Structural responses to the obesity and non‐communicable diseases epidemic: Update on the Chilean law of food labelling and advertising

Chile approved the law of food labelling and advertising in 2012; this law aims to address the obesity epidemic, particularly in children. The implementation details were published in 2015, and the law was implemented finally in 2016, as described in the current article. Regulated foods were defined based on a specially developed nutrient profiling, which considered natural foods as gold standard. For liquid foods, amounts of energy, sugars, saturated fats, and sodium in 100 mL of cow's milk were used as cut‐offs. For solid foods, values within the 90th ‐ 99th percentile range for energy and critical nutrients were selected as cut‐off within a list of natural foods. A stop sign stating “High in <nutrient>” was chosen as warning label for packaged regulated foods. Regulated foods were also forbidden to be sold or offered for free at kiosks, cafeterias, and feeding programme at schools and nurseries. Besides, regulated foods cannot be promoted to children under 14 years. A staggered implementation of the regulation was decided, with nutrients cut‐offs becoming increasingly stricter over a 3‐year period. These regulatory efforts are in the right direction but will have to be sustained and complemented with other actions to achieve their ultimate impact of halting the obesity epidemic.     

Viewpoint: scaling up testing services for non‐communicable diseases in Africa: priorities for implementation research

The burden of non‐communicable diseases in Africa is rising rapidly and implementation of evidence‐based control strategies is needed urgently. Testing people for hypertension and diabetes will be an important component in the fight against these diseases, as voluntary counselling and testing was for HIV‐infection. We discuss the below the areas where we believe evidence is needed to inform policy.     

Narrative review of reviews of preconception interventions to prevent an increased risk of obesity and non‐communicable diseases in children

Evidence for the effect of preconception and periconceptional risk factors on childhood outcomes such as obesity and other non‐communicable diseases (NCDs) in later life is growing. Issues such as maternal malnutrition need to be addressed before pregnancy, to prevent a transgenerational passage of risk of NCDs. The aim of this review was to evidence for preconception interventions to prevent obesity and other risk factors for NCDs in children. A search for systematic reviews of interventions in the preconception period published between 2006 and 2018 was conducted on academic databases. Fifteen reviews were included, two of the reviews also included pregnant women. None of the reviews directly reported on obesity or NCD outcomes in children. Results suggest that exercise‐ and diet‐based interventions significantly reduced maternal weight postpartum, weight gain during pregnancy, and improved prevention and control of gestational diabetes. Balanced protein energy supplementation during and before pregnancy was associated with an increase in mean birth weight and reduction of low birth weight babies. There is a dearth of evidence for preconception programmes that follow up on childhood outcomes related to a risk of NCDs. Nevertheless, results suggest that women who received preconception interventions were more likely to have improved pregnancy‐related and behavioural outcomes.     

Relationship of serum uric acid level with non‐alcoholic fatty liver disease and its inflammation progression in non‐obese adults

Aim

This study aimed to evaluate the relationship between serum uric acid (SUA) level and non‐alcoholic fatty liver disease (NAFLD) in non‐obese adults.

Methods

A cross‐sectional study was carried out among 4098 adults, including 1936 non‐obese and 2162 obese individuals. An additional 93 non‐obese adults with biopsy‐proven NAFLD were also included.

Results

The overall prevalence of NAFLD was 39.51% in the study group, and 14.88% in non‐obese adults. The NAFLD patients had significantly higher SUA levels than controls in both men and women. The non‐obese group had a higher NAFLD risk with increased SUA levels than the obese group, with odd ratios (95% confidence interval) of 2.559 (1.870–3.503) and 1.692 (1.371–2.087), respectively. In 93 non‐obese adults with biopsy‐proven NAFLD, SUA levels were significantly higher in those with non‐alcoholic steatohepatitis. The prevalence of non‐alcoholic steatohepatitis and lobule inflammation tended to increase to 57.58% and 66.67% as the SUA level increased to the fourth quartile. Subjects with hyperuricemia had significantly higher NAFLD activity scores and more serious lobule inflammation than the normal group.

Conclusion

Non‐obese adults have higher NAFLD risk with increased SUA levels than obese individuals, and the inflammation progression of NAFLD is associated with increased SUA level in non‐obese subjects.

