Trends in food production and food consumption in Vietnam during the period 1980-2000

During the last ten years much attention has been paid to improving the health and nutritional status of the Vietnamese people. In 1995, the Government of Vietnam ratified the National Plan of Action for Nutrition (NPAN) for the period 1995-2000. Poverty reduction was one of the basic social policies given special attention. Several programs have been implemented in Vietnam by different sectors and ministries in an attempt to improve food intake and the nutritional status of the people. The implementation of the first NPAN (1995-2000) and other intervention programs to improve food production and consumption in Vietnam during the last decade have been successful. Trends showing improvement in the production of main foods during the last decade have been observed. The population's dietary intake has clearly improved in terms of both quality and quantity with the consumption of foods such as meats, fish, fat oils, and ripe fruits being much higher compared to 1987. The prevalence of child malnutrition during the last decade shows a marked decrease.     

Single food focus dietary guidance: lessons learned from an economic analysis of egg consumption

Background

Schizophrenia is a severe, chronic, and costly illness that adversely impacts patients' lives and health care payer budgets. Cost comparisons of treatment regimens are, therefore, important to health care payers and researchers. Pre-Post analyses ("mirror-image"), where outcomes prior to a medication switch are compared to outcomes post-switch, are commonly used in such research. However, medication changes often occur during a costly crisis event. Patients may relapse, be hospitalized, have a medication change, and then spend a period of time with intense use of costly resources (post-medication switch). While many advantages and disadvantages of Pre-Post methodology have been discussed, issues regarding the attributability of costs incurred around the time of medication switching have not been fully investigated.

Methods

Medical resource use data, including medications and acute-care services (hospitalizations, partial hospitalizations, emergency department) were collected for patients with schizophrenia who switched antipsychotics (n = 105) during a 1-year randomized, naturalistic, antipsychotic cost-effectiveness schizophrenia trial. Within-patient changes in total costs per day were computed during the pre- and post-medication change periods. In addition to the standard Pre-Post analysis comparing costs pre- and post-medication change, we investigated the sensitivity of results to varying assumptions regarding the attributability of acute care service costs occurring just after a medication switch that were likely due to initial medication failure.

Results

Fifty-six percent of all costs incurred during the first week on the newly initiated antipsychotic were likely due to treatment failure with the previous antipsychotic. Standard analyses suggested an average increase in cost-per-day for each patient of $2.40 after switching medications. However, sensitivity analyses removing costs incurred post-switch that were potentially due to the failure of the initial medication suggested decreases in costs in the range of $4.77 to $9.69 per day post-switch.

Conclusion

Pre-Post cost analyses are sensitive to the approach used to handle acute-service costs occurring just after a medication change. Given the importance of quality economic research on the cost of switching treatments, thorough sensitivity analyses should be performed to identify the impact of crisis events around the time of medication change.     

Structural, material and economic influences on the food-purchasing choices of socioeconomic groups

Abstract: Australian and overseas studies have found that respondents in low socioeconomic groups are least likely to purchase food that accords with recommendations in dietary guidelines. British and United States researchers have proposed that this consistently observed association is partly due to structural, material and economic factors that differentially affect socioeconomic groups. This study tested that proposition. Specifically, this study examined the notion that socioeconomic variability in food-purchasing choices are in part a function of the availability, accessibility and affordability of food recommended by dietary guidelines. Data collected from socioeconomic groups in the general community, and information provided by welfare recipients living in low-income areas of Brisbane and Logan city provided little support for this notion. Although significant differences were found between socioeconomic groups in terms of their food-purchasing choices, most respondents from all socioeconomic groups shopped at large supermarkets where recommended food was readily available, few reported difficulties obtaining access to these facilities, and the price difference between recommended and regular foods was, in most cases, small or nonexistent. This evidence leaves largely unanswered the question of why socioeconomic groups differ in their food-purchasing behaviours.     

A systematic review of socioeconomic differences in food habits in Europe: consumption of cheese and milk

OBJECTIVE: To assess differences in cheese and milk consumption across socioeconomic groups in representative samples from several European countries. DESIGN: A meta-analysis of published and unpublished surveys of food habits performed in nine European countries between 1985 and 1999. Educational and occupational levels were used as indicators of socio-economic status. RESULTS: A higher socioeconomic status was associated with a greater consumption of cheese. The pooled estimate of the difference in cheese consumption between women in the highest vs the lowest educational level was 9.0 g/day (95% CI: 7.1 to 11.0). The parallel observation in men was 6.8 g/day (95% CI: 3.4 to 10.1). Similar results were obtained using occupation as an indicator of socioeconomic status. The pooled estimates of the higher cheese consumption among subjects belonging to the highest (vs the lowest) occupational level were 5.1 g/day (95% CI: 3.7 to 6.5) in women and 4.6 g/day (95% CI: 2.1 to 7.0) in men. No statistically significant associations were found for milk consumption concerning educational or occupational level. CONCLUSIONS: Our findings suggest that consumption of cheese is likely to be higher among subjects belonging to higher socioeconomic levels. We did not find enough evidence to support that milk intake is different according to educational or social levels.     

