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Lower energy intake associated with higher risk of cardiovascular mortality in chronic kidney disease patients on a low-protein diets

An increasing number of studies shown that inadequate energy intake causes an increase in adverse incidents in chronic kidney disease (CKD) patients on low-protein diets (LPD). The study aimed to investigate t...

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Experiences participating in federal nutrition assistance programs during the early months of the COVID-19 pandemic: an investigation in Vermont

Federal nutrition assistance programs serve as safety nets for many American households, and participation has been linked to increased food security and, in some instances, improved diet quality and mental he...

Brief instruments for measuring nutrition literacy - the Nutrition Health Literacy Scale and the Self-Perceived Food Literacy Scale Short Form

A healthy diet is a critical factor in maintaining long-term health. In addition to a health-promoting food environment, the nutrition health literacy (NHL) and food literacy (FL) of the population are importa...

Adverse events profile associated with intermittent fasting in adults with overweight or obesity: a systematic review and meta-analysis of randomized controlled trials

There is little evidence to comprehensively summarize the adverse events (AEs) profile of intermittent fasting (IF) despite its widespread use in patients with overweight or obesity.

Differences in the cost and environmental impact between the current diet in Brazil and healthy and sustainable diets: a modeling study

While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the c...

Correlation between serum trimethylamine-N-oxide and body fat distribution in middle-aged and older adults: a prospective cohort study

Trimethylamine-N-oxide (TMAO) is linked with obesity, while limited evidence on its relationship with body fat distribution. Herein, we investigated the associations between serum TMAO and longitudinal change ...

Identifying the barriers and facilitators to fruit and vegetable consumption in rural Australian adults: a mixed methods analysis

Low fruit and vegetable consumption is a leading contributor to non-communicable disease risk. However, understanding of barriers and facilitators to fruit and vegetable intake in rural settings is limited. Th...

Dietary choline intake in European and non-european populations: current status and future trends—a narrative review

Choline is a nutrient necessary for the proper functioning of the body with a multidimensional impact on human health. However, comprehensive studies evaluating the dietary intake of choline are limited. The a...

Association of maternal ultra-processed food consumption during pregnancy with atopic dermatitis in infancy: Korean Mothers and Children’s Environmental Health (MOCEH) study

Maternal diet during pregnancy might influence the development of childhood allergic disorders. There are few studies on the association between processed food intake and infant atopic dermatitis (AD) during p...

Assessing the relative validity of a web-based self-administered 24-hour dietary recall in a Canadian adolescent’s population

Healthy eating habits at a young age are crucial to support growth and development and good general health. In this context, monitoring youth dietary intakes adequately with valid tools is important to develop...

Effects of DASH diet with or without time-restricted eating in the management of stage 1 primary hypertension: a randomized controlled trial

Time-restricted eating (TRE), a popular form of intermittent fasting, has shown benefits for improving metabolic diseases and cardiometabolic health. However, the effect of TRE in the regulation of blood press...

A comprehensive approach to lifestyle intervention based on a calorie-restricted diet ameliorates liver fat in overweight/obese patients with NAFLD: a multicenter randomized controlled trial in China

Nonalcoholic fatty liver disease (NAFLD) is a globally increasing health epidemic. Lifestyle intervention is recommended as the main therapy for NAFLD. However, the optimal approach is still unclear. This stud...

Fish oil supplementation and risk of incident systemic lupus erythematosus: a large population-based prospective study

Although fish oil has been considered to have an anti-inflammatory effect and has been proven to play a beneficial role in the incidence of numerous diseases, the association between fish oil supplementation a...

Association of weight-adjusted waist index with all-cause mortality among non-Asian individuals: a national population-based cohort study

The Weight-Adjusted Waist Index (WWI) is a new indicator of obesity that is associated with all-cause mortality in Asian populations. Our study aimed to investigate the linear and non-linear associations betwe...

Relationship between sex, APOE genotype, endocannabinoids and cognitive change in older adults with metabolic syndrome during a 3-year Mediterranean diet intervention

The Mediterranean diet (MedDiet) has demonstrated efficacy in preventing age-related cognitive decline and modulating plasma concentrations of endocannabinoids (eCBs) and N- acylethanolamines (NAEs, or eCB-like co...

Association between serum vitamin D level and Graves’ disease: a systematic review and meta-analysis

This meta-analysis aims to analyze the relationship between serum vitamin D (VD) levels and Graves’ disease (GD).

Gardening and subjective cognitive decline: a cross-sectional study and mediation analyses of 136,748 adults aged 45+ years

Given the benefits of gardening for physical and psychological health, we explored whether gardening was associated with lower risks of subjective cognitive decline (SCD), a precursor of dementia, and SCD-rela...

Association between watching eating shows and unhealthy food consumption in Korean adolescents

Eating habits formed during adolescence greatly influence the maintenance of health in adulthood. With the recent development of social media and easy access to the Internet, adolescents watch plenty of food v...

Diet quality from mid to late life and its association with physical frailty in late life in a cohort of Chinese adults

It is unclear if improving diet quality after midlife could reduce the risk of physical frailty at late life. We aimed to associate changes in diet quality after midlife with physical frailty at late life.

Adherence to the Mediterranean Diet and its association with sustainable dietary behaviors, sociodemographic factors, and lifestyle: a cross-sectional study in US University students

Promoting healthy and sustainable diets is increasingly important and the Mediterranean Diet (MD) has been recognized as an appropriate example that can be adapted to different countries. Considering that the ...

Trends in the contribution of greenhouse gas emissions from food and beverage purchases in Mexico: 1989–2020

Assessing the trends in dietary GHGE considering the social patterning is critical for understanding the role that food systems have played and will play in global emissions in countries of the global south. O...

Higher oxidative balance score was associated with decreased risk of erectile dysfunction: a population-based study

Erectile dysfunction (ED) is a prevalent condition that is thought to be significantly impacted by oxidative stress. The oxidative balance score (OBS) has been built to characterize the state of antioxidant/pr...

Correction: Effect of soy isoflavone supplementation on blood pressure: a meta-analysis of randomized controlled trials

The original article was published in Nutrition Journal 2024 23 :32

National trends in nine key minerals intake (quantity and source) among U.S. adults, 1999 to march 2020

Changes in economy and dietary guidelines brought a great shock to diet quality and meal behaviors, but if these transformations have extended to minerals intake and their sources was still poorly understood. ...

Causal relationship of interleukin-6 and its receptor on sarcopenia traits using mendelian randomization

Previous research has extensively examined the role of interleukin 6 (IL-6) in sarcopenia. However, the presence of a causal relationship between IL-6, its receptor (IL-6R), and sarcopenia remains unclear.

Development and application of the Meal and Snack Assessment (MESA) quality scale for children and adolescents using item response theory

Meals differ in terms of food items and nutritional quality. The aim of the present study was to propose a scale to measure the meals quality of schoolchildren according to food processing degree, perform a pr...

Estimating effects of whole grain consumption on type 2 diabetes, colorectal cancer and cardiovascular disease: a burden of proof study

Previous studies on whole grain consumption had inconsistent findings and lacked quantitative assessments of evidence quality. Therefore, we aimed to summarize updated findings using the Burden of Proof analys...

Nonlinear relationship between oxidative balance score and hyperuricemia: analyses of NHANES 2007–2018

Limited data regarding the correlation between oxidative balance score (OBS) and hyperuricemia highlights the necessity for thorough investigations. This study aims to examine the link between OBS, which incor...

Effects of whole grains on glycemic control: a systematic review and dose-response meta-analysis of prospective cohort studies and randomized controlled trials

Whole grains have recently been promoted as beneficial to diabetes prevention. However, the evidence for the glycemic benefits of whole grains seems to conflict between the cohort studies and randomized contro...

Remnant cholesterol is an effective biomarker for predicting survival in patients with breast cancer

Breast cancer is the most common malignancy in women worldwide. The relationship between remnant cholesterol (RC) and the prognosis of patients with breast cancer has not been clearly reported. This study inve...

Epidemiological study of pediatric nutritional deficiencies: an analysis from the global burden of disease study 2019

Nutritional deficiencies (ND) continue to threaten the lives of millions of people around the world, with children being the worst hit. Nevertheless, no systematic study of the epidemiological features of chil...

Association between watching eating broadcast “Mukbang and Cookbang” and body mass index status in South Korean adolescents stratified by gender

It has been suggested that Mukbang and Cookbang, a type of eating broadcast originating from Korea and gaining popularity, may contribute to obesity. However, despite suggestions that Mukbang might contribute ...

The global diet quality score as an indicator of adequate nutrient intake and dietary quality – a nation-wide representative study

The Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settin...

Development of a sustainable diet index in US adults

A transformation towards healthy diets through a sustainable food system is essential to enhance both human and planet health. Development of a valid, multidimensional, quantitative index of a sustainable diet...

Maternal vitamin D status and risk of gestational diabetes mellitus in twin pregnancies: a longitudinal twin pregnancies birth cohort study

Gestational diabetes mellitus (GDM) is a common complication of pregnancy, with significant short-term and long-term implications for both mothers and their offspring. Previous studies have indicated the poten...

Correction: Dietary intake and gastrointestinal symptoms are altered in children with Autism Spectrum Disorder: the relative contribution of autism-linked traits

The original article was published in Nutrition Journal 2024 23 :27

A late eating midpoint is associated with increased risk of diabetic kidney disease: a cross-sectional study based on NHANES 2013–2020

Modifying diet is crucial for diabetes and complication management. Numerous studies have shown that adjusting eating habits to align with the circadian rhythm may positively affect metabolic health. However, ...

Traditional japanese diet score and the sustainable development goals by a global comparative ecological study

Reducing the environmental impact of the food supply is important for achieving Sustainable Development Goals (SDGs) worldwide. Previously, we developed the Traditional Japanese Diet Score (TJDS) and reported ...

Association between dietary magnesium intake and muscle mass among hypertensive population: evidence from the National Health and Nutrition Examination Survey

Magnesium is critical for musculoskeletal health. Hypertensive patients are at high risk for magnesium deficiency and muscle loss. This study aimed to explore the association between magnesium intake and muscl...

Adult dietary patterns with increased bean consumption are associated with greater overall shortfall nutrient intakes, lower added sugar, improved weight-related outcomes and better diet quality

Limited evidence is available that focuses on beans within American dietary patterns and health. The purpose of this study was to identify commonly consumed adult dietary patterns that included beans and compa...

Validity and reproducibility of the PERSIAN Cohort food frequency questionnaire: assessment of major dietary patterns

Dietary patterns, encompassing an overall view of individuals’ dietary intake, are suggested as a suitable means of assessing nutrition’s role in chronic disease development. The aim of this study was to evalu...

Associations of dietary patterns and longitudinal brain-volume change in Japanese community-dwelling adults: results from the national institute for longevity sciences-longitudinal study of aging

The association of dietary patterns and longitudinal changes in brain volume has rarely been investigated in Japanese individuals. We prospectively investigated this association in middle-aged and older Japane...

Association between serum 25-hydroxyvitamin D and vitamin D dietary supplementation and risk of all-cause and cardiovascular mortality among adults with hypertension

The relationship between vitamin D status and mortality among adults with hypertension remains unclear.

Effect of soy isoflavone supplementation on blood pressure: a meta-analysis of randomized controlled trials

Previous experimental studies have suggested that the consumption of soy isoflavones may have a potential impact on lowering blood pressure. Nevertheless, epidemiological studies have presented conflicting out...

The Correction to this article has been published in Nutrition Journal 2024 23 :53

The effects of L-carnitine supplementation on inflammation, oxidative stress, and clinical outcomes in critically Ill patients with sepsis: a randomized, double-blind, controlled trial

Sepsis, a life-threatening organ dysfunction caused by a host’s dysregulated response to infection with an inflammatory process, becomes a real challenge for the healthcare systems. L-carnitine (LC) has antiox...

Metabolic syndrome risk in adult coffee drinkers with the rs301 variant of the LPL gene

Metabolic syndrome (MetS), a cluster of metabolic and cardiovascular risk factors is influenced by environmental, lifestyle, and genetic factors. We explored whether coffee consumption and the rs301 variant of...

Towards objective measurements of habitual dietary intake patterns: comparing NMR metabolomics and food frequency questionnaire data in a population-based cohort

Low-quality, non-diverse diet is a main risk factor for premature death. Accurate measurement of habitual diet is challenging and there is a need for validated objective methods. Blood metabolite patterns refl...

Circulating concentrations of bile acids and prevalent chronic kidney disease among newly diagnosed type 2 diabetes: a cross-sectional study

The relationship between circulating bile acids (BAs) and kidney function among patients with type 2 diabetes is unclear. We aimed to investigate the associations of circulating concentrations of BAs, particul...

Dietary intake and gastrointestinal symptoms are altered in children with Autism Spectrum Disorder: the relative contribution of autism-linked traits

Dietary and gastrointestinal (GI) problems have been frequently reported in autism spectrum disorder (ASD). However, the relative contributions of autism-linked traits to dietary and GI problems in children wi...

The Correction to this article has been published in Nutrition Journal 2024 23 :40

Validity of food and nutrient intakes assessed by a food frequency questionnaire among Chinese adults

Studies regarding the validity of the food frequency questionnaire (FFQ) and the food composition table (FCT) are limited in Asian countries. We aimed to evaluate the validity of a 64-item FFQ and different me...

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Nutrition Journal

ISSN: 1475-2891

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2020 Global Nutrition Report

The 2020 Global Nutrition Report looks beyond global and national patterns, revealing significant inequalities in nutrition outcomes within countries and populations. Based on the best-available data, in-depth analysis and expert opinion rooted in evidence, the report identifies critical actions to achieve nutrition equity. Everyone deserves access to healthy, affordable food and quality nutrition care. Photo: UNICEF/Vishwanathan.

The 2020 Global Nutrition Report in the context of Covid-19

The Global Nutrition Report's emphasis on nutritional well-being for all, particularly the most vulnerable, has a heightened significance in the face of this new global threat. The need for more equitable, resilient and sustainable food and health systems has never been more urgent.

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Executive summary

Malnutrition remains a pressing global challenge. Some progress has been made towards ending malnutrition. But this progress has been slow and deeply unfair. Now is the time to take action and overcome the barriers holding back progress to end malnutrition.

  • English PDF 335.7kB
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Chapter One

Introduction: towards global nutrition equity

The vision of a world free from malnutrition means leaving no one behind. Understand why equity is the missing piece in the puzzle for ending malnutrition – and how a pro-equity agenda is needed to achieve the Sustainable Development Goals.

  • English PDF 488.7kB
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Chapter Two

Inequalities in the global burden of malnutrition

Learn about how the burden of malnutrition is unequally distributed by examining factors such as location, age, sex, wealth and education. What progress is being made towards meeting nutrition targets at the global, regional and national levels?

  • English PDF 2.4MB
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Chapter Three

Mainstreaming nutrition within universal health coverage

Nutrition care should form part of the wider package of primary healthcare. The commitment to provide universal health coverage presents an opportunity to make this a reality. Explore the benefits and challenges of mainstreaming nutrition care using the health system framework.

  • English PDF 807.4kB
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Chapter Four

Food systems and nutrition equity

Food systems need to change: inequities currently impact the quality, availability and affordability of food. Explore how nutrition outcomes could be improved by rethinking food systems – especially the food environment – to ensure that healthy and sustainably produced food is the most accessible, affordable and desirable choice for all.

  • English PDF 996.0kB

Chapter Five

Equitable financing for nutrition

More investments and strengthened accountability will be needed to meet global nutrition goals. Whether using traditional resources or innovative approaches, financing should target those most in need. What might equity-focused investments to improve nutrition look like?

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Chapter Six

Ensuring equitable nutrition: a collective responsibility

We all have a role to play in ending malnutrition, and we must act now. From health systems to food systems, coordination, finance, and accountability – we can do better. Adopting a pro-equity agenda is vital to improve nutrition outcomes and ensure no one is left behind.

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Acronyms and abbreviations

A list of the acronyms and abbreviations we have used across the report

Shareable definitions of the terms we have used across the report

Endorsements, acknowledgements and suggested citation

Endorsements of the report, thanks to those involved in creating it and a suggestion for how to cite it

Dataset and metadata

The data, metadata and technical note used for the 2020 Global Nutrition Report

appendix one

Appendix 1: Nutrition indicators

The indicators the 2020 Global Nutrition Report uses to track progress on malnutrition

appendix two

Appendix 2: Assessing progress against the global nutrition targets

How the 2020 Global Nutrition Report tracks global and country progress against the global nutrition targets using the latest available data

appendix three

Appendix 3: Countries on track for the 2025 global nutrition targets

The 2020 Global Nutrition Report's assessment of country-level progress towards eight of the ten 2025 global nutrition targets

Share 2020 Global Nutrition Report

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Download the 2020 Global Nutrition Report

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Fruits, vegetables, and health: A comprehensive narrative, umbrella review of the science and recommendations for enhanced public policy to improve intake

Affiliations.

