A Framework for Assessing Effects of the Food System (2015) / Chapter Skim
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3 Health Effects of the U.S. Food System
3 Health Effects of the U.S. Food System
Pages 85-126
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From page 85... ...
THE FOOD SYSTEM AND HEALTH EFFECTS The federal government invests resources to achieve certain public health goals. It monitors dietary patterns, nutrient intakes, and nutrition status indicators to promote human health and to prevent chronic disease.
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From page 86... ...
. Market forces, including consumer demand, do not always support dietary practices that are consistent with public health nutrition recommendations, such as the DGA, and their associated public health goals (e.g., reducing chronic disease risk and micronutrient deficiencies)
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Food safety is not considered a competitive advantage by the food industry in the United States. Thus, significant food safety advances are pioneered by industry as a whole and shared and adopted among companies.
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From page 88... ...
regulations requiring nutrient fortifi F cation of certain products • SDA Pathogen Reduction and Hazard Analysis and Critical Control U Points (HACCP) systems regulations, which requires meat and poultry processing plants to have safety plans to prevent contamination • ood Safety Modernization Act, which mandates FDA to write policy to F improve food safety management • DA Food Allergen Labeling and Consumer Protection Act, which informs F consumers about allergens in foods • DA Food Code, a model of food safety regulations that state and local F governments can adopt for the food retail and service industries • DA guidance with recommendations on the use of antimicrobials in F foods (an attempt to voluntarily scale back the use of antibiotics in live stock)
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From page 89... ...
• ood Allergy Research and Resource Program (industry-supported re F search and education) Education Efforts • utritional information on the front of the product package to inform con N sumers about salient benefits of the products • ducational campaigns, such as the White House's Let's Move, which E aims at improving the health of children and has nutrition as one of its core components • ood safety education to consumers, such as the website foodsafety.com, F established by the Centers for Disease Control and Prevention, FDA, and USDA • rade association food safety education on Listeria environmental moni T toring and controls • utrition education provided by USDA on the Dietary Guidelines for N Americans (e.g., ChooseMyPlate.gov)
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From page 90... ...
FIGURE 3-1 Heat map of the top risk factors that contribute to the burden of noncommunicable diseases in Western countries. The major dietary risks are low consumption of fruit, nuts, seeds, vegetables, and whole grains and elevated intakes of sodium, fat, processed meats, and trans fats.
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From page 91... ...
SOURCE: CDC/NCHS, 2014a. Bitmapped Figure 3-2 presents age-adjusted death rates for several chronic diseases2 in the United States between 2000 and 2010 (CDC/NCHS, 2014a)
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From page 92... ...
Obesity is classified as a disease by the American Medical Association, and it is also a risk factor for other common chronic diseases, such as CVD, type 2 diabetes, certain cancers, osteoarthritis, liver and gall bladder disease, and others (Dagenais et al., 2005; IOM, 2005; Malnick and Knobler, 2006)
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From page 93... ...
of 25 or greater but less than 30; obesity is BMI greater than or equal to 30; and extreme obesity is BMI greater than or equal to 40. SOURCE: Fryar et al., 2014, with data from Centers for Disease Control and Prevention/National Center for Health Statistics, National Health Examination Survey 1960-1962; and National Health and Nutrition Examination Surveys 1971-1974, 1976-1980, 1988-1994, 1999-2000, 2001-2002, 2003-2004, 2005-2006, 20072008, 2009-2010, and 2011-2012.
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From page 94... ...
Increases in the obesity rate in the United States since the 1980s, however, have coincided with substantial changes in the availability of food, food consumption, and the food environment. These changes, in turn, are driven by an evolution in technology, agricultural policies, marketing, and consumer life styles.
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. Researchers have suggested a number of potential pathways by which increased calorie levels in the food supply have translated into rising obesity rates.
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. Price and preference formation also play an important role in household food purchasing, and thus in food consumption.
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Chronic Diseases Evidence supporting the relationships among diet and risk of chronic diseases has been graded and summarized in numerous reports and data resources (e.g., USDA's Nutrition Evidence Library [NEL, 2014a] , World Cancer Research Fund/American Institute for Cancer Research Diet and Cancer Report [WCRF/AICR, 2007]
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From page 98... ...
Strong evidence demonstrates that saturated fatty acid intakes are associated with increased insulin resistance and risk of type 2 diabetes, and that a substitution of just 5 percent of saturated fats with monounsaturated fatty acids or polyunsaturated fatty acids can improve insulin response. Furthermore, strong evidence shows that an improved lipid profile can be achieved with the substitution of monounsaturated or polyunsaturated fatty acids for saturated fatty acids.
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From page 99... ...
. DRIs are nutrient intake standards for healthy individuals that are based on best available scientific evidence and are reviewed regularly.
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persons, National Health and Nutrition Examination Survey, 2003-2006. NOTES: Nutrition indicators were measured in different ages (e.g., age 1 year and older, age 6 years and older)
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Microbiological Foodborne Illness In the United States, foodborne disease surveillance is collected using both active and passive surveillance systems (see "Methodologies to Measure Health Outcomes" section on p. 109 and also Appendix B, Table B-3)
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. FoodNet also is used as the basis for the current estimates of foodborne disease in the United States, which considers underreporting and the burden of disease related to unrecognized etiologies.
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, seafood-related agents were the most common chemical food safety issue, with scombroid toxin/histamine (351 outbreaks) , ciguatoxin (190 outbreaks)
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Children and the developing fetus are more vulnerable to endocrine disruptors than are adults, again demonstrating that health outcomes related to the food supply can differ among human populations. Environmental Pollutants An important note is that in addition to food, some chemical exposures occur through air or water.
