Food and Agricultural Policy and the Prevention of Cardiometabolic Disease Open Access

Siegel, Karen Rae (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/tt44pn519?locale=en
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Abstract

The global burdens of obesity and cardiometabolic diseases are large and rising. Unhealthy diets - those high in calories, saturated fats and refined carbohydrates and sugars, but low in fruits, vegetables and fiber - are modifiable risk factors for cardiometabolic diseases; less is known about how societal factors influence these individual-level risk factors. The main objective of this dissertation was to expand upon knowledge of the role of societal drivers of cardiometabolic disease, focusing on food availability and agricultural subsidies. I conducted studies to (1) quantify associations between diabetes prevalence and societal factors using global, macro-level data, (2) estimate an individual's consumption of foods derived from subsidized food commodities and examine associations between consumption and cardiometabolic risk factors using nationally representative data on 18-64 year old respondents to the National Health and Nutrition Examination Surveys (NHANES) 2001-2006, and (3) using food production data from FAO, investigate whether there is sufficient global supply of fruits and vegetables to meet population nutritional needs for preventing cardiometabolic disease. The global macro-level analysis showed that higher availability of sugar and sweeteners and animal fats as a percentage of total calories is associated with higher diabetes prevalence, while higher availability of fruits and vegetables is associated with lower diabetes prevalence. The NHANES analysis found that more than half (56.7%) of calories consumed in the US are derived from subsidized food commodities, and that younger, less-educated, and poorer individuals tend to consume diets with significantly higher proportions of subsidized commodities. Individuals who consume a diet with a higher proportion of calories from subsidized food commodities have worse cardiometabolic health outcomes - specifically, higher prevalence of obesity, abdominal adiposity, elevated lipids, and dysglycemia. Subsidized food commodities consumed in the form of meat products appeared to be the main drivers of the associations for obesity, abdominal adiposity, and elevated lipids. Lastly, results from the third study highlight a 22% global gap in supply of fruits and vegetables relative to need, and this ranged from 58% in low-income countries to no gap in high-income countries. Results underscore the importance of aligning food and agricultural policies with nutrition recommendations and population needs.

Table of Contents

TABLE OF CONTENTS
CHAPTER 1 - INTRODUCTION ............................................................................................................. 1
CHAPTER 2 - BACKGROUND ................................................................................................................ 6
THE GLOBAL BURDEN OF CARDIOMETABOLIC DISEASE ...................................... 7
INDIVIDUAL-LEVEL RISK FACTORS ....................................................................... 8
SOCIETAL-LEVEL RISK FACTORS........................................................................ 10
FOOD AND AGRICULTURAL POLICY IN THE US: AN HISTORICAL PERSPECTIVE 12
FOOD AND AGRICULTURAL POLICIES AND HEALTH - WHAT IS KNOWN? ........ 13
CHAPTER 3 - SOCIETAL CORRELATES OF DIABETES PREVALENCE: A CROSS-COUNTRY ANALYSIS OF 94 COUNTRIES ............................................................................................................ 16
INTRODUCTION .................................................................................................. 18
MATERIALS AND METHODS ............................................................................... 19
Data sources and variable selection............................................................................................................ 19
Statistical analysis ............................................................................................................................................... 21
RESULTS ............................................................................................................. 22
Summary Statistics .............................................................................................................................................. 22
Societal correlates of diabetes prevalence ............................................................................................... 23
Interpretation ........................................................................................................................................................ 23
DISCUSSION ........................................................................................................ 24
CHAPTER 4 - THE CONTRIBUTION OF SUBSIDIZED FOOD COMMODITIES TO TOTAL ENERGY INTAKE AMONG ADULTS IN THE UNITED STATES .................................................. 36
INTRODUCTION .................................................................................................. 39
STUDY POPULATION AND METHODS .................................................................. 41
Data sources ........................................................................................................................................................... 41
Tracing food commodities throughout the food system .................................................................... 42
Subsidy consumption score ............................................................................................................................. 44
Statistics ................................................................................................................................................................... 45
Validation ................................................................................................................................................................ 47
FINDINGS ............................................................................................................ 47
Sensitivity analysis .............................................................................................................................................. 49
Validation ................................................................................................................................................................ 49
DISCUSSION ........................................................................................................ 49
ACKNOWLEDGEMENTS ....................................................................................... 52
CHAPTER 5 - CONSUMPTION OF SUBSIDIZED FOODS AND CARDIOMETABOLIC RISK IN THE UNITED STATES ........................................................................................................................... 62
INTRODUCTION .................................................................................................. 65
METHODS ........................................................................................................... 66
Data Sources and Participant Selection .................................................................................................... 66
Exposure Variables .............................................................................................................................................. 66
Outcome Measures .............................................................................................................................................. 67
Covariates ................................................................................................................................................................ 69
Statistical Analysis ............................................................................................................................................... 70
RESULTS ............................................................................................................. 70

DISCUSSION ........................................................................................................ 73
CHAPTER 6 - DO WE PRODUCE ENOUGH FRUITS AND VEGETABLES TO MEET GLOBAL HEALTH NEED? ...................................................................................................................................... 94
Abstract .................................................................................................................................................................... 95
INTRODUCTION .................................................................................................. 97
METHODS ........................................................................................................... 98
Data Sources ........................................................................................................................................................... 98
Data Analysis.......................................................................................................................................................... 99
Sensitivity Analyses .......................................................................................................................................... 101
RESULTS .......................................................................................................... 101
DISCUSSION ..................................................................................................... 103
CHAPTER 7 - SUMMARY, CONCLUSIONS, AND PUBLIC HEALTH IMPLICATIONS .......... 120
KEY FINDINGS ................................................................................................. 120
LIMITATIONS ................................................................................................... 125
STRENGTHS ..................................................................................................... 127
PUBLIC HEALTH IMPLICATIONS AND FUTURE DIRECTIONS ........................... 128
CONCLUSIONS AND FUTURE RESEARCH .......................................................... 132
CHAPTER 8 - REFERENCES .............................................................................................................. 139

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