  • 1 Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA.
  • 2 Think Healthy Group, Inc., Washington, DC, USA.
  • 3 Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA.
  • 4 Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
  • 5 Center for Nutrition Research, Institute for Food Safety and Health, Illinois Institute of Technology, Bedford Park, Illinois, USA.
  • 6 Biofortis Research, Merieux NutriSciences, Addison, Illinois, USA.
  • 7 Department of Human Nutrition, University of Alabama, Tuscaloosa, Alabama, USA.
  • 8 Department of Epidemiology, University of Washington, Seattle, Washington, USA.
  • 9 School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA.
  • 10 Bone and Body Composition Laboratory, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia, USA.
  • 11 College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA.
  • 12 Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey, USA.
  • 13 D&V Systematic Evidence Review, Bronx, New York, USA.
  • PMID: 31267783
  • DOI: 10.1080/10408398.2019.1632258

Fruit and vegetables (F&V) have been a cornerstone of healthy dietary recommendations; the 2015-2020 U.S. Dietary Guidelines for Americans recommend that F&V constitute one-half of the plate at each meal. F&V include a diverse collection of plant foods that vary in their energy, nutrient, and dietary bioactive contents. F&V have potential health-promoting effects beyond providing basic nutrition needs in humans, including their role in reducing inflammation and their potential preventive effects on various chronic disease states leading to decreases in years lost due to premature mortality and years lived with disability/morbidity. Current global intakes of F&V are well below recommendations. Given the importance of F&V for health, public policies that promote dietary interventions to help increase F&V intake are warranted. This externally commissioned expert comprehensive narrative, umbrella review summarizes up-to-date clinical and observational evidence on current intakes of F&V, discusses the available evidence on the potential health benefits of F&V, and offers implementation strategies to help ensure that public health messaging is reflective of current science. This review demonstrates that F&V provide benefits beyond helping to achieve basic nutrient requirements in humans. The scientific evidence for providing public health recommendations to increase F&V consumption for prevention of disease is strong. Current evidence suggests that F&V have the strongest effects in relation to prevention of CVDs, noting a nonlinear threshold effect of 800 g per day (i.e., about 5 servings a day). A growing body of clinical evidence (mostly small RCTs) demonstrates effects of specific F&V on certain chronic disease states; however, more research on the role of individual F&V for specific disease prevention strategies is still needed in many areas. Data from the systematic reviews and mostly observational studies cited in this report also support intake of certain types of F&V, particularly cruciferous vegetables, dark-green leafy vegetables, citrus fruits, and dark-colored berries, which have superior effects on biomarkers, surrogate endpoints, and outcomes of chronic disease.

Keywords: Fruit; health; nutrition; produce; vegetable.

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News from NHLBI: Nutrition Research at the National Heart, Lung, and Blood Institute and Future Opportunities

Alison g m brown.

Clinical Applications and Preventions Branch, Division of Cardiovascular Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA

Travis Hyams

Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA

Alanna N Brown

Environmental and Health Sciences Program, Spelman College, Atlanta, GA, USA

Holly Nicastro

Charlotte a pratt.

Nutrition plays a major role in the prevention and treatment of cardiovascular and other chronic diseases; hence, nutrition research is a priority for the National Heart, Lung, and Blood Institute (NHLBI). The purpose of this analysis is to describe the scope of NHLBI-funded extramural nutrition research grants over the past decade and offer insights into future opportunities for nutrition research relevant to NHLBI's mission.

Data were extracted using the Research, Condition, and Disease Categorization spending categories from the publicly available NIH Research Portfolio Online Reporting Tool Expenditures and Results. New 2018 and 2019 grants were coded into categories and mapped to the 2016 NHLBI Strategic Vision priorities.

Approximately 90% of nutrition research funds supported extramural grants, particularly through investigator-initiated R series grants (69.6%). Of these, 19.8% were classified as clinical trials. Consistent nutrition-related topics, including physical activity, weight loss, fatty acids, metabolic syndrome, childhood obesity, and other topics such as gut microbiota, arterial stiffness, sleep duration, and meal timing, emerged in 2014–2019.  Mapping of the NHLBI Strategic Vision objectives revealed that 32% of newly funded grants focused on pathobiological mechanisms important to the onset and progression of heart, lung, blood, and sleep disorders, with opportunities including developing novel diagnostic and therapeutic strategies and clinical and implementation science research.

The findings show the breadth of NHLBI-funded nutrition research and highlight potential research opportunities for nutrition scientists.

Introduction

Nutrition plays a major role in the prevention and treatment of cardiovascular diseases and other chronic diseases, including diabetes, obesity, hypertension, and some cancers ( 1 ). Nutrition research traditionally involves a broad range of topics and modalities across the translational spectrum, including basic molecular studies, epidemiologic studies, clinical trials, and translational research ( 1 , 2 ). In addition, research related to nutrition is important in understanding its role in health and disease at both the individual and population levels, nationally and globally. Investments in nutrition research can be used to improve health in the United States and globally by reducing morbidity, mortality, and the economic impact of nutrition-related diseases ( 3 ). Analyzing the National Heart, Lung, and Blood Institute's (NHLBI's) nutrition research portfolio may help to identify areas of research emphasis and opportunities, as well as provide suggestions for strategic planning and for future research in nutrition as it relates to heart, lung, blood, and sleep (HLBS) diseases and conditions.

The NIH funds nutrition research as part of its mission, and the NHLBI is the second largest funder of nutrition research at the NIH, led by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) ( 4 ). Nutrition research is an integral part of the NHLBI mission, which is to “[provide] global leadership for a research, training, and education program to promote the prevention and treatment of heart, lung, blood disorders [and sleep] (HLBS) and enhance the health of all individuals so that they can live longer and more fulfilling lives” ( 5 ). Historically, NHLBI-funded nutrition research projects have been funded through contracts or grants and include observational or epidemiologic studies (e.g., cohort studies such as the Framingham Heart Study, Jackson Heart Study, Coronary Artery Risk Development in Young Adults study, Hispanic Community Health Study/Study of Latinos, and Women's Health Initiative) ( 6 ), basic science and foundational research, clinical trials (e.g., PREMIER, Dietary Approaches to Stop Hypertension Trial, the OmniHeart trial, the Childhood Obesity Prevention and Treatment Research Consortium and Practice-Based Opportunity for Promotion of Weight Reduction Trials) ( 7 ), and behavioral and social science research and interventions.

The purpose of this analysis is to describe the NHLBI-funded nutrition research portfolio from 2008 to 2019 and to highlight areas for potential research opportunities. This study also assesses the relevance of NHLBI nutrition research grants awarded in fiscal years 2018 and 2019 to the NHLBI Strategic Vision ( 8 , 9 ) priorities. Findings from this analysis may be useful to the external scientific community in guiding future nutrition research and highlighting future opportunities in the research and training portfolio to address NHLBI's Strategic Vision priority areas.

Data extraction

Data were extracted from NIH Research Portfolio Online Reporting Expenditures and Results tool (RePORTER) ( 10 ) using the following search criteria: fiscal years 2008–2019, NHLBI-administered projects, extramural grant (research project grants, research centers, other research related), training (individual), training (institutional), and “Nutrition” as the Research, Condition, and Disease Categorization (RCDC) ( 11 ) category. The nutrition category is broadly defined and inclusive of 1 ) basic research such as nutrient requirements and metabolism, mechanisms of taste, and cell culture studies related to human nutrition; 2 ) research on specific diets as related to weight management and food and dietary supplements; 3 ) diet-related behavioral interventions; and 4 ) conditions such as obesity, eating disorders, and food allergies as they are related to nutrition.

For purposes of this analysis, we focused on the NHLBI extramural research and training grants. The overall NIH portfolio was extracted using the same search criteria for “All NIH Institutes and Centers.” RCDC categories were used to ensure reproducibility and reportability of the study findings. We chose 2008 as the starting year because widespread implementation and use of RCDC codes began in that year ( 11 ). Some analyses and awards were condensed into groups defined by their core grant numbers. Data were downloaded and analyzed using Microsoft Excel. Topical visualizations were created using a clustering algorithm that used words and phrases from funded grant applications (Title, Abstract, and Specific Aims) to display a visual representing categories and subcategories varying in size by their respective frequency of occurrence.

Descriptive statistics were generated to characterize the extramural nutrition portfolios and funds allocated for nutrition within NHLBI and NIH as a whole. Examples of characteristics described include research category [e.g., human, animal (basic), both, or neither], clinical trial categorization, funding mechanisms (e.g., R series, K series, U series), subjects studied (e.g., human and/or animal), and the number of new applications by year. To describe shifts and characterize any changes in priority areas over the study period, we compared topical areas of nutrition-related grants between 2008–2013 and 2014–2019 by visualizing differing cell sizes that represent clusters of words commonly found together.

NHLBI Strategic Vision mapping

Given the 2016 release of the NHLBI Strategic Vision and the most recent available data in RePORTER, type 1 grants (newly funded) from fiscal years 2018 and 2019 were extracted from the larger data set for mapping to the NHLBI Strategic Vision. The 8 objectives in the NHLBI Strategic Vision ( 8 ) include the following:

  • Understand normal biological function and resilience
  • Investigate newly discovered pathobiological mechanisms important to the onset and progression of HLBS diseases
  • Investigate factors that account for differences in health among populations
  • Identify factors that account for individual differences in pathobiology and in responses to treatments
  • Develop and optimize novel diagnostic and therapeutic strategies to prevent, treat, and cure HLBS diseases
  • Optimize clinical and implementation research to improve health and reduce disease
  • Leverage emerging opportunities in data science to open new frontiers in HLBS research
  • Further develop, diversify, and sustain a scientific workforce capable of accomplishing the NHLBI's mission

Conference grants (R13) and short-term project awards (R56) were removed from the data set due to insufficient information to code into Strategic Vision objective categories. Program project grants (P01) and their subprojects were collapsed into the parent grant number and coded as a single project for analysis. A final data set of 228 grants was included in the strategic mapping analysis. Three coders independently coded a subset of the final data set whereby each unique grant was given a mutually exclusive code corresponding to a single Strategic Vision objective. Coders met to adjudicate differences in coding, and consensus was made by the group. The primary coding for training grants (F, K, T, R35, and SC1 awards) fell under Strategic Vision objective 8 (develop, diversity, and sustain a scientific workforce), and their secondary coding was based on their primary area of science (objectives 1–7).

From 2008 to 2019, the total investment in nutrition research grants administered by NHLBI's extramural program was approximately $2.13 billion toward 1611 nutrition-related research projects. Approximately 69.6% of projects were Research Projects (R series, including R01s, R21, etc.) followed by Career Development Projects (K series) (14%), Fellowship Awards (F30, F31, and F32) (6.2%), Cooperative Agreements (U series) (5.1%), Program Projects (P series) (4.6%), and 0.3% other activity codes (S series). Of the total number of research projects, 1154 were newly funded projects (type 1) with the number of new nutrition grants (type 1) awarded annually remaining consistent from 2008 to 2019. Similar to the overall portfolio, R awards represented most new grants in the NHLBI nutrition portfolio. As anticipated, a smaller percentage (20.2%) of the NHLBI awards went toward F series and K series grants than R series grants (69.6%), and there were no new (type 1) T awards during this time period.

NHLBI nutrition research topics

The portfolio contained several nutrition-related research topics, demonstrated by projects containing >1 RCDC category (see  Figure 1 A ), which are not mutually exclusive. The top overlapping RCDC categories for newly funded (type 1) ( n = 1154) extramural research projects included Cardiovascular ( n = 759, 65.8%), Prevention ( n = 715, 62.0%), Clinical Research ( n = 700, 60.7%), Obesity ( n = 653, 56.6%), Heart Disease ( n = 436, 37.8%), Behavioral and Social Science ( n = 337, 29.2%), Diabetes ( n = 243, 21.1%), Translational Research ( n = 268, 23.2%), Pediatric ( n = 224, 19.4%), Genetics ( n = 202, 17.5%), Aging ( n = 178, 15.4%), and Atherosclerosis ( n = 178, 15.4%). A smaller proportion of funded nutrition research included RCDC categories directly relevant to lung-, blood-, and sleep-related disorders. These projects included Lung ( n = 139, 12.0%), Sleep Research ( n = 88, 7.6%), Asthma ( n = 61, 5.3%), Hematology ( n = 33, 2.9%), Smoking and Health ( n = 17, 1.5%), and Tobacco ( n = 17, 1.5%). Approximately 54.9% of new grants included only human participants ( n = 634), 30.9% ( n = 357) included only animals (basic science), 8.5% included neither animals nor humans ( n = 98), and 5.6% included both animals and humans ( n = 65). Of the grants, 19.8% were classified as clinical trials ( n = 229). Figure 1B highlights the subtopics for each identified RCDC category. Noteworthy is the consistency of certain topics across each RCDC category, including adipose tissue, weight loss and gain, metabolic syndrome, and fatty acids. Other less common topics included DNA methylation (epigenetics), plasma trimethylamine N -oxide (TMAO), and oxidative stress. Vitamin D was also a consistenttopic, as well as for topics on prevention, pediatrics, genetics, and heart disease and clinical research.

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National Heart, Lung, and Blood Institute nutrition Research, Condition, and Disease Categorization.

When comparing major topics for newly funded NHLBI nutrition-related extramural research grants between the years 2008–2013 and 2014–2019, some new topics emerged ( Table 1 ). Briefly, physical activity, weight loss, fatty acids, and vitamin D have remained top research areas for newly funded research in the NHLBI portfolio for the decade. Gut microbiome, sleep duration, meal timing, vascular function, and arterial stiffness emerged as major topical areas for newly funded grants in the 2014–2019 period. Platelet activation is an example of a cluster that appeared in 2008–2013 but was not as large of a topical area in the 2014–2019 newly funded grant portfolio.

National Heart, Lung, and Blood Institute nutrition research topics and subthemes by cross-sectional time period, 2008–2013 and 2014–2019

Overlapping topical area2008–2013 only2014–2019 onlyBoth time periods
Vitamin D
Fatty acids
Physical activity
Weight loss

COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; RAS, renin angiotensin system; TG, triglycerides.

NHLBI nutrition research portfolio compared with the overall NIH nutrition research portfolio

There are similarities in the types of grants funded (e.g., R series, K series) in the NHLBI research portfolio and the overall NIH portfolio. The projects in the overall NIH nutrition research portfolio consist of 69.8% R series, 10.8% K series, 8.5% F series, 4.4% U series, 4.5% P series, 0.3% T series, and 1.7% of projects with other activity codes (D, G, M, and S). Similar to the NHLBI portfolio, the overall NIH portfolio funds only a small proportion of new T series grants each year. This analysis found only 4 newly awarded T series grants during this time period in the overall NIH nutrition research portfolio.

The investment in the overall extramural NIH nutrition portfolio (excluding intramural, contracts, and interagency agreements) increased from ∼$1.00 billion in 2008 to ∼$1.57 billion in 2019, representing a 56.5% increase. Over the past decade, NHLBI yearly investment in nutrition and nutrition-related research ranged from $136 million to $214 million ( Figure 2 ), and these trends mirrored increases in the NIH investment.

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National Heart, Lung, and Blood Institute (NHLBI) and NIH nutrition research portfolio investment (in millions), fiscal years 2008–2019.

Based on this analysis, NHLBI served as the administrating institute/center for ∼13.6% of the total extramural NIH dollars spent on nutrition projects in 2019 (range from 2008–2019 is 12.9%–15.4%). Across all years, >62% of extramural nutrition research funding was from the NHLBI, NIDDK, and National Cancer Institute (range: 58.8%–65.4%). Although nutrition research is funded across a wide range of NIH institutes, this analysis focused on NHLBI nutrition research funding to provide the spectrum of research and to assess its relevance to the NHLBI Strategic Vision goals.

