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

基本信息

批准号：
8719160
负责人：
DARIUSH MOZAFFARIAN
金额：
$ 1.63万
依托单位：
HARVARD SCHOOL OF PUBLIC HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-15 至 2014-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8719160
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 Excess Dietary Salt 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

项目摘要

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）是美国和全球死亡的主要原因。在美国，CVD的估计直接和间接成本每年超过半万亿美元。这些负担可能会随着人口的老龄增长，医疗保健成本的升级，心脏事件后的患者生存率提高以及主要CVD危险因素（例如肥胖和糖尿病）的增加而增加。我们自己的工作以及许多其他工作表明，饮食习惯差是CVD的主要可预防原因。我们先前的工作表明，多余的盐和反式脂肪以及多不饱和脂肪（代替饱和脂肪），水果和蔬菜，以及海鲜omega-3脂肪，每年在美国每年占数万CVD死亡。大量的糖粉饮料（SSB）和加工的肉以及坚果和全谷物的摄入量不足也有助于CVD风险。显然，实现饮食变化以改善CVD是需要解决的主要挑战。考虑到大多数CVD为时过早并且可以预防或延迟，因此数万亿美元的问题是“哪些干预措施最有效地改善饮食和减少CVD？” 我们建议评估基于证据的人群干预措施改善饮食的比较效果（AIM 1）。我们将专注于人群级别的方法，因为这些方法比单个级别的方法更可持续，成本较低。我们将根据初步工作的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来量化其对饮食的影响。我们将主要关注水果和蔬菜，饮食脂肪，盐和SSB的效果大小。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。我们将使用AIM 1的结果来评估基于循证人群饮食干预措施的循证人群饮食干预措施的比较效应，以使用年龄和性别来降低美国的CVD死亡率，并使用国家代表性数据（AIM 2）。显然，迫切需要开发一种一致的方法，以比较美国背景下不同人口干预对CVD的影响。作为这项工作的一部分，我们将开发并从以前的工作中发展三种不同的模型。评估基于证据的人群策略改善饮食和减少CVD的比较效果，并开发进行这种评估的一致方法，每种方法都是新颖的，并且将为美国提供基于证据的预防性努力的基本见解，并确定未来研究的重要差距。在延长健康的生活并减轻美国CVD的巨大和不断增加的CVD负担时，必须应用这些知识。