divide in Europe. This stresses the need for better nutrition programmes and policies that take account of economic, social and cultural specificities.

Patterns of body weight in the Baltic Republics.

OBJECTIVE Previously recorded rates of obesity in the Baltic Republics have been among the highest in the world although little is known about how they vary within the population. This study investigates the distribution of body mass index (BMI) and obesity in these countries. DESIGN Three cross-sectional surveys conducted in the summer of 1997. SETTING Estonia, Latvia and Lithuania. SUBJECTS Representative national samples of adults with measured weight and height (Estonia: n=1154; Latvia: n=2292; Lithuania: n=2096). RESULTS Between-country differences are particularly large among women: women from Latvia and Lithuania are approximately three times as likely to be obese as those from Estonia (17.4%, 18.3%, 6.0% respectively); only about one-third of this difference is explained by the sociodemographic and behavioural factors studied. In men, the prevalence of obesity varied only slightly among countries (Estonia: 9.9%; Latvia: 9.5%; Lithuania: 11.4%). While the prevalence of obesity increases with age within each republic, particularly in women, it is not associated with nationality or urban/rural region, and no consistent association is observed with income. Obesity is inversely related to education in Latvia and in Lithuanian women. Latvian men and women and Lithuanian men who smoked had a lower prevalence of obesity than non-smokers. Leisure time physical activity was not associated with obesity. CONCLUSIONS Obesity is a major health problem in the Baltic Republics, particularly among Latvian and Lithuanian women. The lack of association between obesity and most demographic, socioeconomic and behavioural factors suggests that the problem is generalized. Health promotion strategies aiming at preventing and controlling excess weight gain in the Baltic Republics will need to target the general population.

Potential underreporting of energy intake in the Ontario Health Survey and its relationship with nutrient and food intakes.

This study investigated potential underreporting of energy intake in the 1990 Ontario Health Survey (OHS). Underreporting was higher in overweight individuals, Asian-born individuals, and respondents from urban areas. Intakes of underreporters were slightly closer to current dietary guidelines (less fat, more fruit and vegetables, fewer sweets). These results underline that caution is warranted when interpreting the association of dietary data with health outcomes.