As shown in  Figure 3 , the most frequently coded objective from the NHLBI Strategic Vision was objective 2 (investigate newly discovered pathobiological mechanisms important to the onset and progression of HLBS diseases), accounting for 32.0% of fiscal year 2018–2019 newly funded grants. The next 2 most frequently aligned Strategic Vision objectives included Strategic Vision 8 (30.2%), develop the workforce, and strategic objective 1, understand normal biological function and resilience (9.2%). Strategic vision 8 coding decisions included 14 F (fellowship) grants, 20 K (career development) grants, and 1 R35 (Outstanding Investigator Award and Emerging Investigator Award programs). Most of the workforce development grants mirrored the overall mapping, with most of these grants addressing Strategic Vision objectives 2 (investigate newly discovered pathobiological mechanisms) and 1 (understand normal biological function and resilience). A smaller subset of the awards targeted objectives 4 (identify factors that account for individual differences in pathobiology and response to treatment) and 5 (develop and optimize novel diagnostic and therapeutic strategies)—representing 13.0% and 11.6%, respectively.

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Mapping of fiscal years 2018–2019 type 1 nutrition research grants to National Heart, Lung, and Blood Institute Strategic Vision ( n = 228). SV, Strategic Vision; SV1, understand normal biological function and resilience; SV2, investigate newly discovered pathobiological mechanisms; SV3, investigate factors that account for differences in health among populations; SV4, identify factors that account for individual differences in pathobiology and responses to treatments; SV5, develop and optimize novel diagnostic and therapeutic strategies; SV6, optimize clinical and implementation research; SV7, leverage emerging opportunities in data science; SV8, develop the workforce.

Over the past decade, the NHLBI yearly investment in nutrition and nutrition has steadily increased and focused on a range of nutrition topics. This analysis provides an overview of the wide range of the NHLBI-funded nutrition research and demonstrates NHLBI's support of nutrition-related research, particularly through investigator-led research project grants (R01s). Although outside of the scope of this analysis, it should be mentioned that NHLBI also stimulates research through the support of extramural contracts by funding key NHLBI cohort studies (e.g., the Framingham Heart Study, Jackson Heart Study, and Coronary Artery Risk Development in Young Adults Study) that contribute to nutrition epidemiologic research.

The findings of new and emerging nutrition-related research (e.g., novel biomarkers such as plasma TMAO, gut microbiome, and metabolomics) are of interest and suggest opportunities for future research. The analysis indicates that some nutrition topics such as fatty acids and vitamin D and nutrition-related topics such as weight loss and physical activity remain research topics of interest during the decade, but nuances in these topics have shifted over time to expand the research activity in these overarching priorities and reflect the fluctuations in the field. For example, the spectrum of nutrition research in the 2008–2013 period differed from those in 2014–2019 ( Table 1 ), suggesting changes in research emphasis as new areas of investigation become evident. Emerging nutrition-related topics such as the gut microbiome and TMAO and new investigation in cholesterol metabolism are evident. Meanwhile, meal timing, intermittent fasting, and the role of nutrition in obesity-related asthma are topics of increasing interest. Maternal nutrition and dietary exposures in utero and its influence on cardiovascular risk across the life course is also an emerging topic.

In May 2020, the NIH released its first NIH-wide strategic plan for nutrition research emphasizing innovative opportunities to advance nutrition research from basic since to experimental design and research training ( 12 , 13 ). The plan was developed with the input from the external research community and the public, highlighting the growing field of precision nutrition as a unifying theme. Research has shown that one diet does not fit all, and advancements in the field of precision nutrition will provide an opportunity to better understand individual responses to diet, which would enable tailored clinical dietary recommendations and the development of tools to allow individuals to make better informed decisions about healthy food choices ( 12 , 13 ). Precision nutrition research may therefore lead to approaches to optimize health and prevent HLBS diseases closely linked to diet and nutrition.

Our mapping analysis of the fiscal year 2018–2019 grants to the NHLBI Strategic Vision reveals opportunities for future research to enhance alignment of the nutrition research portfolio with the priorities of the NHLBI. In particular, since many nutrition-funded grants align with objectives 1 and 2 (understand normal biological function and resilience and explore mechanisms of the onset and progression of HLBS diseases, respectively), future research opportunities could include efforts to address issues that are further down the research-translation continuum, particularly as that research relates to developing novel diagnostic and therapeutic strategies and translation, implementation, and dissemination of nutrition science. Targeting and prioritizing research that translates our existing knowledge of the mechanisms, development, and progression of HLBS diseases may help further our understanding of what interventions are most effective in real-world settings to reduce the morbidity, mortality, and economic impact of nutrition-related diseases. In addition, very few nutrition studies have harnessed emerging opportunities in data science (objective 7), signaling an opportunity in this area. Aligning with this strategic priority, precision nutrition research might leverage big data and data science approaches to advance the field.

This analysis has a number of strengths, including the analysis of over a decade of funded grants, the use of a comprehensive public database, and reproducible methods. However, despite the utility of these analyses for nutrition researchers, there are limitations to consider when interpreting the study findings. For example, extraction of data using RCDC categories has limitations since projects are grouped into RCDC categories with algorithms that use text-mining techniques. These represent broad categorizations and may miss projects that subject matter experts may consider important to nutrition research and, conversely, may include projects that are only loosely tied to the topic of nutrition. Nevertheless, RCDC categories are the standardized means of categorizing NIH projects and are reported to the US Congress. To address this limitation, the authors of this article read each abstract and specific aims and matched the awarded grants to the NHLBI scientific research objectives. An additional limitation of our analysis is the use of 2018–2019 awarded grants to match with the NHLBI Strategic Vision objectives. The NHLBI Strategic Vision objectives were released in 2016, and while the analyses were done for 2018–2019 grants, the 2-y gap may not have provided enough time for the extramural community to be aware of the NHLBI's priorities.

Given the critical role nutrition plays in cardiovascular disease and other major leading causes of death, nutrition research—including research regarding the implementation and translation of nutrition advice to the public and innovations in precision nutrition research—is of substantial interest to the NHLBI. This report identifies areas of future opportunity to advance nutrition science and can be used as a comparison to future studies seeking to evaluate the implementation of the NHLBI Strategic Vision in the context of NHLBI-funded nutrition research. Although this report describes the breadth of the NHLBI's nutrition research portfolio, more important, it highlights key research opportunities for nutrition scientists and has the potential to help NHLBI collaborate more effectively with the research community to fulfill a shared mission to prevent and treat HLBS disorders.

ACKNOWLEDGEMENTS

The authors’ responsibilities were as follows—AGMB and TH: wrote the manuscript; AGMB, TH, ANB, HN, and CAP: provided Strategic Vision coding; AGMB, HN, and CAP: interpreted the results; TH and ANB: analyzed the data; TH and HN: edited the manuscript; CAP: designed the study; and all authors: read and approved the final manuscript.

The authors reported no funding received for this study.

Author disclosures: The authors report no conflicts of interest.

The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute or the US Department of Health and Human Services.

Abbreviations used: HLBS, heart, lung, blood, sleep; NHLBI, National Heart, Lung, and Blood Institute; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; RCDC, Research, Condition, and Disease Categorization; RePORTER, Research Portfolio Online Reporting Tools, Expenditures and Results; TMAO, trimethylamine N -oxide.

Contributor Information

Alison G M Brown, Clinical Applications and Preventions Branch, Division of Cardiovascular Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.

Travis Hyams, Clinical Applications and Preventions Branch, Division of Cardiovascular Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA. Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA.

Alanna N Brown, Clinical Applications and Preventions Branch, Division of Cardiovascular Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA. Environmental and Health Sciences Program, Spelman College, Atlanta, GA, USA.

Holly Nicastro, Clinical Applications and Preventions Branch, Division of Cardiovascular Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.

Charlotte A Pratt, Clinical Applications and Preventions Branch, Division of Cardiovascular Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.

  • Introduction
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Data are from the 1988 to 2020 National Health and Nutrition Examination Survey (N = 2482) and were weighted to be nationally representative. Glycemic control was defined as a glycated hemoglobin (HbA 1c ) level less than 7%, and severe hyperglycemia as an HbA 1c level greater than 10% (to convert percentage of total hemoglobin to proportion of total hemoglobin, multiply by 0.01; to convert to millimoles per mole, multiply by 10.93 and subtract by 23.50). Error bars indicate 95% CIs.

Data are from the 1988 to 2020 National Health and Nutrition Examination Survey (N = 2482). Data were weighted to be nationally representative. Glycemic control was defined as a glycated hemoglobin (HbA 1c ) level less than 7% (to convert percentage of total hemoglobin to proportion of total hemoglobin, multiply by 0.01; to convert to millimoles per mole, multiply by 10.93 and subtract by 23.50). Adults who responded “other” for race and ethnicity were excluded in the race and ethnicity analysis but were included for all other subgroups. Error bars indicate 95% CIs.

a Estimate has a relative SE of 30% or greater and may be unreliable.

Data are from the 1988 to 2020 National Health and Nutrition Examination Survey (N = 2482). Data were weighted to be nationally representative. Severe hyperglycemia was defined as a glycated hemoglobin level greater than 10% (to convert percentage of total hemoglobin to proportion of total hemoglobin, multiply by 0.01; to convert to millimoles per mole, multiply by 10.93 and subtract by 23.50). Adults who responded “other” for race and ethnicity were excluded in the race and ethnicity analysis but were included for all other subgroups. Error bars indicate 95% CIs.

eTable 1. Trends in Insulin Use Among US Adults With Diabetes, NHANES 1988-2020

eTable 2. Trends in Glycemic Control (HbA1c <7%) and Severe Hyperglycemia (HbA1c >10%) Among Adults With Diabetes Using Insulin, NHANES 1988-2020

eTable 3. Glycemic Control Among Adults With Diabetes Using Insulin, Unadjusted and Age-adjusted Based on Age Cutoff Recommendations

eFigure 1. Trends in Glycemic Control (HbA 1c <8%) Among Adults with Diabetes Using Insulin

eFigure 2. Trends in Glycemic Control (HbA1c >9%) Among Adults With Diabetes Using Insulin

eTable 4. Characteristics of Adults Diagnosed With Type 2 Diabetes Using Insulin, HNANES, 1988-2020

eFigure 3. Trends in Glycemic Control (HbA1c <7%) Among Adults With Type 2 Diabetes Using Insulin

eFigure 4. Trends in Severe Hyperglycemia (HbA 1c >10%) Among Adults With Type 2 Diabetes Using Insulin

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Venkatraman S , Echouffo-Tcheugui JB , Selvin E , Fang M. Trends and Disparities in Glycemic Control and Severe Hyperglycemia Among US Adults With Diabetes Using Insulin, 1988-2020. JAMA Netw Open. 2022;5(12):e2247656. doi:10.1001/jamanetworkopen.2022.47656

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Trends and Disparities in Glycemic Control and Severe Hyperglycemia Among US Adults With Diabetes Using Insulin, 1988-2020

  • 1 Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2 Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Question   Has glycemic control improved among US adults with diabetes using insulin over the past 30 years?

Findings   In this cross-sectional study of 2482 US adults with diabetes using insulin, the prevalence of glycemic control (glycated hemoglobin level <7%) remained unchanged (29.2% in 1988-1994 to 27.5% in 2017-2020). Mexican American adults using insulin were less likely than non-Hispanic White adults to achieve glycemic control, and disparities increased during the study period.

Meaning   This study found that over the past 3 decades, glycemic control stagnated and racial and ethnic disparities increased among US adults with diabetes using insulin.

Importance   There have been major advances in insulin delivery and formulations over the past several decades. It is unclear whether these changes have resulted in improved glycemic control for patients with diabetes.

Objective   To characterize trends and disparities in glycemic control and severe hyperglycemia in US adults with diabetes using insulin.

Design, Setting, and Participants   This serial population-based cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) between 1988-1994 and 1999-2020. Participants were nonpregnant US adults aged 20 years or older who had a diagnosis of diabetes and were currently using insulin.

Exposures   Diabetes diagnosis and use of insulin.

Main Outcomes and Measures   Trends in glycemic control (glycated hemoglobin [HbA 1c ] level <7%) and severe hyperglycemia (HbA 1c level >10%; to convert percentage of total hemoglobin to proportion of total hemoglobin, multiply by 0.01; to convert to millimoles per mole, multiply by 10.93 and subtract by 23.50) overall and by age, race and ethnicity, and indicators of socioeconomic status were evaluated using logistic regression. Analyses incorporated sample weights to account for oversampling of certain populations and survey nonresponse.

Results   There were 2482 participants with diabetes using insulin included in the analyses (mean [SD] age, 59.8 [0.4] years); 51.3% were men, 7.0% were Mexican American individuals, 17.9% were non-Hispanic Black individuals, and 65.2% were non-Hispanic White individuals. From 1988-1994 to 2013-2020, the proportion of patients with diabetes who received insulin and achieved glycemic control did not significantly change, from 29.2% (95% CI, 22.6%-36.8%) to 27.5% (95% CI, 21.7%-34.2%). Mexican American adults who received insulin were less likely than non-Hispanic White adults to achieve glycemic control, and disparities increased during the study period. The proportion of adults with severe hyperglycemia did not significantly change and was 14.6% (95% CI, 12.0-17.5) in 2013-2020. Adults who were Mexican American or non-Hispanic Black, were uninsured, or had low family income had the highest prevalence of severe hyperglycemia.

Conclusions and Relevance   In this population-based cross-sectional study of NHANES data over the past 3 decades, glycemic control stagnated and racial and ethnic disparities increased among US adults with diabetes who received insulin. Efforts to improve access to insulin may optimize glycemic control and reduce disparities in this population.

Insulin is typically a last-line therapy for patients with type 2 diabetes. Over the past several decades, there have been major advances in diabetes technology and management strategies as well as insulin delivery and formulations. 1 - 3 However, little is known regarding recent patterns of glycemic control (glycated hemoglobin [HbA 1c ] level <7%; to convert percentage of total hemoglobin to proportion of total hemoglobin, multiply by 0.01; to convert to millimoles per mole, multiply by 10.93 and subtract by 23.50) among patients using insulin. Additionally, few studies have examined severe hyperglycemia (defined as HbA 1c level >10%), which insulin therapy specifically aims to address. 4 Understanding these trends can inform health policy and public health initiatives to improve glycemic control in patients receiving insulin.

Racial and ethnic minority patients, persons from low–socioeconomic status backgrounds, and those without insurance experience slower intensification of their treatment regimen and have less access to technologies that improve the safety of insulin therapy (eg, continuous glucose monitoring systems), potentially contributing to worse glycemic control. 5 In addition, insulin prices have tripled in the US, while out-of-pocket costs per prescription doubled over the past decade. 6 However, few studies have examined how these disparities affect glycemic control over time, specifically among patients with diabetes using insulin. Characterizing population-level disparities is important for designing policies and targeted interventions to address inequities among patients receiving insulin.

The objective of our study was to characterize national trends in glycemic control and severe hyperglycemia among patients with diagnosed diabetes using insulin. We considered these outcomes overall and by race and ethnicity, educational level, income, and health insurance status. To accomplish these objectives, we conducted an analysis of over 3 decades of data (1988-2020) from the National Health and Nutrition Examination Survey (NHANES).