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From page 105... ...
Below are some selected examples of trade-offs and other complexities that are inherent in the food system as it exists today. Different Outcomes for Different Populations Abundant Food Supply, Food Insecurity, and Obesity Despite an abundant food supply, some regions and populations in the United States experience food insecurity, which ironically may contribute to obesity.
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From page 106... ...
Thus, the true cost of hunger and food insecurity is likely much greater than reported. Being food insecure may lead to weight gain because the most accessible food options for low-income households are typically not nutrient-rich but rather energy-dense foods (HER, 2010; Shier et al., 2012)
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From page 107... ...
associated with current folic acid fortification levels, this remains an active area of research. Interactions with Environmental, Social, or Economic Effects Increase in Productivity Versus Exposure to Antibiotic Resistance Through Food and Environment Health effects of the food system are the result of direct exposures to food through consumption; through exposure to other environmental media such as air, water, soil, or livestock; or through a combination of all of them during a lifetime.
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From page 108... ...
Curtailing the spread of resistance in the absence of clear evidence or guidance from the scientific community can be difficult, while the incidence of antibiotic resistance has been increasing (Interagency Task Force on Antimicrobial Resistance, 2012) , threatening human health and impacting animal agriculture.
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The types of data linking food systems to human health include indexes of food exposure (i.e., dietary intake) , indicators of nutritional status, physiological functional indicators, and prevalence of disease.
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From page 110... ...
population and to determine the prevalence of major diseases and their associated risk factors, including nutritional status. These data are available to the research community and are also used by the National Institutes of Health, FDA, and CDC to inform the implementation and evaluation of nutrition policies and initiatives.
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From page 111... ...
Tables B-1 through B-4 in Appendix B include examples of data collected on a routine basis that relate to food safety, food and nutrient consumption, and health outcomes. The tables also include health metrics and analytical methodologies that are often used to answer questions regarding the health status of individuals and populations, including outcomes, contributing factors, and confounders, intended to identify potential interventions to address public health problems.
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Because no single standard exists to evaluate nutrition evidence, various groups have developed their own criteria and published reports. These groups include the Agency for Healthcare Research and Quality, the Academy of Nutrition and Dietetics, and the Dietary Guidelines for Americans Committee (DGAC)
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. For example, although the passive surveillance NORS is standardized, major limitations are the significant underreporting of foodborne disease, frequent lack of identification of causative agent, and exclusion of sporadic cases of illness (one individual becoming ill)
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TABLE 3-2 Conclusion Grading Chart Used to Evaluate the Strength of the Body of Evidence Supporting 114 Conclusion Statements by the Dietary Guidelines for Americans Committee Expert Opinion Elements Strong Moderate Limited Only Grade Not Assignable Quality Studies of strong Studies of strong Studies of weak No studies available No evidence that S • cientific rigor design design with minor design for answering Conclusion based pertains to question and validity Free from design methodological the question on usual practice, being addressed S • tudy design and flaws, bias, and concerns OR inconclusive expert consensus, execution execution problems OR only studies of findings due to clinical experience, weaker study design design flaws, bias, or opinion, or for question execution problems extrapolation from basic research Consistency Findings generally Inconsistency among Unexplained Conclusion Not applicable C • onsistency of consistent in results of studies inconsistency supported solely findings across direction and size with strong design, among results from by statements of studies of effect or degree OR consistency with different studies, informed nutrition of association, minor exceptions OR single study or medical and statistical across studies of unconfirmed by commentators significance weaker design other studies with very minor exceptions Quantity One large study Several studies Limited number of Unsubstantiated by Relevant studies have N • umber of with a diverse by independent studies published research not been done studies population or investigators Low number of studies N • umber of study several good-quality Doubts about subjects studied participants studies adequacy of sample and/or inadequate Large number of size to avoid Type I sample size within subjects studied and Type II error studies Studies with negative results have sufficiently large
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From page 115... ...
sample size for adequate statistical power Impact Studied outcome Some doubt about Studied outcome Objective data Indicates area for future I • mportance of relates directly to the statistical or is an intermediate unavailable research studied outcomes the question clinical significance outcome or M • agnitude of Size of effect is of the effect surrogate for the effect clinically meaningful true outcome of Significant interest (statistical) OR size of effect difference is large is small or lacks statistical and/or clinical significance Generalizability Studied population, Minor doubts about Serious Generalizability Not applicable G • eneralizability intervention, and generalizability doubts about limited to scope of to population of outcomes are generalizability experience interest free from serious due to narrow or doubts about different study generalizability population, intervention, or outcomes studied SOURCE: USDA and HHS, 2010b.
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Diet is a primary risk factor in the etiology of several leading causes of mortality and morbidity. However, despite the presence of this plentiful food supply, some segments of the U.S.
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For example, government agencies have established dietary guidelines for healthy diets, but market forces (e.g., extensive advertising of unhealthy foods along with poor advertising of healthy foods) and consumer preferences do not always support recommended dietary practices.
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American Journal of Clinical Nutrition 85(6)
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2011. Is food insecurity related to overweight and obesity in children and adolescents?
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An IFT Expert Report funded by the IFT Foundation. Comprehensive Reviews in Food Science and Food Safety 8:269-303.
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2010. Enhancing food safety.
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2005. What we eat in America, NHANES 2001 2002: Usual nutrient intakes from food compared to dietary reference intakes.
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2013. Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States.
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American Journal of Clinical Nutrition 76(6)
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2006. Food insecurity and the risks of de pression and anxiety in mothers and behavior problems in their preschool-aged children.
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