Contribution of take-out food consumption to socioeconomic differences in fruit and vegetable intake: a mediation analysis

Lower fruit and vegetable (F/V) intake among socioeconomically disadvantaged groups has been well documented, and may be a consequence of a higher consumption of take-out foods. This study examined whether, and to what extent, take-out food consumption mediated (explained) the association between socioeconomic position and F/V intake. A cross-sectional postal survey was conducted among 1,500 randomly selected adults aged 25 to 64 years in Brisbane, Australia, during 2009 (response rate 63.7%, N=903). A food frequency questionnaire assessed usual daily servings of F/V (0 to 6), overall take-out consumption (times per week), and the consumption of 22 specific take-out items (never to once per day or more). These specific take-out items were grouped into “less healthy” and “healthy” choices and indexes were created for each type of choice (0 to 100). Socioeconomic position was ascertained by education. The analyses were performed using linear regression, and a bootstrap resampling approach estimated the statistical significance of the mediated effects. Mean daily servings of F/V were 1.89±1.05 and 2.47±1.12, respectively. The least educated group members were more likely to consume fewer servings of fruit (β= −.39, P<0.001) and vegetables (β= −.43, P<0.001) compared with members of the highest educated group. The consumption of “less healthy” take-out food partly explained (mediated) education differences in F/V intake; however, no mediating effects were observed for overall and “healthy” take-out consumption. Regular consumption of “less healthy” take-out items may contribute to socioeconomic differences in F/V intake, possibly by displacing these foods.     

The nutrition transition in Jordan: the political, economic and food consumption contexts

This paper describes and analyzes the nutrition transition in Jordan. The nutrition transition is shifting from undernutrition of a population to a diet high in fat, sugar, and refined carbohydrates (overnutrition) and corresponding premature morbidity and mortality from ensuing chronic diseases. The paper reviews and examines secondary data on demographic, epidemiological, economic, social, and dietary changes in the region. Jordan is moving through the nutrition transition at a rapid pace. Demographic, epidemiological, economic, and social changes have been accompanied by changes in diet, food expenditure, and general health. Although mortality rates have dropped significantly, fertility rates still remain high at 3.6 children per woman, especially compared to other countries in the region. Urbanization has increased rapidly from 46% of the population residing in urban areas in 1965 to 75% currently. Declines in real per capita income have created a state in which 27% of families live under the poverty line. Dietary changes in the region, due in part to changes in food availability over the last 40 years, include a general rise in caloric intake (from 2,165 Kcals in 1965 to 3,161 Kcals in 1997) with an increasing percentage of energy supply coming from fats and cereals. Undernutrition and chronic rates of malnutrition are low compared to other developing countries; however, various sources reveal that overweight and obesity are on the rise. Obesity in Jordan tends to be higher among women (16%) than among men (10%), with a much higher prevalence of obesity among uneducated women (50%). In conclusion, overweight and obesity are an emerging problem in Jordan, especially for women. There is a high prevalence of risk factors associated with diet-related non-communicable diseases among both men and women.     

Modeling the effects of health on economic growth

This paper investigates the effects of health indicators such as adult survival rates (ASR) on GDP growth rates at 5-year intervals in several countries. Panel data were analyzed on GDP series based on purchasing power adjustments and on exchange rates. First, we developed a framework for modeling the inter-relationships between GDP growth rates and explanatory variables by re-examining the life expectancy-income relationship. Second, models for growth rates were estimated taking into account the interaction between ASR and lagged GDP level; issues of endogeneity and reverse causality were addressed. Lastly, we computed confidence intervals for the effect of ASR on growth rate and applied a test for parameter stability. The results showed positive effects of ASR on GDP growth rates in low-income countries.     