In this cross-sectional study, we analyzed data from the NHANES III, which was conducted from 1988 to 1994, and from the continuous NHANES, with data available from 1999 to 2020. The NHANES uses a stratified, multistage, probability-cluster design to ensure that sample populations are representative of the nation’s noninstitutionalized civilians. Data are collected from household interviews and from standardized medical examinations including blood sample collections performed in mobile examination centers. Our analysis included nonpregnant adults aged 20 years or older who reported a diagnosis of diabetes by a doctor or health professional other than during pregnancy and who were currently being treated with insulin. The National Center for Health Statistics institutional review board approved the study protocols, and all the participants provided written informed consent. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline. 7

Level of HbA 1c was measured with the use of high-performance liquid chromatography. To account for changing laboratory methods over time, we calibrated HbA 1c levels using a previously validated equipercentile equating approach to correct for shifts in distribution due to laboratory drift. 8 Glycemic control was defined as an HbA 1c level less than 7% (53 mmol/mol). 4 Severe hyperglycemia was defined as an HbA 1c level greater than 10% (86 mmol/mol), an HbA 1c threshold that is a typical indication for insulin initiation to prevent diabetes complications. 4 In sensitivity analyses, we also considered alternative definitions of glycemic control (HbA 1c level <8% [64 mmol/mol]) and severe hyperglycemia (HbA 1c level >9% [75 mmol/mol]). 9 Sensitivity analyses were also conducted using age-adjusted estimates and 2 age-specific cutoff models: (1) HbA 1c level less than 7% for nonpregnant adults and HbA 1c level less than 8% for patients older than 75 years and (2) HbA 1c level less than 7% for nonpregnant adults younger than 65 years, HbA 1c level less than 7.5% (58 mmol/mol) for adults aged 65 to 74 years, and HbA 1c level less than 8% for adults aged 75 years or older. 10 , 11

Participants self-reported their age, gender (man or woman), race and ethnicity (Mexican American, non-Hispanic Black, non-Hispanic White, or other race and ethnicity), educational level (high school or less, some college, or college graduate or above), health insurance status (uninsured, private insurance, or public insurance), health care utilization (number of visits to a health care professional annually), age at diabetes diagnosis, and family income. Based on family income, the income-poverty ratio was categorized as less than 130% of the federal poverty level (FPL), 130% to 349% of the FPL, or 350% or more of the FPL. Body mass index (calculated as weight in kilograms divided by height in meters squared) was calculated from measured height and weight and categorized as less than 25, 25 to less than 30, or 30 or greater. 12

We used χ 2 and t tests to assess differences in sociodemographic and clinical characteristics among adults using insulin. We estimated trends in insulin use, glycemic control, and severe hyperglycemia overall and by age, race and ethnicity, and indicators of socioeconomic status. To increase the precision of our point estimates, we pooled NHANES survey cycles into 5- to 7-year intervals (1988-1994, 1999-2004, 2005-2012, and 2013-2020). We used logistic regression to evaluate trends over time with the midpoint of each survey cycle modeled as a continuous independent variable. 13 We also assessed likelihood of achieving glycemic control or having severe hyperglycemia after adjustment for age, gender, race and ethnicity, educational level, and income-poverty ratio using logistic regression models. We conducted sensitivity analyses (1) using different uniform HbA 1c cutoff values of glycemic control and severe hyperglycemia, (2) using age-adjusted and age-specific HbA 1c cutoff values, and (3) excluding persons with possible type 1 diabetes, defined as those who started using insulin within 1 year of diabetes diagnosis, were currently using insulin, and were diagnosed with diabetes when younger than 30 years. 14

All analyses were conducted using Stata, version 17.0 (StataCorp LLC) and incorporated the recommended sample weights to account for oversampling of certain populations and survey nonresponse. 15 We calculated the variance of estimates using recommended Taylor Series linearization procedures on masked variance units provided on the demographic data files. The calculated estimates are designed to be representative of the US civilian noninstitutionalized population with diagnosed diabetes. We used 2-sided P  < .05 as an indicator of statistical significance.

The demographic profile for the 2482 participants is summarized in Table 1 . These participants had a mean (SD) age of 59.8 (0.4) years; 51.3% were men, 48.7% were women, 7.0% were Mexican American individuals, 17.9% were non-Hispanic Black individuals, and 65.2% were non-Hispanic White individuals. The overall percentage of adults with diabetes who used insulin did not change significantly, from 30.5% in 1988-1994 to 28.2% in 2013-2020 ( P  = .81 for trend) (eTable 1 in Supplement 1 ).

Among adults using insulin for their diabetes treatment, the current mean age was 60.6 years (95% CI, 59.2-61.9 years) and did not change significantly over time ( P  = .39 for trend) ( Table 1 ). From 1988-1994 to 2013-2020, there was a significant increase in mean diabetes duration (12.9 years [95% CI, 11.5-14.3 years] to 17.8 years [95% CI, 16.8-18.8 years]; P  < .001 for trend) as well as the proportion of individuals who were Mexican American (4.2% [95% CI, 3.1%-5.7%] to 9.0% [95% CI, 6.5%-12.3%]; P  = .003 for trend), covered by public or other insurance (23.8% [95% CI, 17.3%-31.9%] to 42.0% [95% CI, 37.2%-47.1%]; P  = .001 for trend), and had a body mass index greater than 30 (38.3% [95% CI, 31.3%-45.8%] to 66.6% [95% CI, 61.1%-71.7%]; P  = .02 for trend).

From 1988-1994 to 2013-2020, there was no significant change in the proportion of adults using insulin who achieved glycemic control (HbA 1c level <7%) (29.2% [95% CI, 22.6%-36.8%] to 27.5% [95% CI, 21.7%-34.2%]; P  = .87 for trend) or had severe hyperglycemia (HbA 1c level >10%) (18.2% [95% CI, 13.0%–24.8%] to 14.6% [95% CI, 12.0%-17.5%]; P  = .28 for trend) ( Figure 1 ). The mean HbA 1c level from 1988-2020 was 8.1% (95% CI, 8.0%-8.2%; 65 mmol/mol [95% CI, X.X-X.X mmol/mol) and did not change significantly over time ( P  = .57 for trend) ( Table 1 ).

Trends in glycemic control were largely consistent across subgroups with the exception of race and ethnicity ( Figure 2 ). Glycemic control decreased significantly for Mexican American adults using insulin (25.1% [95% CI, 17.2%-35.1%] in 1988-1994 to 9.9% [95% CI, 5.4%-17.4%] in 2013-2020; P  = .004 for trend). In 2013-2020, non-Hispanic White individuals (32.9%; 95% CI, 24.3%-42.8%) and college-educated adults (33.9%; 95% CI, 23.3%-46.5%) had higher levels of glycemic control than their respective counterparts (eTable 2 in Supplement 1 ).

Severe hyperglycemia (HbA 1c level >10%) remained largely unchanged for all subgroups ( Figure 3 ). In 2013-2020, the prevalence of severe hyperglycemia was roughly twice as high for Mexican Americans (23.9%; 95% CI, 13.6%-38.7%) and non-Hispanic Black adults (22.7%; 95% CI, 17.4%-29.0%) than it was for non-Hispanic White adults (9.1%; 95% CI, 6.0%-13.7%). Adults who had a income-poverty ratio less than 130% of the FPL (23.4%; 95% CI, 18.1%-29.7%) and were uninsured (39.7%; 95% CI, 24.5%-57.2%) also had a higher prevalence of severe hyperglycemia compared with their counterparts (eTable 2 in Supplement 1 ).

Trends were similar when using alternate uniform HbA 1c cutoffs (HbA 1c level <8% and HbA 1c level >9%), age-adjusted estimates, and age-specific cutoffs for glycemic control and severe hyperglycemia (eTable 3 and eFigures 1 and 2 in Supplement 1 ). Results were also similar after excluding participants who may have had type 1 diabetes (eTable 4 and eFigures 3 and 4 in Supplement 1 ).

After adjusting for age, gender, race and ethnicity, education, and income, Mexican American adults using insulin were significantly less likely (odds ratio [OR], 0.45; 95% CI, 0.30-0.68) to achieve glycemic control than were non-Hispanic White adults ( Table 2 ). Non-Hispanic Black adults (OR, 2.48; 95% CI, 1.71-3.61) and Mexican American adults (OR, 2.29; 95% CI, 1.32-3.98) using insulin were more likely to have severe hyperglycemia compared with non-Hispanic White adults. Adults aged 65 years or older were more likely to achieve glycemic control (OR, 1.71; 95% CI, 1.09-2.67) and less likely to have severe hyperglycemia (OR, 0.20; 95% CI, 0.12-0.32) than were adults in younger age categories.

From 1988-1994 to 2013-2020, there was no significant change in the percentage of adults using insulin or the prevalence of glycemic control and severe hyperglycemia among US adults with diabetes using insulin. Overall, less than 30% of patients with diabetes using insulin had an HbA 1c level less than 7%, while approximately 15% had an HbA 1c level greater than 10%.

Few population-based studies have examined glycemic control among patients using insulin. Previous work showed that the prevalence of glycemic control did not change among US adults with diabetes using insulin from 1988 to 2012, averaging 33% throughout the study period. 8 Our updated results, based on nationally representative data collected from 1988 to 2020, extend this work and show that glycemic control continued to stagnate among insulin users. Our results also establish that the prevalence of severe hyperglycemia did not decrease over time. 16

Several factors may have contributed to the lack of improvement in glycemic control. First, the rising cost of insulin is likely leading to medication nonadherence. 17 Approximately one-third of US adults using insulin report either rationing, dose skipping, or delaying prescription refills to save money. 18 Second, only a small proportion of practitioners may be starting or intensifying insulin therapy in a timely manner. 19 Third, acceptability of insulin remains low among patients, leading to reluctance to begin or continue using insulin therapy as recommended. 20

Trends in glycemic control varied considerably across race and ethnicity. While glycemic control was stable for non-Hispanic White adults using insulin, we found that control declined significantly among Mexican American adults. These disparities may be driven in part by differences in socioeconomic resources, though differences persisted in analyses that adjusted for educational level. Other potential contributors may include unique cultural factors and health beliefs (eg, fear of needles), slower treatment intensification, differences in health care literacy, and discrimination. 21 , 22 Improving diabetes care among Mexican American adults may require culturally tailored interventions.

Hyperglycemic emergencies have increased significantly since the mid-2000s and are especially common in patients with low income and racial and ethnic minority patients. 23 , 24 Our results suggest that suboptimal use of insulin may partly drive these trends. Among adults using insulin, we found that racial and ethnic minority patients, uninsured patients, and those with low family income had the highest levels of severe hyperglycemia. These results suggest that addressing barriers to insulin therapy may be important for reducing hyperglycemic crises in high-risk populations.

This is one of the first nationally representative studies to characterize glycemic control and severe hyperglycemia among US adults with diabetes using insulin. We analyzed the most recent national data available in a large sample of adults with diagnosed diabetes. Nearly 3 decades of data were collected using rigorous and standardized protocols.

Certain limitations should be considered in the interpretation of our results. First, this analysis used cross-sectional data, and we could not determine the causes underlying the trends in glycemic control. Second, use of insulin was self-reported and did not include information on insulin type, dosage, or adherence. Third, to maximize sample size and precision, other concomitant therapies that may influence HbA 1c levels were not explored. Fourth, the NHANES only sampled noninstitutionalized adults, and therefore, certain segments of the population with diabetes are not represented in these estimates. Fifth, due to the relatively small sample size, the study power was insufficient to detect small to moderate changes in insulin use or glycemic control without pooling survey years.

This serial cross-sectional study of NHANES data from 1988 to 2020 demonstrated that despite advancements in insulin formulations and diabetes management strategies, glycemic control and severe hyperglycemia among adults using insulin did not improve in the general US adult population with diabetes. Racial and ethnic disparities in glycemic control among adults with type 2 diabetes persisted and increased. Current rates of glycemic control in minority groups, especially Mexican American individuals, remain unacceptably low. Efforts to facilitate access to insulin will be critical to improve glycemic management. Addressing clinical inertia among practitioners and improving the care process may optimize glycemic control among patients using insulin.

Accepted for Publication: November 3, 2022.

Published: December 20, 2022. doi:10.1001/jamanetworkopen.2022.47656

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2022 Venkatraman S et al. JAMA Network Open .

Corresponding Author: Elizabeth Selvin, PhD, MPH, Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Ste 2-600, Baltimore, MD 21287 ( [email protected] ).

Author Contributions: Mr Venkatraman and Dr Fang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Venkatraman, Selvin, Fang.

Drafting of the manuscript: Venkatraman, Fang.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Venkatraman, Fang.

Obtained funding: Selvin.

Administrative, technical, or material support: Selvin.

Supervision: Echouffo-Tcheugui, Selvin, Fang.

Conflict of Interest Disclosures: Dr Selvin reported receiving grants from the National Institutes of Health (NIH) related and unrelated to this work during the conduct of the study; receiving grants from the NIH and the Foundation for the NIH outside the submitted work; being a deputy editor of Diabetes Care and a member of the editorial board of Diabetologia ; and receiving payments from Wolters Kluwer and UpToDate. No other disclosures were reported.

Funding/Support: Dr Echouffo-Tcheugui was supported by grant K23 HL153774 from the National Heart, Lung, and Blood Institute (NHLBI), NIH. Dr Selvin was supported by grant K24 HL152440 from the NHLBI, NIH.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

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  • Published: 15 July 2024

Prevalence and trends in overactive bladder among men in the United States, 2005–2020

  • Yu Cheng 1   na1 ,
  • Tao Chen 1   na1 ,
  • Guanghao Zheng 1 ,
  • Zhen Song 1 ,
  • Gan Zhang 1 ,
  • Xuepeng Rao 1 ,
  • Tao Zeng 1 &
  • Changfei Yuan 1  

Scientific Reports volume  14 , Article number:  16284 ( 2024 ) Cite this article

Metrics details

  • Risk factors

The purpose of present study was to examine the current prevalence and recent trends of overactive bladder (OAB) among US adult men and examine the correlations between OAB and several potential risk factors. The study used the nationally representative data between 2005 and 2020 from the National Health and Nutrition Examination Survey in the US. A total of 18,386 participants aged ≥ 20 years were included in the study. We divided the data into three groups: 2005–2008, 2009–2014 and 2015–2020 to investigate the trends in OAB prevalence. The weighted prevalence and corresponding 95% confidence intervals (CI) of OAB were calculated. The differences (95% CI) in prevalence between the surveys were calculated and multivariate-adjusted weighted logistic regression analysis was performed to determine the correlates of OAB. Among all US adult men, the overall prevalence of OAB increased slightly from 11.3% in 2005–2008 to 11.7% in 2009–2014 and significantly increased to 14.5% in 2015–2020 (difference, 3.2% [95% CI (1.9–4.4%)]; P  < 0.05). Increases in OAB prevalence especially concentrated on those who were 40–59 years, non-Hispanic White, non-Hispanic Black and those who were overweight and obese. Older age, non-Hispanic Black, lower educational level and family poverty ratio, diabetes, depression, sleep disorder, other chronic comorbidities, less intense recreational activity, poorer health condition and unsafe food were independent risk factors of OAB. The contemporary prevalence of OAB was high, affecting 14.5% US men and the estimated overall prevalence significantly increased from 2005 to 2020. Therefore, future research should be focused to prevent and remedy this growing socioeconomic and individually troublesome malady.

Introduction

Overactive bladder (OAB) is a widespread condition that affects millions of individuals globally, with a high prevalence among men and women 1 . It can have significant impact on physical and psychological health, and quality of life 2 . Additionally, OAB caused a substantial economic burden, with estimated costs of 7 billion euros in Europe and 66 billion USD in the United States (US) annually, these costs include expenses related to urgency urinary incontinence (UUI) and nursing home admissions 3 . As the population aged and living standards improved, the financial burden is projected to increase in the future.

OAB is a condition characterized by urinary urgency, increased frequency during the day and night (nocturia), accompanied by UUI or not, and without urinary tract infection 4 . The overall prevalence of OAB varies across different countries and studies. In the EPIC study performed in five western countries, the prevalence was estimated to be 11.8% 1 . An OAB-POLL study reported the prevalence was 8% in men and 20% in women in the US 5 . The overall prevalence of OAB in Asia was 20.8%, and the prevalence of OAB in China was 23.9% 6 , while in Austria it was 16.8% 7 and in Europe and Canada it was 10.8% and 12.8% in men and women respectively 1 . The difference in OAB prevalence rate may be related to the geographic distribution, method of epidemiological investigation, study designs, different OAB definitions, response rates, and study population. Although recent epidemiology of OAB has focused on men and women 8 , 9 , the current incidence and recent trends in male OAB are unclear.

The correlated factors and pathogenesis of OAB remain uncertain, age, socioeconomic status, lifestyles, nutritional status and comorbidities may all be associated with OAB 10 . To address these gaps, we used nationally representative data from the National Health and Nutrition Examination Survey (NHANES) to evaluate the contemporary prevalence and trends in OAB from 2005 to 2020 among US men and to further determine the associations between sociodemographic features, BMI, chronic comorbidities, lifestyles and OAB.

Materials and methods

Study design.

The NHANES is a program of surveys conducted by the National Center for Health Statistics (NCHS) to collect health-related data from the civilian noninstitutionalized population in the US. These surveys use a complex and multistage probability sample design to establish a representative sample of the population. The aim is to obtain comprehensive information on health and nutrition status through interviews and examinations. The detailed information of study design, protocol, and data collection for NHANES are described in existing publications 11 . From 1999 to March 2020, there were a total of ten cycles for NHANES surveys, consisting of nine 2-year cycles spanning from 1999 to 2016 and one combined cycle from 2017 to March 2020, which was impacted by the COVID-2019 pandemic 12 . For this study, the NHANES protocol obtained approval from the NCHS Research Ethics Review Board, and all participants provided written informed consent. The present study included adult men aged ≥ 20 years and who had complete data for OAB associated symptoms including UUI and nocturia from the 2005–2006 cycle through the 2017–2020 cycle, the unweighted total male response rates ranged from 49.7 to 80.0% for the interviewed samples and from 45.6 to 77.1% for the examined samples 13 .

