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Table 1 Selected dietary factors, price-responsiveness in consumption levels, and estimated etiologic effects on cardiometabolic diseases

From: The potential impact of food taxes and subsidies on cardiovascular disease and diabetes burden and disparities in the United States

Dietary factora Educational levelb 2012 intake among US adultsc Percent (%) change in intake per 10% price changed Disease outcomese Unit of etiologic effect Etiologic effect at age 50f Etiologic effect at age 70f
   mean ± SD     RR (95% CIs) RR (95% CIs)
Fruit (g/d) (excl. 100% fruit juices) < HS 90.9 ± 88.3 15.5 ↓ CHD per 1 serving (100 g)/d 0.93 (0.89–0.97) 0.95 (0.92–0.98)
  HS 103 ± 105 14.2 ↓ Ischemic stroke   0.86 (0.80–0.92) 0.90 (0.86–0.94)
  COL 146 ± 112 13.1 ↓ Hemorrhagic stroke   0.69 (0.56–0.84) 0.77 (0.67–0.89)
Vegetables (g/d) (incl. legumes) < HS 162 ± 79.6 15.5 ↓ CHD per 1 serving (100 g)/d 0.94 (0.91–0.97) 0.96 (0.94–0.98)
  HS 168 ± 92.1 14.2 ↓ Ischemic stroke   0.80 (0.70–0.92) 0.91 (0.84–0.97)
  COL 217 ± 129 13.1 ↓ Hemorrhagic stroke   0.80 (0.67–0.96) 0.86 (0.76–0.97)
Nuts/seeds (g/d) < HS 5.78 ± 14.2 15.5 ↓ CHD per 1 serving (1 oz)/wk 0.91 (0.87–0.94) 0.93 (0.91–0.96)
  HS 9.87 ± 13.1 14.2 ↓ Diabetes   0.96 (0.94–0.98) 0.97 (0.96–0.99)
  COL 17.7 ± 30.9 13.1     
Whole grains (g/d) < HS 15.5 ± 16.1 15.5 ↓ CHD per 1 serving (50 g)/d 0.96 (0.93–0.99) 0.97 (0.95–0.99)
  HS 19.7 ± 17.9 14.2 ↓ Ischemic stroke   0.90 (0.83–0.97) 0.93 (0.88–0.98)
  COL 26.5 ± 19.7 13.1 ↓ Hemorrhagic stroke   0.90 (0.83–0.97) 0.93 (0.88–0.98)
     ↓ Diabetes   0.86 (0.80–0.92) 0.90 (0.86–0.94)
Processed meats (g/d) < HS 29.4 ± 14.1 –3.4 ↑ CHD per 1 serving (50 g)/d 1.24 (1.04–1.47) 1.16 (1.03–1.30)
  HS 33.6 ± 21.3 –3.2 ↑ Diabetes   1.65 (1.30–2.08) 1.41 (1.20–1.65)
  COL 27.2 ± 16.5 –2.9     
Red meats, unprocessed (g/d) < HS 52.8 ± 28.6 –3.4 ↑ Diabetes per 1 serving (100 g)/d 1.47 (1.14–1.88) 1.30 (1.09–1.54)
  HS 50.2 ± 19.7 –3.2     
  COL 40.0 ± 24.6 –2.9     
Sugar-sweetened beverages (8 oz/d) < HS 1.49 ± 1.56 –7.3 ↑ BMI (baseline BMI < 25) ↑ BMI (baseline BMI < 25) 0.10 kg/m2 (0.05–0.15) 0.10 kg/m2 (0.05–0.15)
  HS 1.31 ± 1.56 –6.7 ↑ BMI (baseline BMI ≥ 25)   0.23 kg/m2 (0.14–0.32) 0.23 kg/m2 (0.14–0.32)
  COL 0.69 ± 0.99 –5.6 ↑ CHD, direct effect (BMI adjusted)   1.26 (1.15–1.37) 1.17 (1.10–1.24)
     ↑ Diabetes, direct effect (BMI adjusted)   1.27 (1.11–1.46) 1.18 (1.07–1.29)
  1. aDietary factors for which we identified probable or convincing evidence for etiologic effects on cardiometabolic diseases (CMD), including coronary heart disease (CHD), stroke, or type 2 diabetes mellitus; see text for further details
  2. bEducation strata were defined as less than high school education (< HS), high school or some college (HS), college graduates (COL)
  3. cBased on nationally representative data combining the 2009–2010 and 2011–2012 cycles of the National Health and Nutrition Examination Survey for the adult US population (age 25+ years; N = 8516), accounting for complex survey design and sampling weights as appropriate [50]. Mean and SD of dietary intakes were estimated using two non-consecutive 24-hour dietary recalls per person; accounting for within-person variation and adjusting for total energy using the residual method (2000 kcal/d) to reduce measurement error and further account for differences in body size, metabolic efficiency, and physical activity. Intakes of food groups were obtained using the Food Patterns Equivalents Database, with servings converted to g/day [16]. Definitions and units for each dietary factor were defined to be consistent with definitions used in epidemiological studies or trials that provided evidence on etiologic effects on cardiometabolic diseases [51]
  4. dThe estimated percent change in the quantity of a food consumed in relation a percent change in its price, based on meta-analysis of prospective changes in intakes in response to changes in price of demand [21]. Estimated price responsiveness of healthy foods were based on findings for fruits and vegetables; and for unhealthy foods, on findings for sugar-sweetened beverages. We further accounted for differences in price-responsiveness by socioeconomic status based on a meta-analysis of global cross-sectional price-elasticity estimates (‘low gradient’ case, shown in this Table) and observed responses to a beverage excise tax in Mexico (‘high gradient’ case) [11, 23]; see text for further details
  5. eData on US deaths by age, sex, and education were derived from the National Center for Health Statistics, including deaths due to ischemic heart disease (ICD10: I20–I25), ischemic stroke (I63, I65–I67 (except I67.4), I69.3, G45), hemorrhagic and other non-ischemic stroke (I60–I62, I64, I69.0–I69.2, I69.4, I69.8, I67.4), diabetes mellitus (E10–E14, except E10.2, E11.2, E12.2, E13.2), and hypertensive heart disease (I11)
  6. fObtained from published or de novo dose-response meta-analyses of prospective cohorts or randomized trials. Meta-analyses were evaluated and selected based on design, number of studies and events, definitions of dietary exposure and disease outcomes, length of follow-up, statistical methods, evidence of bias, and control for confounders [18]. Estimated etiologic effects and uncertainty were quantified per standardized units. No differential effects on incidence versus case-specific mortality were identified for these dietary factors; thus, mortality effects were assumed to be similar to effects on incidence. For unclassified (other) strokes, we utilized the weighted average of effects (RRs) on ischemic and hemorrhagic stroke, based on the relative proportions of ischemic vs. hemorrhagic stroke deaths among classified cases in the National Center for Health Statistics database. We incorporated differences in proportional effects (RRs) by age in groups from 25–34 to 75+ years as previously established; representative RRs at age 50 and 70 are shown. We did not identify evidence for differences in etiologic effects by sex [18]