A rodent model of low- to moderate-dose ethanol consumption during pregnancy: patterns of ethanol consumption and effects on fetal and offspring growth

It is unknown whether low to moderate maternal alcohol consumption adversely affects postnatal health. The aim of the present study was to develop a rodent model of low-moderate-dose prenatal ethanol (EtOH) exposure. Sprague-Dawley rats were fed a liquid diet with or without 6% v/v EtOH throughout gestation and the pattern of dietary consumption determined. Fetal bodyweights and hepatic alcohol-metabolising gene expression were measured on embryonic Day (E) 20 and offspring growth studied until 1 year. At E8 the plasma EtOH concentration was 0.03%. There was little difference in dietary consumption between the two treatment groups. At E20, EtOH-exposed fetuses were significantly lighter than controls and had significantly decreased ADH4 and increased CYP2E1 gene expression. Offspring killed on postnatal Day (PN) 30 did not exhibit any growth deficits. Longitudinal repeated measures of offspring growth demonstrated slower growth in males from EtOH-fed dams between 7 and 12 months of age; a cohort of male pups killed at 8 months of age had a reduced crown-rump length and kidney weight. In conclusion, a liquid diet of 6% v/v EtOH fed to pregnant dams throughout gestation caused a 3-8% reduction in fetal growth and brain sparing, with growth differences observed in male offspring later in life. This model will be useful for future studies on the effects of low-moderate EtOH on the developmental origins of health and disease.     

Growth promoting antibiotics in food animal production: an economic analysis

OBJECTIVE: Considerable controversy persists regarding the use of human antibiotics to promote growth in animals raised for food. The authors examined the economic effect of removing antibiotics used for growth promotion in commercial broiler chickens. METHODS: The authors utilized data published by the Perdue company, the fourth largest poultry producer in the United States, in which a non-randomized controlled trial of growth-promoting antibiotic (GPA) use was conducted with seven million broiler chickens to evaluate the impact of removing GPAs on production. RESULTS: Positive production changes were associated with GPA use, but were insufficient to offset the cost of the antibiotics. The net effect of using GPAs was a lost value of 0.0093 dollars per chicken (about 0.45% of total cost). Based upon these data, the authors found no basis for the claim that the use of GPAs lowers the cost of production. Note that this study does not include veterinary cost changes or changes in performance variability associated with the removal of GPAs. CONCLUSIONS: This economic analysis is the first study to the authors' knowledge utilizing large-scale empirical data collected by U.S. industry, in which it is demonstrated that the use of GPAs in poultry production is associated with economic losses to the producers. These data are of considerable importance in the ongoing national debate concerning the continued use of antibiotics for growth promotion of food animals. Based on the industry study and the resulting economic impact, the use of GPAs in U.S. poultry production should be reconsidered.     

Patterns of food selection during meals in women with bulimia

Eating behavior of women with bulimia was compared with that of control subjects who had no eating disorders. Both groups were presented with two buffet-style multiple-item meals. In one meal subjects were instructed to eat normally and in the other they were instructed to eat as much as they could. The eating patterns of patients differed from control subjects in the quantity of food selected and in the rate of eating. During the binge meal, patients spent more of their meal time eating dessert and snacks than did control subjects and began their dessert and snack consumption earlier than control subjects. Patients distributed their meat consumption more evenly across the meal, whereas control subjects ate meat predominantly early in the meals. Most patients consumed either more or less than control subjects when not binge eating, indicating that the eating disturbances in bulimic patients are not confined to episodes of binge eating.     

Hemoglobin level and anemia in children in the State of Pernambuco, Brazil: association with socioeconomic and food consumption factors

This study aimed to assess hemoglobin level and anemia prevalence and their association with food-consumption and socioeconomic variables. A cross-sectional survey was conducted in the State of Pernambuco, Brazil, in 1997, using three-stage sampling which included 746 6-to-59-month-old children. Hemoglobin testing and a 24-hour food recall interview were performed. The anemia rate was 40.6% and was higher in the rural area and inversely proportional to age, income, and maternal schooling. Most children (88.9%) consumed cow's milk. Anemia was associated directly with the proportion of calories from cow's milk and indirectly with the iron level. Child's age, geographic area, per capita family income, maternal schooling, iron density (total, heme, and non-heme), and the proportion of calories from cow's milk in the diet were determinants for anemia.     

Vietnam during economic transition: a tracer study of health service access and affordability.

For many decades, Vietnam had a well-structured public health service with extensive population coverage, with free care at government health facilities until 1989. Since then the country has been going through economic transition, including major changes to the health system. These include the reduction of financial support to public facilities and the introduction of user charges. Concern has been growing about the effect of these changes on access and affordability of health care, particularly for poor families. Using data from the Vietnam National Health Survey conducted in 2001-2002, the authors conducted a tracer study of people with diarrheal illness to examine equity in access to and use of health care and the financial burdens placed on patients in seeking care. The study found that children, the elderly, and the poorly educated were more likely to suffer from diarrhea; poor people often did not seek any care regardless of severity of illness, largely because they could not afford it. The opportunity cost due to lost income was also much greater for poor families. Several new policies have been developed in Vietnam to improve access to basic health care for the poor. However, the effects of such policies require close monitoring and remain to be evaluated.