Assessment and definitions of OAB

The data on OAB associated symptoms including UUI and nocturia were collected by using Kidney Conditions-Urology (KIQ_U) questionnaire in the mobile examination center (MEC). Two questions were asked to assess the severity of UUI: 1. “During the past 12 months, have you leaked or lost control of even a small amount of urine with an urge or pressure to urinate and you couldn’t get to the toilet fast enough?” 2. “How frequently does this occur?” And another question was asked to assess the severity of nocturia: “During the past 30 days, how many times per night did you most typically get up to urinate, from the time you went to bed at night until the time you got up in the morning?”.

To further identify OAB, we used the established OABSS questionnaire developed by Blaivas et al. 14 The method for conversion of NHANES symptom frequencies to OABSS are shown in Table 1 . Finally, we combined the UUI score and nocturia score and total score of ≥ 3 indicated a diagnosis of OAB disorder.

Correlates of OAB

We extracted data on age (20–39 years, 40–59 years and ≥ 60 years), race/ethnicity (Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian and other), education (< high school, high school and > high school), family poverty ratio (a ratio of family income to poverty threshold; < 1.3, 1.3–3.5 and ≥ 3.5), body mass index (BMI; < 25 kg/m 2 , 25–30 kg/m 2 , ≥ 30 kg/m 2 ), smoking (yes, no), hypertension (yes, no), diabetes (yes, no), depression (yes, no), sleep time (yes, no), sleep disorder (yes, no), chronic conditions (including asthma, arthritis, congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, stroke, thyroid problem, any liver condition and cancer), recreational activity (sports, fitness, or recreational activities; mild, moderate and vigorous), healthy diet (yes, no), general health condition (good, not good), food security (safe, not safe) and health insurance (yes, no).

Statistical analysis

Statistical analysis was performed with R version 4.3.1. Data from NHANES 2005–2006 to 2017–2020 were divided into three surveys: 2005–2008, 2009–2014 and 2015–2020. Descriptive statistics were conducted to show the demographic characteristics and other participants’ features in each survey. Estimates on weighted overall prevalence (95% confidence interval (CI)) of OAB were calculated in each survey and were further calculated by age group, race/ethnicity group and BMI group. The differences (95% CI) of prevalence between the surveys were calculated and were considered to be statistically significant if χ 2 test had a P value of less than 0.05. To perform the multiple logistic regression analysis, we tested the multicollinearity of independent variables and found no multicollinearity in these variables. In addition, the sample size was enough to conduct the multiple logistic regression analysis. Thus, weighted logistic regressions were used to explore the correlates of OAB by incorporating age, race/ethnicity, education, family poverty ratio, body mass index, smoking, hypertension, diabetes, depression, sleep time, sleep disorder, chronic conditions, recreational activity, diet, health condition, food security and health insurance. All statistical tests were 2 sided, with P  < 0.05 considered statistically significant.

Participant characteristics

Of the 76,496 individuals who participated in NHANES from 2005 to 2020, we excluded 33,084 participants who were younger than 20 years, 22,385 who were women, and 2641 who had incomplete information of UUI and/or nocturia. The final study population included 18,386 male adults aged ≥ 20 years and who had complete data. There was no significant difference of the most variables including age and race/ethnicity composition between the three surveys. Detailed data on demographic characteristics and other participants’ features in each survey were shown in Table 2 .

Prevalence and trends of OAB

The overall prevalence of OAB increased slight from 11.3% in 2005–2008 to 11.7% in 2009–2014 and increased significantly to 14.5% in 2015–2020 (difference, 3.2% [95% CI 1.9–4.4%)]; P  < 0.05) (Table 3 and Fig.  1 A). A similar increasing pattern was observed for men aged 40–59 years from 9.7% to 13.5% (difference, 3.8% [95% CI 1.7–5.9%)]; P  < 0.05). For those aged 20–39 years, the prevalence had a slightly decrease from 3.6% to 3.2%, but significantly rose to 4.5% ( P  < 0.05); yet the prevalence was stable for those aged ≥ 60 years ( P  > 0.05) from 2005–2008 to 2015–2020. By race/ethnicity group, the prevalence of OAB increased significantly from 11.1% to 14.5% (difference, 3.4% [95% CI 1.5–5.3%)]; P  < 0.05) for non-Hispanic White and from 15.4% to 20.3% (difference, 4.9% [95% CI 1.9–8.0%]; P  < 0.05) for non-Hispanic Black from 2005–2008 to 2015–2020. For Hispanic, the prevalence had a slightly decrease from 10.5% to 10.0%, but significantly rose to 12.3% ( P  < 0.05) (Fig.  1 B). By BMI group, the prevalence of OAB for overweight men increased from 11.0% in 2005–2008 to 14.2% in 2015–2020 (difference, 3.2% [95% CI (1.0–5.4%]; P  < 0.05), and increased from 13.2% to 16.3% (difference, 3.1% [95% CI (0.8–5.3%]; P  < 0.05) for obese men, while the prevalence was stable for those with a BMI < 25 kg/m 2 (Fig.  1 C). Detailed data were shown in Table 3 .

figure 1

Trends in OAB prevalence by age ( A ), race/ethnicity ( B ) and BMI ( C ). * P  < 0.05, BMI body mass index, OAB overactive bladder.

In multivariate logistic regression analysis, the prevalence of OAB was higher for those aged ≥ 60 years (OR 7.21; 95% CI 5.75–9.03) and those aged 40–59 years (OR 2.63; 95% CI 2.20–3.14) when compared with men aged 20–39 years (Table 4 and Fig.  1 A). Hispanic (OR 1.07; 95% CI 0.91–1.26) and non-Hispanic Black men (OR 1.91; 95% CI 1.62–2.24) had a higher prevalence of OAB than non-Hispanic White men (Fig.  1 B). In addition, for those who had diabetes (OR 1.54; 95% CI 1.32–1.80), depression (OR 2.44; 95% CI 1.97–3.04), sleep disorder (OR 1.27; 95% CI 1.07–1.51), chronic conditions (OR 1.67; 95% CI 1.43–1.93), mild recreational activity (OR 1.31; 95% CI 1.04–1.65) or moderate recreational activity (OR 1.35; 95% CI 1.05–1.73), poorer health condition (OR 1.34; 95% CI 1.14–1.59) and unsafe food (OR 1.31; 95% CI 1.09–1.57) had a significantly higher prevalence of OAB. For those who had high school (OR 0.80; 95% CI 0.65–0.97) or higher than high school educational level (OR 0.65; 95% CI 0.55–0.77), family poverty ratio between 1.3 and 3.5 (OR 0.86; 95% CI 0.73–1.00) or ≥ 3.5 (OR 0.74; 95% CI 0.61–0.90) had a significantly lower prevalence of OAB (Table 4 ).

Data on the epidemiology of male OAB are scarce. About two decades ago, the National Overactive Bladder Evaluation (NOBLE) program was performed to investigate the overall prevalence and burden of OAB in the US and reported an overall prevalence of 16.0% for US men in 2002 15 using clinically validated computer-assisted telephone interview (CATI) questionnaire which was different from OABSS. Another study published in 2013 reported the prevalence of OAB defined by the presence of urinary urgency ≥ ‘‘often,’’ and/or the presence of UUI was around 8% in US men 5 . The difference in OAB prevalence between our study and previous studies may be related to the method of epidemiological investigation, study designs, different OAB definitions, response rates, and study population. The contemporary prevalence and recent trends in male OAB were unknown. The present study, for the first time, systematically evaluated nearly 20-year trend in OAB among US men. Although two prior studies that revealed the overall incidence of UUI increased significantly from 2005 to 2018 16 and the overall incidence of nocturia increased significantly from 2005 to 2016 17 in US men, the authors did not evaluate the prevalence of OAB, thus the increasing trends in UUI and nocturia may be attributed to the increasing OAB prevalence.

The reason and mechanism of increasing OAB prevalence remained unclear, it may not because of the increase in aging population, as we did not observe the increasing trend of OAB prevalence in those aged ≥ 60 years. Additionally, although we found a significant increase in non-Hispanic Black men, the proportion of Black men did not increase across the three surveys. Although obese persons seemed to be increasing and an increasing trend was observed in obese men, we failed to demonstrate an independent association of obesity and OAB. Nevertheless, neurological disorders, particularly Parkinson disease and multiple sclerosis, and antidepressant use are potential causes of OAB, and are increasing in the US in recent years 18 , 19 , 20 . Therefore, future study should be focused to explore the reasons why OAB prevalence increased.

The prevalence and trends of OAB were found to be associated with some sociodemographic features. Non-Hispanic Black men had a higher prevalence of OAB, this was consistent with the results of a racially diverse population study 21 . Moreover, a significant increase trend was observed in non-Hispanic Black men in our study. However, the specific reasons for racial differences in OAB remained unclear, they were likely multifactorial. OAB is commonly found in men diagnosed with benign prostatic hyperplasia (BPH) and/or an enlarged prostate. The risk of developing BPH is significantly higher among non-Hispanic Black and Hispanic men compared to non-Hispanic White men 22 , 23 . Furthermore, racial minorities in the US tend to have lower educational levels, engage in physically demanding jobs, earn lower incomes, and experience higher stress levels. These factors have been associated with an increased risk of urinary system diseases 24 , 25 . Additionally, the reason that a higher educational level and family poverty ratio had a lower prevalence of OAB 6 , 10 , 15 may be attributed to the fact those people tend to have better health-seeking behaviors and adopt healthier lifestyles. Conversely, individuals with lower education and income levels may have a higher prevalence of smoking, poor diet, increased physical labor, and exposure to toxins, which increases their susceptibility to developing OAB.

Chronic comorbidities, diabetes, stroke or cancer, were all associated with a higher prevalence with OAB, probably by compromising pelvic floor vascular, nerve and muscle function 26 , 27 , 28 . Stroke, diabetes and cancer may cause neurological conditions such as central nerve system injury and diabetic autonomic neuropathy, which may lead to the occurrence of OAB 29 . Additionally, depression and sleep disorder were associated with a higher prevalence of OAB in our study. Previous studies demonstrated that OAB or its associated symptoms such as nocturia may result in poor sleep and sleep apnea 30 , 31 , and mental health conditions such as anxiety and depression may influence the natural history of OAB in US veterans 32 . In fact, sleep or mental problems and OAB may be causal to each other, OAB can obviously affect mental health and sleep quality and sleep disorder or mental problems such as anxiety and depression, in turn, affect and aggravate the condition of OAB, which may be related to the dysregulation of bladder function by numerous neural pathways. Additionally, this analysis found that those who had a vigorous recreational activity, good health condition and good food security had a lower risk of experiencing OAB. Therefore, these healthy lifestyles are recommended in daily life to prevent the occurrence of OAB and relieve or manage OAB.

The NHANES design constituted the principal strengths of this study. NHANES employed a sophisticated multistage, probability-based sampling procedure to enroll a sample that properly represented the overall United States population. Furthermore, standardized protocols ensured the quality of data collection in NHANES. However, this study had some limitations, such as the fact that confirmation of OAB relied on self-reported information with no comprehensive clinical examination, including physical assessment, urine analysis, ultrasound, or urodynamic testing. Additionally, recall biases could have influenced the self-reported data used in the study. Due to the cross-sectional nature of the study, it was not possible to capture newly developed cases of OAB or assess the duration of OAB. Finally, the noninstitutionalized nature of participants included in the study implied that the actual prevalence of OAB may have been underestimated since individuals in hospitals or nursing homes were not represented. However, the present study provided crucial observations of contemporary epidemiology of OAB, and disparities of OAB in sociodemographic, comorbidities and lifestyles, which may inform future studies and public health planning.

Conclusions

The contemporary prevalence of OAB was high, affecting 14.5% US men. The overall prevalence of OAB significantly increased across recent two decades, especially among men who were aged 40–59 years, non-Hispanic White and Black, and overweight and obese men. Future studies are needed to address OAB disparities across sociodemographic subgroups and to investigate the factors driving the rising trends in subtypes of OAB among older men, non-Hispanic White and Black, and obese men. Focused research can help prevent and remedy this growing socioeconomic and individually troublesome malady.

Data availability

The datasets generated and/or analyzed during the current study are available in the open database NHANES website: https://wwwn.cdc.gov/nchs/nhanes/Default.aspx .

Irwin, D. E. et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: Results of the EPIC study. Eur. Urol. 50 (6), 1306–1314 (2006) ( discussion 1314–1315 ).

Article   PubMed   Google Scholar  

Coyne, K. S. et al. The burden of lower urinary tract symptoms: Evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 103 (Suppl 3), 4–11 (2009).

Milsom, I. et al. Global prevalence and economic burden of urgency urinary incontinence: A systematic review. Eur. Urol. 65 (1), 79–95 (2014).

Abrams, P. et al. The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-committee of the International Continence Society. Am. J. Obstet. Gynecol. 187 (1), 116–126 (2002).

Coyne, K. S. et al. The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: Results from OAB-POLL. Neurourol. Urodyn. 32 (3), 230–237 (2013).

Chuang, Y. C. et al. Prevalence of overactive bladder in China, Taiwan and South Korea: Results from a cross-sectional, population-based study. Low Urin. Tract. Symptoms 11 (1), 48–55 (2019).

Temml, C., Heidler, S., Ponholzer, A. & Madersbacher, S. Prevalence of the overactive bladder syndrome by applying the International Continence Society definition. Eur. Urol. 48 (4), 622–627 (2005).

Al Edwan, G. et al. The prevalence of overactive bladder symptoms in women in Algeria, Egypt, Jordan and Lebanon: A cross-sectional population-based survey. Adv. Ther. 38 (2), 1155–1167 (2021).

Article   CAS   PubMed   Google Scholar  

Plata, M. et al. Prevalence of lower urinary tract symptoms and overactive bladder in men and women over 18 years old: The Colombian overactive bladder and lower urinary tract symptoms (COBaLT) study. Neurourol. Urodyn. 38 (1), 200–207 (2019).

Mckellar, K., Bellin, E., Schoenbaum, E. & Abraham, N. Prevalence, risk factors, and treatment for overactive bladder in a racially diverse population. Urology 126 , 70–75 (2019).

National Center for Health Statistics. 2022. NHANES survey methods and analytic guidelines. https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx#sample-design Accessed 27 Feb 2023.

National Center for Health Statistics. 2022. NHANES 2017-March 2020 pre-pandemic. https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?Cycle=2017-2020 Accessed 23 May 2023.

National Center for Health Statistics. 2022. NHANES response rates and population totals. https://wwwn.cdc.gov/nchs/nhanes/ResponseRates.aspx Accessed 27 Feb 2023.

Blaivas, J. G., Panagopoulos, G., Weiss, J. P. & Somaroo, C. Validation of the overactive bladder symptom score. J. Urol. 178 (2), 543–547 (2007) ( discussion 547 ).

Stewart, W. F. et al. Prevalence and burden of overactive bladder in the United States. World J. Urol. 20 (6), 327–336 (2003).

Cao, C. et al. Trends and racial disparities in the prevalence of urinary incontinence among Men in the USA, 2001–2020. Eur. Urol. Focus 8 (6), 1758–1767 (2022).

Soysal, P. et al. Trends and prevalence of nocturia among US adults, 2005–2016. Int. Urol. Nephrol. 52 (5), 805–813 (2020).

GBD 2017 US Neurological Disorders Collaborators et al. Burden of neurological disorders across the US from 1990–2017 a global burden of disease study. JAMA Neurol. 78 (2), 165–176 (2021).

Article   Google Scholar  

Mojtabai, R. & Olfson, M. National trends in long-term use of antidepressant medications: Results from the U.S. National Health and Nutrition Examination Survey. J. Clin. Psychiatry 75 (2), 169–177 (2014).

GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: An analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 7(2), e105–e125 (2022).

Akbar, A. et al. Racial differences in urinary incontinence prevalence, overactive bladder and associated bother among men: The multi-ethnic study of atherosclerosis. J. Urol. 205 (2), 524–531 (2021).

Kristal, A. R. et al. Race/ethnicity, obesity, health related behaviors and the risk of symptomatic benign prostatic hyperplasia: Results from the prostate cancer prevention trial. J. Urol. 177 (4), 1395–1400 (2007).

Fowke, J. H. et al. Race and socioeconomic status are independently associated with benign prostatic hyperplasia. J Urol. 180 (5), 2091–2096 (2008) ( discussion 2096 ).

Article   PubMed   PubMed Central   Google Scholar  

Williams, D. R., Priest, N. & Anderson, N. B. Understanding associations among race, socioeconomic status, and health: Patterns and prospects. Health Psychol. 35 (4), 407–411 (2016).

Van Den Eeden, S. K. et al. Urologic diseases in America Project. Evaluating racial/ethnic disparities in lower urinary tract symptoms in men. J. Urol. 187 (1), 185–189 (2012).