     

Can the rural poor in India afford to treat non‐communicable diseases

Objective Non‐communicable diseases (NCD) are on the increase in low‐income countries, where healthcare costs are paid mostly out‐of‐pocket. We investigate the financial burden of NCD vs. communicable diseases (CD) among rural poor in India and assess whether they can afford to treat NCD. Methods We used data from two household surveys undertaken in 2009–2010 among 7389 rural poor households (39 205 individuals) in Odisha and Bihar. All persons from the sampled households, irrespective of age and gender, were included in the analysis. We classify self‐reported illnesses as NCD, CD or ‘other morbidities’ following the WHO classification. Results Non‐communicable diseases accounted for around 20% of the diseases in the month preceding the survey in Odisha and 30% in Bihar. The most prevalent NCD, representing the highest share in outpatient costs, were musculoskeletal, digestive and cardiovascular diseases. Cardiovascular and digestive problems also generated the highest inpatient costs. Women, older persons and less‐poor households reported higher prevalence of NCD. Outpatient costs (consultations, medicines, laboratory tests and imaging) represented a bigger share of income for NCD than for CD. Patients with NCD were more likely to report a hospitalisation. Conclusion Patients with NCD in rural poor settings in India pay considerably more than patients with CD. For NCD cases that are chronic, with recurring costs, this would be aggravated. The cost of NCD care consumes a big part of the per person share of household income, obliging patients with NCD to rely on informal intra‐family cross‐subsidisation. An alternative solution to finance NCD care for rural poor patients is needed.     

GLP‐1 receptor agonists: effects on the progression of non‐alcoholic fatty liver disease

Non‐alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases, and its incidence has been increasing recently. In addition to hepatic complications, NAFLD is also recognized as an independent risk factor for cardiovascular disease. Unfortunately, the current therapies for NAFLD display variable efficacy; a novel and effective drug is urgently needed. Glucagon‐like peptide‐1 (GLP‐1), a receptor agonist is a new drug approved for treating type 2 diabetes. Recently, these types of agents have shown a novel therapeutic effect on NAFLD. However, the mechanisms of GLP‐1 receptor agonists on the treatment of NAFLD have not yet been explained precisely. Recent studies have demonstrated that GLP‐1 reverses the progression of NAFLD not only indirectly through an incretin effect that improves key parameters involved in NAFLD, but also a direct effect on lipid metabolism of hepatocytes and inflammation in liver. In this review, we provided an overview of the role and mechanisms of GLP‐1 in the therapy of NAFLD. Copyright © 2014 John Wiley & Sons, Ltd.     

Association of chitotriosidase genotype with the development of non‐alcoholic fatty liver disease

Aim: Based on the role of chitotriosidase (CHIT‐1) in the evolution of non‐alcoholic fatty liver disease, we explored whether CHIT‐1 mutant allele plays a role in NAFLD progression. Methods: We genotyped 200 patients with NAFLD (110 with non‐alcoholic steatohepatitis [NASH] and 90 with simple steatosis) and 100 control subjects. The χ²‐test was performed for a case–control study. Odds ratios (OR) were adjusted for age, sex and body mass index (BMI) by using multiple logistic regression analysis with genotypes (additive model), age, sex and BMI as the independent variables. Multiple linear regression analysis was performed to test the independent effect of risk allele on clinical parameters while considering the effects of other variables (age, sex and BMI), which were assumed to be independent of the effect of the single nucleotide polymorphism. Results: The risk allele frequency of CHIT‐1 wild type (Wt) was 0.71 in the control subjects, 0.77 in simple steatosis and 0.92 in patients with NASH. The OR (95% confidence interval) adjusted for age and BMI was 1.73. Multiple linear regression analysis indicated that the CHIT‐1 Wt was significantly associated with increases in ferritin levels (P = 0.014) and the fibrosis stage (P = 0.011) in the patients with NASH, even after adjustment for age, sex and BMI, corroborating that the presence of the CHIT‐1 Wt allele was an independent predictor of fibrotic NAFLD. In contrast, the steatosis grade was not associated with CHIT‐1 mutant allele. Conclusion: These findings suggest that a functional polymorphism in the CHIT‐1 gene protects against NAFLD progression.     

The INFORMAS healthy food environment policy index (Food‐EPI) in Mexico: An assessment of implementation gaps and priority recommendations

Mexico is one of the countries with the highest prevalence of obesity and recently declared a national epidemic of diabetes. Healthy food environments have the potential to improve the diet of the population and decrease the burden of disease. The aim of the study was to assess the efforts of the Mexican Government towards creating healthier food environments using the Healthy Food Environment Policy Index (Food‐EPI). The tool was developed by the International Network for Food and Obesity/Non‐communicable Diseases Research, Monitoring and Action Support (INFORMAS). Then, it was adapted to the Latin‐American context and assessed the components of policy and infrastructure support. Actors from academia, civil society, government, and food industry assessed the level of implementation of food policies compared with international best practices. Actors were classified as (1) independents from academia and civil society (n = 36), (2) government (n = 28), and (3) industry (n = 6). The indicators with the highest percentage of implementation were those related to monitoring and intelligence. Those related to food retail were rated lowest. When stratified by type of actor, the government officials rated several indicators at a higher percentage of implementation compared with independent actors. None of the indicators were rated at high implementation. Government officials and independent actors agreed upon nine priority actions to improve the food environment in Mexico. These actions have the potential to improve government commitment and advocacy efforts to create healthier food environments.