Comparative-Effectiveness of Population Strategies to Improve Diet and Reduce CVD

改善饮食和减少心血管疾病的人群策略的比较有效性

• 批准号: 8505702
• 负责人: DARIUSH MOZAFFARIAN
• 金额: $ 73.13万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-15 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8505702
• 关键词: Accounting; Address; Age; Aging; Cardiac; Cardiovascular Diseases; Cause of Death; Cessation of life; Chronic Disease; Data; Development; Diabetes Mellitus; Diet; Diet Habits; Dietary Factors; Dietary Fats; Dietary Fiber; Dietary Intervention; Dietary intake; Direct Costs; Disease; Economics; Education; Environment; Ethnic Origin; Evaluation; Event; Facilities and Administrative Costs; Fatty acid glycerol esters; Food Policy; Future; Grant; Health Care Costs; Heterogeneity; Incentives; Individual; Intake; Intervention; Intervention Studies; Knowledge; Label; Life; Malignant Neoplasms; Meat; Methodology; Methods; Modeling; Mortality Decline; National Health and Nutrition Examination Survey; Natural experiment; Nuts; Obesity; Observational Study; Omega-3 Fatty Acids; Patients; Policies; Population; Population Distributions; Population Intervention; Prevention strategy; Preventive; Process; Publishing; Race; Reducing diet; Relative (related person); Research; Risk Assessment; Risk Factors; Schools; Seafood; Socioeconomic Status; Sodium Chloride; Subgroup; Time; Trans Fats; United States National Center for Health Statistics; Update; Work; Workplace; abstracting; aging population; base; behavior change; burden of illness; cardiovascular disorder risk; comparative; comparative effectiveness; compare effectiveness; cost effectiveness; evidence base; fruits and vegetables; improved; innovation; insight; markov model; mortality; novel; polyunsaturated fat; premature; prevent; programs; saturated fat; sex; sugar; sweetened beverage

Abstract Cardiovascular disease (CVD) is the leading cause of death in the US and globally. In the US, the estimated direct and indirect costs of CVD exceed half a trillion dollars each year. These burdens may increase further with the aging of the population, escalating healthcare costs, improved patient survival following cardiac events, and increasing rates of major CVD risk factors such as obesity and diabetes. Our own work and that of many others has demonstrated that poor dietary habits are a major preventable cause of CVD. Our prior work has shown that excess salt and trans fats and insufficient polyunsaturated fats (in place of saturated fats), fruits and vegetables, and seafood omega-3 fats each account for tens of thousands of CVD deaths in the US each year. High intakes of sugar-sweetened beverages (SSBs) and processed meats and inadequate intake of nuts and whole grains also contribute to CVD risk. Clearly, achieving dietary change to improve CVD is a major challenge that needs to be addressed. Considering that most CVD is premature and can be prevented or delayed, the trillion-dollar question is "which interventions are most effective to improve diet and reduce CVD?" We propose to evaluate the comparative-effectiveness of evidence-based population interventions to improve diet (Aim 1). We will focus on population-level approaches as these are more sustainable and less costly compared to individual-level ones. We will select the most promising population interventions based on the results of our preliminary work, and quantify their effect sizes on diet based on pooling the published evidence. We will primarily focus on effect sizes for fruits and vegetables, dietary fats, salt, an SSBs. Depending on data availability, we will secondarily consider seafood omega-3 fats, nuts, whole grains, and processed meats. We will use the results of Aim 1 to subsequently evaluate the comparative-effectiveness of evidence-based population dietary interventions to reduce CVD mortality in the US by age and sex, using nationally-representative data (Aim 2). There is clearly an urgent need to develop a consistent methodology to compare the impact of different population interventions on CVD in the US context. As part of this effort, we will develop and extend from our prior work three different models. The assessment of the comparative-effectiveness of evidence-based population strategies to improve diet and reduce CVD, and the development of a consistent methodology to perform such an assessment, are each novel, and will provide essential insights for evidence-based preventive efforts in the US, and also identify important gaps for future studies. Application of that knowledge will be imperative in extending healthy life and reducing enormous and ever-increasing burdens of CVD in the US.

抽象的 心血管疾病（CVD）是美国和全球的首要死亡原因。在美国，每年 CVD 的直接和间接成本估计超过 5000 亿美元。随着人口老龄化、医疗保健成本不断上升、心脏事件后患者生存率的提高以及肥胖和糖尿病等主要心血管疾病危险因素发生率的增加，这些负担可能会进一步增加。我们自己和许多其他人的工作已经证明，不良的饮食习惯是心血管疾病的一个可预防的主要原因。我们之前的研究表明，过量的盐和反式脂肪以及不足的多不饱和脂肪（代替饱和脂肪）、水果和蔬菜以及海鲜 omega-3 脂肪每年导致美国数以万计的 CVD 死亡。大量摄入含糖饮料 (SSB) 和加工肉类以及坚果和全谷物摄入不足也会增加 CVD 风险。显然，通过改变饮食来改善心血管疾病是一个需要解决的重大挑战。考虑到大多数 CVD 都是过早发生并且可以预防或延迟，因此价值数万亿美元的问题是“哪些干预措施对于改善饮食和减少 CVD 最有效？” 我们建议评估基于证据的人群干预措施改善饮食的相对有效性（目标 1）。我们将重点关注人口层面的方法，因为与个人层面的方法相比，这些方法更具可持续性且成本更低。我们将根据我们的初步工作结果选择最有希望的人口干预措施，并根据汇总已发表的证据量化其对饮食的影响大小。我们将主要关注水果和蔬菜、膳食脂肪、盐、SSB 的效应大小。根据数据可用性，我们将其次考虑海鲜 omega-3 脂肪、坚果、全谷物和加工肉类。我们将使用目标 1 的结果，随后使用全国代表性数据（目标 2）来评估基于证据的人群饮食干预措施的相对有效性，以降低美国按年龄和性别划分的 CVD 死亡率。显然迫切需要开发一种一致的方法来比较美国不同人群干预措施对心血管疾病的影响。作为这项工作的一部分，我们将在之前的工作基础上开发和扩展三种不同的模型。 对改善饮食和减少心血管疾病的循证人口策略的比较有效性的评估，以及开发一致的方法来执行此类评估，都是新颖的，将为美国基于证据的预防工作提供重要的见解，并为未来的研究确定重要的差距。应用这些知识对于延长美国的健康寿命和减少巨大且不断增加的心血管疾病负担至关重要。