Kaplan, S. A. Re: Is type-2 diabetes mellitus associated with overactive bladder symptoms in men with lower urinary tract symptoms?. J. Urol. 194 (3), 736 (2015).

CAS   PubMed   Google Scholar  

Itoh, Y. et al. Burden of overactive bladder symptom on quality of life in stroke patients. Neurourol. Urodyn. 32 (5), 428–434 (2013).

Wein, A. J. Re: A review of detrusor overactivity and the overactive bladder after radical prostate cancer treatment. J. Urol. 196 (2), 500–501 (2016).

PubMed   Google Scholar  

Yamaguchi, C. et al. Overactive bladder in diabetes: A peripheral or central mechanism?. Neurourol. Urodyn. 26 (6), 807–813 (2007).

Savoie, M. B. et al. Beyond the bladder: Poor sleep in women with overactive bladder syndrome. Am. J. Obstet. Gynecol. 222 (6), 600.e1-600.e13 (2020).

Lowenstein, L. et al. The relationship between obstructive sleep apnea, nocturia, and daytime overactive bladder syndrome in women. Am. J. Obstet. Gynecol. 198 (5), 598.e1–5 (2008).

Bradley, C. S. et al. Longitudinal associations between mental health conditions and overactive bladder in women veterans. Am. J. Obstet. Gynecol. 217 (4), 430.e1-430.e8 (2017).

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Yu Cheng, Tao Chen, Guanghao Zheng, Zhen Song, Gan Zhang, Xuepeng Rao, Tao Zeng & Changfei Yuan

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Study concept and design: Cheng, Chen, Yuan. Acquisition of data: Zheng, Song, Zhang, Rao. Analysis and interpretation of data: Cheng, Chen, Yuan. Drafting of the manuscript: Cheng, Chen, Yuan. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Cheng, Chen, Yuan. Administrative, technical, or material support: Zeng. Supervision: Zeng. Funding acquisition: Yuan.

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nutrition research articles 2020

Assessing the Cost of Healthy and Unhealthy Diets: A Systematic Review of Methods

  • Public Health Nutrition (KE Charlton, Section Editor)
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  • Published: 09 September 2022
  • Volume 11 , pages 600–617, ( 2022 )

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nutrition research articles 2020

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Purpose of Review

Poor diets are a leading risk factor for chronic disease globally. Research suggests healthy foods are often harder to access, more expensive, and of a lower quality in rural/remote or low-income/high minority areas. Food pricing studies are frequently undertaken to explore food affordability. We aimed to capture and summarise food environment costing methodologies used in both urban and rural settings.

Recent Findings

Our systematic review of high-income countries between 2006 and 2021 found 100 relevant food pricing studies. Most were conducted in the USA ( n  = 47) and Australia ( n  = 24), predominantly in urban areas ( n  = 74) and cross-sectional in design ( n  = 76). All described a data collection methodology, with just over half ( n  = 57) using a named instrument. The main purpose for studies was to monitor food pricing, predominantly using the ‘food basket’, followed by the Nutrition Environment Measures Survey for Stores (NEMS-S). Comparatively, the Healthy Diets Australian Standardised Affordability and Price (ASAP) instrument supplied data on relative affordability to household incomes.

Future research would benefit from a universal instrument reflecting geographic and socio-cultural context and collecting longitudinal data to inform and evaluate initiatives targeting food affordability, availability, and accessibility.

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nutrition research articles 2020

A tale of two cities: the cost, price-differential and affordability of current and healthy diets in Sydney and Canberra, Australia

Healthy diets asap – australian standardised affordability and pricing methods protocol, testing the price and affordability of healthy and current (unhealthy) diets and the potential impacts of policy change in australia.

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Introduction

Poor diets, described as those low in fruits, vegetables, and whole grains, and high in red and processed meats and ultra-processed foods, are a leading risk factor for chronic disease globally [ 1 ]. In most high-income countries (HIC), poor diets disproportionally affect lower socioeconomic populations, Indigenous Peoples, and those living in rural and/or remote areas [ 2 , 3 , 4 , 5 ]. Rather than solely a consequence of individual behaviours, poor diets are critically informed by broad contextual factors, including social, commercial, environmental, and cultural influences [ 6 , 7 ]. Crucially, the consumption of a healthy diet is constrained by the range, affordability, and acceptability of foods available for sale [ 8 ]. Research suggests that healthy foods are often harder to access, more expensive, and often of a lower quality in rural, remote, or low-income/high minority areas, than in metropolitan or high-income areas [ 9 , 10 , 11 , 12 ]. Such food environments contribute to higher rates of diet-related non-communicable diseases and food insecurity [ 13 , 14 ]. In order to improve population diets, all aspects of the food environment must be addressed to ensure healthy foods are affordable, available, and of adequate nutritional quality [ 15 ].

Price is a primary factor impacting food choice, diet quality, and food security, therefore having affordable, acceptable, healthy food should be a political and social priority [ 8 , 15 , 16 ]. Some research suggests that healthy diets are associated with greater total spending [ 17 , 18 , 19 ], while other studies report that adherence to a healthy diet is less expensive than current or ‘unhealthy’ diets [ 9 , 20 , 21 ]. Regardless, the cost of a healthy diet is a proportionately large household expense (> 30% of household income) and may therefore be considered ‘unaffordable’ [ 22 ]. Additionally, public perception that healthy diets are expensive is high, which itself may be a barrier to the purchase of healthy foods [ 23 ]. Therefore, improving the affordability of healthy food could improve population diets, regardless of context [ 24 ].

To address the issue of food affordability and inform appropriate attenuating policy and intervention strategies, food pricing studies are frequently undertaken. Food pricing, however, is not a universal construct and is highly influenced by country and context. Numerous methods have been developed to measure food pricing, with data therefore not always comparable or replicable, and of limited value to inform appropriate policy [ 25 ]. Most studies that collect food pricing data conclude that food prices are rising, making healthy eating unaffordable for many populations. However, few studies to date have used this data to suggest strategies to improve affordability. Our systematic review aims to capture and summarise food environment costing methodologies used in HIC, in both urban and rural settings, between 2006 and 2021. In addressing this aim, we answer the following questions: (i) What is the stated purpose of collecting data on food prices, including whether the data is used to inform or advocate for interventions? (ii) Which instruments are being used to measure food pricing? (iii) What are the strengths and limitations of each instrument as reported by study authors?

To address the research aim, we undertook a systematic review of the literature, following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 26 ]. We followed four steps: (i) systematic search for relevant literature; (ii) selection of studies, (iii) data extraction, and (iv) analysis and synthesis of results.

Systematic Search Strategy

After consultation with a research liaison librarian, databases used included EBSCOHOST (Academic Search Complete, CINAHL Complete, GlobalHealth, Medline Complete, and PsychINFO) and Informit. We chose these databases for their comprehensiveness and conventional use in the public health nutrition discipline. We identified search terms using a scoping review and key words used in previous food pricing reviews [ 15 , 23 , 27 , 28 ]. We searched both article abstracts and titles using the following search string: ‘food affordability’ OR ‘food cost’ OR ‘food price*’ OR ‘food promotion*’. We completed an initial search for studies published 2016–2021 in October 2021, followed by a search for studies published 2006–2015 in December 2021.

Selection of Studies

Studies were included if they were English, peer-reviewed journal articles presenting original research, monitored food prices in a high-income country/s, and were published between 2006 and 2021. The article by Glanz (2006) [ 15 ] is considered a seminal paper in food pricing research and was therefore chosen as the starting date for our search. Studies prior to this date were considered unlikely to be relevant to the research question and were thus excluded. Review articles, opinion pieces, posters, perspectives, study protocols, viewpoints, editorials, and commentaries were excluded, as well as those assessing middle- or low-income countries.

Study screening involved an initial review of all titles and removal of duplicates by A1 using online Covidence software [ 29 ], followed by abstract screening (A1), and then full text screening of remaining studies (A1). A second reviewer independently screened all articles by abstract and full text to minimise bias (A2 and A3). Disagreements were resolved through discussion between researchers; where no agreement was reached, a third party acted as an arbiter (A2 and A3). Limited hand searching was conducted given the volume of papers identified. Online Resource 1 presents a PRISMA flow chart of the study selection process.

Data Extraction

Included studies were uploaded to an Endnote (V. X9) [ 30 ] library. We systematically extracted details of each study to Microsoft Excel (V. 2112), including the author/s, year published, article title, aim, pricing instrument used (if specified), country and geographical context (e.g. urban or rural), type of data collected, number and type of locations assessed, number and type of food items captured, population (if the study used sales receipts to estimate food prices), time period of study, strengths, limitations, and conclusions.

Data Analysis and Synthesis

The coded data were used to identify major themes that were then synthesised in the results. We used an inductive thematic approach for our analysis, with the results discussed between the research team to limit researcher subjectivity [ 31 ]. We used Microsoft Excel to calculate descriptive statistics and graphical outputs.

Overview of Studies

Database searching identified 2737 studies, with 1882 studies remaining after removal of duplicates. After abstract screening, a total of 287 were identified for full-text screening, with 187 excluded, and a total of 100 studies included in this systematic review (Online Resource 1).

We observed an increasing number of studies each year, with peaks in 2013, 2014, and 2018 (Fig.  1 ).

figure 1

Frequency of studies published assessing food prices between 2006 and 2021

Most studies measured food prices in the USA ( n  = 47), followed by Australia ( n  = 25). Urban food environments were assessed more frequently ( n  = 74) than rural ( n  = 33). Most studies were cross-sectional ( n  = 77). Most studies included instore price audits ( n  = 59), followed by online price audits (supermarket websites, n  = 13), or electronic point of sale data (consumer receipts, register sales, or electronic scanning of food prices in the home, n  = 12), and a combination of these ( n  = 17). Most studies collected food price data from more than 20 food retail outlets ( n  = 34) (Table 1 ).

Details of all included studies, grouped according to data source used (instore price audits, online price audits, electronic point of sale, and combinations of these), are shown in Tables 2 , 3 , and 4 . Details include instrument used (if applicable), purpose of data collection, country, context, study type (e.g. cross-sectional, longitudinal), healthiness comparisons (between healthy and unhealthy products or diets), study author, and year. The use of a named instrument was captured to identify commonalities in usage of instruments, and not as an indication of study quality. When assessing differentials in ‘healthiness’, studies either presented a comparison of a ‘healthy diet’ with an ‘unhealthy or currently consumed diet’ or a comparison of the cost of ‘healthy’ and ‘unhealthy’ foods or product categories.

Study Purpose for Collecting Data on Food Prices

The studies included in this review had a multitude of aims (Tables 2 , 3 , and 4 ). While most studies were conducted solely to monitor food prices in a specific location/s [ 33 , 39 , 42 , 46 , 47 , 52 , 54 , 56 , 57 , 59 , 64 , 67 , 71 , 75 , 80 , 81 , 88 , 89 , 104 , 106 , 108 , 109 , 114 ], others aimed to monitor food price changes over time [ 53 , 63 , 74 , 83 , 93 , 97 , 111 , 127 ], assess food prices as a function of income, socioeconomic status, or welfare assistance [ 9 , 19 , 20 , 33 , 36 , 37 , 38 , 40 , 41 , 66 , 69 , 70 , 77 , 84 , 85 , 86 , 90 , 91 , 92 , 94 , 100 , 110 , 115 , 116 , 117 , 122 ]; assess food price in relation to geographic distance [ 19 , 77 , 91 , 92 , 94 , 98 ]; compare perceptions of food price with actual food prices [ 68 , 101 , 107 ]; and relate food price with a health outcome [ 34 , 35 , 37 , 40 , 47 , 58 , 70 , 72 , 78 , 105 , 116 , 117 , 124 , 125 ], compare the price of healthy or unhealthy foods/diets [ 9 , 20 , 34 , 43 , 50 , 51 , 55 , 60 , 61 , 62 , 63 , 64 , 65 , 76 , 85 , 86 , 93 , 94 , 95 , 96 , 99 , 102 , 110 , 111 , 112 , 120 , 121 , 123 , 124 , 126 ], assess diet costs for a specific population [ 82 , 118 ], compare food prices between brands [ 79 ], compare approaches for estimating dietary costs [ 32 ], or understand how prices impact consumption [ 44 ]. Only seven studies specifically aimed to collect data to inform policy strategies and/or community interventions to improve population health [ 10 , 11 , 49 , 80 , 87 , 103 , 113 ]. However, 26 studies did discuss their study findings on food price in relation to potential further action to improve food environments [ 9 , 19 , 20 , 33 , 36 , 37 , 40 , 43 , 47 , 49 , 50 , 54 , 55 , 59 , 63 , 64 , 81 , 85 , 86 , 87 , 88 , 103 , 104 , 105 , 110 ]. Specific suggested strategies included those targeting individuals, such as education campaigns to promote healthy and more affordable food choices [ 9 , 36 , 43 , 45 , 49 , 50 , 55 ], and those targeting environmental changes, such as taxes on ‘unhealthy’ foods [ 33 , 49 , 85 , 104 , 110 ], subsidies and exemptions for ‘healthy’ foods [ 9 , 20 , 45 , 62 , 63 , 85 , 104 , 110 ], vouchers for farmer’s markets [ 43 ], establishing more food stores [ 33 , 45 , 48 , 104 ], better public transportation for consumers to access food stores [ 59 ], generating savings at the manufacturer/wholesaler level that can be passed on to customers [ 81 ], establishing community-led food supply options [ 9 ], and increasing welfare support proportionate to food prices and geographic distances to food stores [ 37 , 40 , 50 , 73 , 85 ].

Overview of Instruments Used to Measure Food Prices

Of the 100 included studies, 57 used a named instrument to measure food prices, as described below. The remaining 43 studies did not name a pre-existing data collection instrument; instead, the authors described the data collection methodology used, for example, in store, online, or via electronic sales data.

Food Basket Instruments

The majority ( n  = 30) of studies used a variation of a ‘food basket’ to estimate food prices. Food baskets capture the prices of a pre-defined list of foods, often in quantities representative of the total diet of reference families over a defined timeframe [ 9 ], and is a longstanding methodology used to investigate the availability and affordability of food. Food basket studies were mainly conducted in the USA ( n  = 14) and Australia ( n  = 12) [ 19 , 20 , 80 , 81 , 83 , 87 , 88 , 89 , 90 , 91 , 92 ]. Food basket studies using named instruments were conducted in the USA—using the Thrifty Food Plan Market Basket ( n  = 5), the Fred Hutchinson Cancer Research Center Market Basket ( n  = 3), the University of Washington’s Center for Public Health Nutrition Market Basket ( n  = 3), and the USDA Market Basket ( n  = 2); in Australia—using the Victorian Healthy Food Basket ( n  = 4), the Food Basket informed by the INFORMAS framework ( n  = 2), the Adelaide Healthy Food Basket ( n  = 2), the Illawarra Healthy Food Basket ( n  = 2), the Queensland Healthy Food Access Basket Survey ( n  = 1), and the Northern Territory Market Basket ( n  = 1); and in Canada—using the Ontario Nutritious food basket ( n  = 1), the Revised Northern Food Basket ( n  = 1), and an unspecified market basket ( n  = 1). Food basket studies were conducted in both rural ( n  = 13) [ 19 , 37 , 49 , 50 , 52 , 81 , 83 , 87 , 88 , 90 , 91 , 103 , 110 ] and urban contexts ( n  = 25) [ 19 , 20 , 37 , 38 , 40 , 46 , 49 , 50 , 51 , 52 , 62 , 63 , 64 , 66 , 67 , 70 , 80 , 81 , 83 , 88 , 89 , 92 , 104 , 105 , 111 ].

All but two [ 37 , 40 ] food basket studies collected prices from physical instore locations [ 19 , 20 , 38 , 43 , 46 , 49 , 50 , 51 , 52 , 55 , 62 , 63 , 64 , 66 , 67 , 70 , 73 , 80 , 81 , 83 , 87 , 88 , 89 , 90 , 91 , 92 , 103 , 104 , 105 , 110 ], with four of these studies supplementing the data with online supermarket prices [ 62 , 63 , 64 , 81 ]. Additionally, three instruments compared the cost of a ‘healthy diet’ to either an ‘unhealthy or currently consumed diet’ [ 20 , 88 , 110 ], 13 instruments compared the cost of ‘healthy’ and ‘unhealthy’ individual foods or product categories [ 19 , 38 , 51 , 62 , 63 , 66 , 83 , 87 , 89 , 90 , 103 ], and 14 instruments did not present a comparison [ 37 , 40 , 46 , 49 , 50 , 52 , 64 , 67 , 70 , 80 , 81 , 91 , 92 , 104 , 105 ]. ‘Current’ diets were defined using national survey data [ 20 , 110 ]. Level of healthiness was defined using various benchmarks, namely the NOVA food processing classification system [ 38 ], nutrient composition and energy density [ 38 , 51 , 62 , 63 , 66 , 80 , 83 , 90 ], national Dietary Guidelines [ 19 , 43 , 70 , 87 , 88 , 89 , 90 ], and the Dietary Approaches to Stop Hypertension (DASH) dietary pattern [ 43 ]. Food affordability was benchmarked using household income [ 20 , 49 , 50 , 90 , 91 , 92 , 103 , 105 , 110 ], government subsidies [ 37 , 40 , 87 , 89 , 91 ], and minimum wage [ 38 , 66 , 70 ]; however, most studies ( n  = 13) did not determine relative affordability in their analysis [ 43 , 51 , 52 , 55 , 62 , 63 , 64 , 67 , 73 , 80 , 81 , 83 , 88 ].

Healthy Diets Australian Standardised Affordability and Price (ASAP) Instrument

Following critiques of existing food baskets, the previously described INFORMAS instrument was refined to assess and compare the price and affordability of healthy and current diets in Australia, leading to the development of the Healthy Diets Australian Standardised Affordability and Price (ASAP). This instrument assesses the cost of a ‘recommended’ Australian diet (defined by the Australian Dietary Guidelines and Australian Guide to Healthy Eating) and the cost of the ‘current’ Australian diet (as reported in the 2011–12 Australian Health Survey) using the reference household of two parents and two children (boy aged 14 years; girl aged 8 years) [ 128 ]. Thus, all studies using this instrument present a comparison of the cost of a ‘healthy’ and ‘unhealthy’ diet in their analysis. Intrinsic to the instrument, the relative affordability of a healthy diet is measured against household incomes. The ASAP instrument was used by four studies to collect food price data in physical instore locations [ 9 , 85 , 86 ] or from online supermarkets [ 94 ]. Studies were conducted in both rural ( n  = 2) [ 9 , 85 , 94 ] and urban ( n  = 2) [ 85 , 86 , 94 ] contexts.

Nutrition Environment Measures Survey for Stores (NEMS-S) Instrument

The Nutrition Environment Measures Survey for Stores (NEMS-S) and its variants were also frequently used throughout food pricing studies ( n  = 15). These included NEMS-S-Rev (Nutrition Environment Measures Survey for Stores Revised), TxNEAS (Texas Nutrition Environment Assessment), NEMS-S-NL (Nutrition Environment Measures Survey for Stores Newfoundland and Labrador), and The Bridging the Gap Food Store Observation Form. This instrument was used mostly in the USA ( n  = 11) [ 11 , 33 , 36 , 44 , 47 , 48 , 54 , 57 , 68 , 71 , 107 ]. Studies were conducted in both rural ( n  = 4) [ 10 , 11 , 56 , 106 ] and urban ( n  = 11) [ 33 , 36 , 44 , 47 , 48 , 54 , 57 , 68 , 71 , 107 , 108 ] contexts. Compared to the food basket methodology, the NEMS-S instrument compares products in the same category that are considered ‘healthy’ or ‘unhealthy’ based on American Dietetic Association (ADA) recommended dietary guidelines, focusing on availability, price, and quality. All studies using the NEMS-S instrument collected food price data in physical instore locations. While the instrument itself does not include a calculation of relative affordability, approximately half the NEMS-S studies included this step in their methods [ 33 , 36 , 44 , 47 , 48 , 54 , 57 ], while all others did not [ 10 , 11 , 56 , 68 , 71 , 106 , 107 , 108 ].

Other Instruments

Several other named instruments were identified, used in single studies. These included the Diet and Nutrition Tool for Evaluation (DANTE) [ 101 ], the Flint Store Food Assessment Instrument [ 60 ], the Food Label Trial registry tool [ 76 ], the New Zealand Food Price Index [ 111 ], the USDA Food Store Survey Instrument [ 73 ], USDA Low-cost food plan [ 55 ] and audit forms developed by the Yale Rudd Center [ 39 ], the Hartford Advisory Commission on Food Policy [ 59 ], and the USDA Authorized Food Retailers’ Characteristics and Access Study [ 43 ]. Only three instruments compared healthy and unhealthy products [ 43 , 76 , 111 ] and none analysed the relative affordability of food.

Instrument Strengths and Limitations

The strengths and limitations of instruments commonly used across studies, as identified by study authors, are presented in Online Resource 2 . Commonly cited limitations, regardless of instrument used, included that actual purchasing behaviours were not captured (unless electronic point of sales data was utilised); culturally important and region-specific products were often not captured; tools were cross-sectional in nature, thus seasonality or changes overtime were not considered; and out-shopping, described as food purchases undertaken outside the local residential geography, including internet orders or foods purchased during travel to other communities, could not be accounted for. While some food basket studies and those using the ASAP instrument did contextualise the relative affordability of healthy foods and/or diets, this was not a part of the methodology for NEMS-S. Other limitations specific to NEMS-S included the length of the survey, and a low convergence between NEMS-S results and consumer perceptions of affordability. Specific limitations for food basket studies included results being constrained by the reference family used and the assumption that food is shared equally among household members. Additionally, most instruments did not capture geographical information regarding access to food retail outlets or availability of foods within food retail outlets.

Authors less commonly described instrument strengths. For NEMS-S, cited strengths included the ability to compare food prices between healthy and unhealthy options, that it has strong inter-rater and test-re-test reliability, and that it has been validated in multiple countries. ASAP studies, and some food basket studies, included a comparison between healthy and current (‘unhealthy’) diets (based on actual consumption) and included alcohol in the survey.

Our systematic review details the key purposes, and methodologies used, for measuring food prices in HIC between 2006 and 2021. While most studies were conducted solely to monitor food prices in specific locations, some sought to report price changes over time, and others collected data to assess comparability of food costs to healthier alternatives, average earnings, welfare payments, rurality, and socioeconomic position. Most studies measured food prices in urban areas, using instore food price audits, with an emerging use of online data collection evident. The most frequently used instruments were ‘food baskets’, used predominantly to monitor food prices; the NEMS-S instrument, used to provide data on relative cost and availability; and the ASAP instrument, use to provide data on relative affordability.

Our review differs from previous reviews of food price and affordability instruments [ 23 , 28 ] by taking a broadened focus on food pricing measures used in HIC globally and including new technology that is affording opportunities for electronic food pricing data collection. While a previous review critiqued food pricing measures for relevance specific to a rural context, our review includes both rural and urban contexts [ 28 ]. Another review [ 23 ] also describes the components of individual instruments, such as the identification of differently sized ‘food baskets’, ranging between 30 and 200 food items. Such critique was beyond the scope of our research questions.

Despite emerging options for electronic methodologies, the predominance of in person, instore data collection continues, notwithstanding the time-consuming and resource-intensive nature of this method. Studies indicate that these instore instruments can be targeted and applied within multiple contexts, such as rural [ 9 , 10 , 11 , 12 ], Indigenous [ 129 , 130 ], and low socioeconomic areas [ 85 ]. Perhaps researchers consider instore data collection as providing real-world insights at a community and population health level. Our review identified that food pricing instruments were mostly used to monitor food prices at a single point in time (cross-sectional) rather than changes at different time points (longitudinal). Instruments that enable the comparison of food prices in terms of a healthy diet (as recommended by dietary guidelines) compared with current dietary patterns (as reported through population health surveys) [ 128 ], and relative affordability for families, appear to provide data of greater practice and policy relevance with regard to community strategies, taxes, and subsidies that have potential to enhance food affordability, availability, and accessibility.

Technological innovations are an emerging alternative to in person data collection, facilitating the acquisition of online supermarket prices, a less labour-intensive method for capturing food prices [ 131 ]. To date, this method has been used within major chain-supermarkets, with a recent study reporting similar results when comparing pricing data obtained instore versus online [ 94 ]. This method therefore holds potential where an online supermarket presence exists, which was increasingly the case during the COVID-19 pandemic [ 53 ], providing rapid feedback to inform price promotions. However, for smaller and/or independent food retail outlets, frequently located in rural areas, online data collection does not appear to capture the contextual nuances of instore price promotions.

Our review found an over-representation of food pricing studies within urban areas. This is consistent with multiple studies that reflect inequities experienced within rural environments [ 132 ], and rural food environments are no exception [ 133 ]. The predominance of research within urban areas may also reflect a pragmatic researcher response to the physical proximity of stores (ease of measurement) and larger population reach (potential for greater population impact). Previous research shows significant differences in income-based variables, food environments, and the affordability of healthy food between urban and rural settings [ 134 ]. There is therefore a need for rural-specific food pricing studies, using appropriate instruments, to evaluate and inform rural-specific food environment initiatives [ 28 ].

During the period covered by this review, high level experts from the World Health Organization [ 135 ], the Lancet Commission [ 136 ], and the Food and Agricultural Organisation of the United Nations [ 137 ] have identified the potential benefits that initiatives located within food retail environments can provide in nudging dietary choices towards healthier options through instore food pricing and promotion, with the overall aim of improving population level diets [ 14 ]. Measures of food pricing, and the relative affordability of a healthy diet, are important to both inform and measure the effectiveness of such initiatives. However, few studies in our review explicitly aimed to inform initiatives or strategies, either at the community or policy level. Assessment of author-reported strengths and limitations of food pricing instruments and methodologies also identified a need for a universal instrument that reflects contextual geographic and socio-cultural information; is intended to be used repeatedly over time; and is adaptable to different country/cultural/contextual settings [ 17 , 23 ]. Future research would benefit from linking the purpose of undertaking food pricing data collection more explicitly to potential initiatives. Our review supports this call and suggests that the instrument selected should suit the context and collect longitudinal data to provide greater insights into the design and effectiveness of initiatives that make healthy food not only affordable but also available and accessible.

Strengths and Limitations

This systematic review provides a current and comprehensive overview of international food pricing studies across HIC. We acknowledge that while food prices are an important factor influencing food choice, it is only one component of the food environment; however, analysing instruments that assess food acceptability, availability, and accessibility was beyond the scope of this review. This review focused on HIC and a similar review on food pricing studies in low- and middle-income countries would be informative. This review may have missed additional relevant data as it only included English language studies and did not include grey literature or hand searching of reference lists.

Food security has come under heightened scrutiny given the food supply interruptions experienced worldwide during the COVID-19 pandemic. While studies providing a snapshot of food prices can be useful to identify areas impacted by rising food prices, much of this cross-sectional data is known. This review raises questions regarding the purpose of collecting food price data, and how this data can best be used to inform change through practice and policy strategies. We suggest that longitudinal studies using a consistent methodology, which acknowledges contextual nuances and demonstrates temporal changes in food pricing, are needed to inform and to evaluate community-based or legislative strategies to improve the relative affordability of a healthy diet.

Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1223–49.

Article   Google Scholar  

Australian Institute of Health and Welfare. Australia’s Health 2022: Burden of Disease. Canberra: AIHW; 2020.

Google Scholar  

Sloane DC, Diamant AL, Lewis LB, Yancey AK, Flynn G, Nascimento LM, Mc Carthy WJ, Guinyard JJ, Cousineau MR. Improving the nutritional resource environment for healthy living through community-based participatory research. J Gen Intern Med. 2003;18:568–75.

Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, Gortmaker SL. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378:804–14.

Darmon N, Drewnowski A. Does social class predict diet quality? Am J Clin Nutr. 2008;87:1107–17.

Article   CAS   Google Scholar  

Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Glob Health. 2016;4:e895–6.

Wilkinson RG, Marmot M. Social determinants of health: the solid facts, (World Health Organization). 2003.

Lee JH, Ralston RA, Truby H. Influence of food cost on diet quality and risk factors for chronic disease: a systematic review. Nutr Diet. 2011;68:248–61.

Love P, Whelan J, Bell C, Grainger F, Russell C, Lewis M, Lee A. Healthy diets in rural Victoria-cheaper than unhealthy alternatives, yet unaffordable. Int J Environ Res Public Health. 2018;15.

Whelan J, Millar L, Bell C, Russell C, Grainger F, Allender S, Love P. You can’t find healthy food in the bush: poor accessibility, availability and adequacy of food in rural Australia. Int J Environ Res Public Health. 2018;15:2316.

Pereira RF, Sidebottom AC, Boucher JL, Lindberg R, Werner R. Peer Reviewed: Assessing the Food Environment of a Rural Community: Baseline Findings From the Heart of New Ulm Project, Minnesota, 2010–2011. Prev Chronic Dis. 2014;11.

Vilaro MJ, Barnett TE. The rural food environment: a survey of food price, availability, and quality in a rural Florida community. Food Public Health. 2013;3:111–8.

Garasky S, Morton LW, Greder KA. The effects of the local food environment and social support on rural food insecurity. J Hunger Environ Nutr. 2006;1:83–103.

Swinburn B, Sacks G, Vandevijvere S, Kumanyika S, Lobstein T, Neal B, Barquera S, Friel S, Hawkes C, Kelly B. INFORMAS (I nternational N etwork for F ood and O besity/non-communicable diseases R esearch, M onitoring and A ction S upport): overview and key principles. Obes Rev. 2013;14:1–12.

Glanz K, Johnson L, Yaroch AL, Phillips M, Ayala GX, Davis EL. Measures of retail food store environments and sales: review and implications for healthy eating initiatives. J Nutr Educ Behav. 2016;48(280–288): e281.

Begemann F. Ecogeographic differentiation of bambarra groundnut (Vigna subterranea) in the collection of the International Institute of Tropical Agriculture (IITA, (Wissenschaftlicher Fachverlag). 1988.

Lee A, Mhurchu CN, Sacks G, Swinburn B, Snowdon W, Vandevijvere S, Hawkes C, L’Abbé M, Rayner M, Sanders D. Monitoring the price and affordability of foods and diets globally. Obes Rev. 2013;14:82–95.

Rao M, Afshin A, Singh G, Mozaffarian D. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open. 2013;3: e004277.

Palermo C, McCartan J, Kleve S, Sinha K, Shiell A. A longitudinal study of the cost of food in Victoria influenced by geography and nutritional quality. Aust N Z J Public Health. 2016;40:270–3.

Lee AJ, Kane S, Ramsey R, Good E, Dick M. Testing the price and affordability of healthy and current (unhealthy) diets and the potential impacts of policy change in Australia. BMC Public Health. 2016;16:1–22.

Clark P, Mendoza-Gutiérrez CF, Montiel-Ojeda D, Denova-Gutiérrez E, López-González D, Moreno-Altamirano L, Reyes A. A healthy diet is not more expensive than less healthy options: cost-analysis of different dietary patterns in Mexican children and adolescents. Nutrients. 2021;13:3871.

Burns C, Friel S. It’s time to determine the cost of a healthy diet in Australia. Aust N Z J Public Health. 2007;31:363–5.

Lewis M, Lee A. Costing ‘healthy’food baskets in Australia–a systematic review of food price and affordability monitoring tools, protocols and methods. Public Health Nutr. 2016;19:2872–86.

Moayyed H, Kelly B, Feng X, Flood V. Is living near healthier food stores associated with better food intake in regional Australia? Int J Environ Res Public Health. 2017;14:884.

Seal J. Monitoring the price and availability of healthy food–time for a national approach? Nutr Diet. 2004;61:197–200.

Moher D, Liberati A, Tetzlaff J, Altman D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.

Caspi CE, Sorensen G, Subramanian S, Kawachi I. The local food environment and diet: a systematic review. Health Place. 2012;18:1172–87.

Love P, Whelan J, Bell C, McCracken J. Measuring rural food environments for local action in Australia: a systematic critical synthesis review. Int J Environ Res Public Health. 2019;16:2416.

Covidence systematic review software. Volume 2022. (Melbourne, Australia: Veritas Health Innovation).

The Endnote Team. Endnote. Endnote. X9 ed. Philadelphia, PA: Clarivate; 2013.

Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11:589–97.

Aaron GJ, Keim NL, Drewnowski A, Townsend MS. Estimating dietary costs of low-income women in California: a comparison of 2 approaches. Am J Clin Nutr. 2013;97:835–41.

Andreyeva T, Blumenthal DM, Schwartz MB, Long MW, Brownell KD. Availability and prices of foods across stores and neighborhoods: the case of New Haven, Connecticut. Health affairs (Project Hope). 2008;27:1381–8.

Anekwe TD, Rahkovsky I. The association between food prices and the blood glucose level of US adults with type 2 diabetes. Am J Public Health. 2014;104:678–85.

Bernstein AM, Bloom DE, Rosner BA, Franz M, Willett WC. Relation of food cost to healthfulness of diet among US women. Am J Clin Nutr. 2010;92:1197–203.

Borja K, Dieringer S. Availability of affordable healthy food in Hillsborough County, Florida. J Public Aff (14723891). 2019;19. N.PAG-N.PAG.

Bronchetti ET, Christensen G, Hoynes HW. Local food prices, SNAP purchasing power, and child health. J Health Econ. 2019;68: 102231.

Buszkiewicz J, House C, Anju A, Long M, Drewnowski A, Otten JJ. The impact of a city-level minimum wage policy on supermarket food prices by food quality metrics: a two-year follow up study. Int J Environ Res Public Health. 2019;16:102.

Caspi CE, Pelletier JE, Harnack LJ, Erickson DJ, Lenk K, Laska MN. Pricing of staple foods at supermarkets versus small food stores. Int J Environ Res Public Health. 2017;14.

Christensen G, Bronchetti ET. Local food prices and the purchasing power of SNAP benefits. Food Policy. 2020;95. N.PAG-N.PAG.

Colabianchi N, Antonakos CL, Coulton CJ, Kaestner R, Lauria M, Porter DE. The role of the built environment, food prices and neighborhood poverty in fruit and vegetable consumption: an instrumental variable analysis of the moving to opportunity experiment. Health Place. 2021;67: 102491.

Cole S, Filomena S, Morland K. Analysis of fruit and vegetable cost and quality among racially segregated neighborhoods in Brooklyn. New York J Hunger Environ Nutr. 2010;5:202–15.

Connell CL, Zoellner JM, Yadrick MK, Chekuri SC, Crook LB, Bogle ML. Energy density, nutrient adequacy, and cost per serving can provide insight into food choices in the lower Mississippi Delta. J Nutr Educ Behav. 2012;44:148–53.

DiSantis KI, Grier SA, Oakes JM, Kumanyika SK. Food prices and food shopping decisions of black women. Appetite. 2014;77:106–14.

Fan L, Canales E, Fountain B, Buys D. An assessment of the food retail environment in counties with high obesity rates in Mississippi. J Hunger Environ Nutr. 2021;16:571–93.

Franzen L, Smith C. Food system access, shopping behavior, and influences on purchasing groceries in adult Hmong living in Minnesota. Am J Health Promot. 2010;24:396–409.

Ghosh-Dastidar B, Cohen D, Hunter G, Zenk SN, Huang C, Beckman R, Dubowitz T. Distance to store, food prices, and obesity in urban food deserts. Am J Prev Med. 2014;47:587–95.

Ghosh-Dastidar M, Hunter G, Collins RL, Zenk SN, Cummins S, Beckman R, Nugroho AK, Sloan JC, Wagner LV, Dubowitz T, et al. Does opening a supermarket in a food desert change the food environment? Health Place. 2017;46:249–56.

Greenberg JA, Luick B, Alfred JM, Barber LR Jr, Bersamin A, Coleman P, Esquivel M, Fleming T, Guerrero RTL, Hollyer J, et al. The affordability of a thrifty food plan-based market basket in the United States-affiliated Pacific Region. Hawaii J Med Public Health. 2020;79:217–23.

Hardin-Fanning F, Rayens MK. Food cost disparities in rural communities. Health Promot Pract. 2015;16:383–91.

Hardin-Fanning F, Wiggins AT. Food costs are higher in counties with poor health rankings. J Cardiovasc Nurs. 2017;32:93–8.

Hilbert N, Evans-Cowley J, Reece J, Rogers C, Ake W, Hoy C. Mapping the cost of a balanced diet, as a function of travel time and food price. Journal of Agriculture, Food Systems and Community Development. 2014;5:105–27.

Hillen J. Online food prices during the COVID-19 pandemic. Agribusiness (New York). 2021;37:91–107.

Jin H, Lu Y. Evaluating consumer nutrition environment in food deserts and food swamps. Int J Environ Res Public Health. 2021;18.

Karp RJ, Wong G, Orsi M. Demonstrating nutrient cost gradients: a Brooklyn case study. Int J Vitam Nutr Res. 2014;84:244–51.

Ko LK, Enzler C, Perry CK, Rodriguez E, Mariscal N, Linde S, Duggan C. Food availability and food access in rural agricultural communities: use of mixed methods. BMC Public Health. 2018;18. N.PAG-N.PAG.

Lee Smith M, Sunil TS, Salazar CI, Rafique S, Ory MG. Disparities of food availability and affordability within convenience stores in Bexar County. Texas J Environ Public Health. 2013;2013:1–7.

Lipsky LM. Are energy-dense foods really cheaper? Reexamining the relation between food price and energy density. Am J Clin Nutr. 2009;90:1397–401.

Martin KS, Ghosh D, Page M, Wolff M, McMinimee K, Zhang M. What role do local grocery stores play in urban food environments? A case study of Hartford-Connecticut. PLoS ONE. 2014;9: e94033.

Mayfield KE, Hession SL, Weatherspoon L, Hoerr SL. A cross-sectional analysis exploring differences between food availability, food price, food quality and store size and store location in Flint Michigan. J Hunger Environ Nutr. 2020;15:643–57.

Meyerhoefer CD, Leibtag ES. A spoonful of sugar helps the medicine go down: the relationship between food prices and medical expenditures on diabetes. Am J Agr Econ. 2010;92:1271–82.

Monsivais P, Drewnowski A. The rising cost of low-energy-density foods. J Am Diet Assoc. 2007;107:2071–6.

Monsivais P, McLain J, Drewnowski A. The rising disparity in the price of healthful foods: 2004–2008. Food Policy. 2010;35:514–20.

Monsivais P, Perrigue MM, Adams SL, Drewnowski A. Measuring diet cost at the individual level: a comparison of three methods. Eur J Clin Nutr. 2013;67:1220–5.

Nansel TR, Lipsky LM, Eisenberg MH, Liu A, Mehta SN, Laffel LMB. Can families eat better without spending more? Improving diet quality does not increase diet cost in a randomized clinical trial among youth with type 1 diabetes and their parents. J Acad Nutr Diet. 2016;116:1751.

Otten JJ, Buszkiewicz J, Tang W, Anju A, Long M, Vigdor J, Drewnowski A. The impact of a city-level minimum-wage policy on supermarket food prices in Seattle-King County. Int J Environ Res Public Health. 2017;14:1039.

Richards R, Smith C. Shelter environment and placement in community affects lifestyle factors among homeless families in Minnesota. Am J Health Promot. 2006;21:36–44.

Shen Y, Clarke P, Gomez-Lopez IN, Hill AB, Romero DM, Goodspeed R, Berrocal VJ, Vydiswaran VV, Veinot TC. Using social media to assess the consumer nutrition environment: comparing Yelp reviews with a direct observation audit instrument for grocery stores. Public Health Nutr. 2019;22:257–64.

Smith C, Butterfass J, Richards R. Environment influences food access and resulting shopping and dietary behaviors among homeless Minnesotans living in food deserts. Agric Hum Values. 2010;27:141–61.

Spoden AL, Buszkiewicz JH, Drewnowski A, Long MC, Otten JJ. Seattle’s minimum wage ordinance did not affect supermarket food prices by food processing category. Public Health Nutr. 2018;21:1762–70.

Stroebele-Benschop N, Wolf K, Palmer K, Kelley CJ, Jilcott Pitts SB. Comparison of food and beverage products’ availability, variety, price and quality in German and US supermarkets. Public Health Nutr. 2020;23:3387–93.

Townsend MS, Aaron GJ, Monsivais P, Keim NL, Drewnowski A. Less-energy-dense diets of low-income women in California are associated with higher energy-adjusted diet costs. Am J Clin Nutr. 2009;89:1220–6.

Wright L, Palak G, Yoshihara K. Accessibility and affordability of healthy foods in food deserts in Florida: policy and practice implications. Florida Public Health Review. 2018;15:98–103.

Yang Y, Leung P. Price premium or price discount for locally produced food products? A temporal analysis for Hawaii. J Asian Pac Econ. 2020;25:591–610.

Zenk SN, Grigsby-Toussaint DS, Curry SJ, Berbaum M, Schneider L. Short-term temporal stability in observed retail food characteristics. J Nutr Educ Behav. 2010;42:26–32.

Abreu MD, Charlton K, Probst Y, Li N, Crino M, Wu JHY. Nutrient profiling and food prices: what is the cost of choosing healthier products? J Hum Nutr Diet. 2019;32:432–42.

Ball K, Timperio A, Crawford D. Neighbourhood socioeconomic inequalities in food access and affordability. Health Place. 2009;15:578–85.

Brimblecombe J, Ferguson M, Liberato SC, O’Dea K, Riley M. Optimisation modelling to assess cost of dietary improvement in remote aboriginal Australia. PLoS ONE. 2013;8: e83587.

Chapman K, Innes-Hughes C, Goldsbury D, Kelly B, Bauman A, Allman-Farinelli M. A comparison of the cost of generic and branded food products in Australian supermarkets. Public Health Nutr. 2013;16:894–900.

Cuttler R, Evans R, McClusky E, Purser L, Klassen KM, Palermo C. An investigation of the cost of food in the Geelong region of rural Victoria: essential data to support planning to improve access to nutritious food. Health Promot J Austr. 2019;30:124–7.

Ferguson M, O’Dea K, Chatfield M, Moodie M, Altman J, Brimblecombe J. The comparative cost of food and beverages at remote Indigenous communities, Northern Territory, Australia. Aust N Z J Public Health. 2016;40(Suppl 1):S21–6.

Ferguson M, O’Dea K, Holden S, Miles E, Brimblecombe J. Food and beverage price discounts to improve health in remote Aboriginal communities: mixed method evaluation of a natural experiment. Aust N Z J Public Health. 2017;41:32–7.

Harrison MS, Coyne T, Lee AJ, Leonard D, Lowson S, Groos A, Ashton BA. The increasing cost of the basic foods required to promote health in Queensland. Med J Aust. 2007;186:9–14.

Kettings C, Sinclair AJ, Voevodin M. A healthy diet consistent with Australian health recommendations is too expensive for welfare-dependent families. Aust N Z J Public Health. 2009;33:566–72.

Lee A, Patay D, Herron L-M, Parnell Harrison E, Lewis M. Affordability of current, and healthy, more equitable, sustainable diets by area of socioeconomic disadvantage and remoteness in Queensland: insights into food choice. Int J Equity Health. 2021;20:1–17.

Lee AJ, Kane S, Herron L-M, Matsuyama M, Lewis M. A tale of two cities: the cost, price-differential and affordability of current and healthy diets in Sydney and Canberra, Australia. Int J Behav Nutr Phys Act. 2020;17:1–13.

Palermo CE, Walker KZ, Hill P, McDonald J. The cost of healthy food in rural Victoria. Rural Remote Health. 2008;8. (1 December 2008).

Pollard CM, Landrigan TJ, Ellies PL, Kerr DA, Lester MLU, Goodchild SE. Geographic factors as determinants of food security: a Western Australian food pricing and quality study. Asia Pac J Clin Nutr. 2014;23:703–13.

Tsang A, Ndung’u MW, Coveney J, O’Dwyer L. Adelaide Healthy Food Basket: a survey on food cost, availability and affordability in five local government areas in metropolitan Adelaide, South Australia. Nutr Diet. 2007;64:241–7.

Walton K, do Rosario V, Kucherik M, Frean P, Richardson K, Turner M, Mahoney J, Charlton K, Andre do Rosario V. Identifying trends over time in food affordability: the Illawarra Healthy Food Basket survey, 2011–2019. Health Promot J Austr. 2021;1–1.

Ward PR, Coveney J, Verity F, Carter P, Schilling M. Cost and affordability of healthy food in rural South Australia. Rural Remote Health 2012;12. Article No. 1938.

Wong K, Coveney J, Ward P, Muller R, Carter P, Verity F, Tsourtos G. Availability, affordability and quality of a healthy food basket in Adelaide, South Australia. Nutr Diet. 2011;68:8–14.

Burns C, Sacks G, Gold L. Longitudinal study of Consumer Price Index (CPI) trends in core and non-core foods in Australia. Aust N Z J Public Health. 2008;32:450–3.

Zorbas C, Lee A, Peeters A, Lewis M, Landrigan T, Backholer K. Streamlined data-gathering techniques to estimate the price and affordability of healthy and unhealthy diets under different pricing scenarios. Public Health Nutr. 2021;24:1–11.

Conklin AI, Monsivais P, Khaw K, Wareham NJ, Forouhi NG. Dietary diversity, diet cost, and incidence of type 2 diabetes in the United Kingdom: a prospective cohort study. PLoS Med. 2016;13: e1002085.

Jones NRV, Tong TYN, Monsivais P. Meeting UK dietary recommendations is associated with higher estimated consumer food costs: an analysis using the National Diet and Nutrition Survey and consumer expenditure data, 2008–2012. Public Health Nutr. 2018;21:948–56.

Lan H, Lloyd T, Morgan W, Dobson PW. Are food price promotions predictable? The hazard function of supermarket discounts. J Agric Econ. 2021;1.

Mackenbach JD, Burgoine T, Lakerveld J, Forouhi NG, Griffin SJ, Wareham NJ, Monsivais P. Accessibility and affordability of supermarkets: associations with the DASH diet. Am J Prev Med. 2017;53:55–62.

Monsivais P, Scarborough P, Lloyd T, Mizdrak A, Luben R, Mulligan AA, Wareham NJ, Woodcock J. Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom. Am J Clin Nutr. 2015;102:138–45.

Timmins KA, Hulme C, Cade JE. The monetary value of diets consumed by British adults: an exploration into sociodemographic differences in individual-level diet costs. Public Health Nutr. 2015;18:151–9.

Timmins KA, Morris MA, Hulme C, Edwards KL, Clarke GP, Cade JE. Comparability of methods assigning monetary costs to diets: derivation from household till receipts versus cost database estimation using 4-day food diaries. Eur J Clin Nutr. 2013;67:1072–6.

Vogel C, Abbott G, Ntani G, Barker M, Cooper C, Moon G, Ball K, Baird J. Examination of how food environment and psychological factors interact in their relationship with dietary behaviours: test of a cross-sectional model. Int J Behav Nutr Phys Act. 2019;16. N.PAG-N.PAG.

Kenny T-A, Fillion M, MacLean J, Wesche SD, Chan HM. Calories are cheap, nutrients are expensive – the challenge of healthy living in Arctic communities. Food Policy. 2018;80:39–54.

Latham J, Moffat T. Determinants of variation in food cost and availability in two socioeconomically contrasting neighbourhoods of Hamilton, Ontario, Canada. Health Place. 2007;13:273–87.

Lear SA, Gasevic D, Schuurman N. Association of supermarket characteristics with the body mass index of their shoppers. Nutr J. 2013;12. (13 August 2013).

Mah CL. Taylor N. Store patterns of availability and price of food and beverage products across a rural region of Newfoundland and Labrador. Canadian journal of public health = Revue canadienne de sante publique. 2020;111:247–256.

Minaker LM, Raine KD, Wild TC, Nykiforuk CIJ, Thompson ME, Frank LD. Objective food environments and health outcomes. Am J Prev Med. 2013;45:289–96.

Minaker LM, Raine KD, Wild TC, Nykiforuk CIJ, Thompson ME, Frank LD. Construct validation of 4 food-environment assessment methods: adapting a multitrait-multimethod matrix approach for environmental measures. Am J Epidemiol. 2014;179:519–28.

Pakseresht M, Lang R, Rittmueller S, Roache C, Sheehy T, Batal M, Corriveau A, Sangita S. Food expenditure patterns in the Canadian Arctic show cause for concern for obesity and chronic disease. Int J Behav Nutr Phys Act. 2014;11. (17 April 2014).

Mackay S, Buch T, Vandevijvere S, Goodwin R, Korohina E, Funaki-Tahifote M, Lee A, Swinburn B. Cost and affordability of diets modelled on current eating patterns and on dietary guidelines, for New Zealand total population, Māori and Pacific households. Int J Environ Res Public Health. 2018;15.

Mackay S, Vandevijvere S, Lee A. Ten-year trends in the price differential between healthier and less healthy foods in New Zealand. Nutrition & dietetics: the journal of the Dietitians Association of Australia. 2019;76:271–6.

Vandevijvere S, Young N, Mackay S, Swinburn B, Gahegan M. Modelling the cost differential between healthy and current diets: the New Zealand case study. Int J Behav Nutr Phys Act. 2018;15:1–1.

Wilson N, Nghiem N, Mhurchu CN, Eyles H, Baker MG, Blakely T. Foods and dietary patterns that are healthy, low-cost, and environmentally sustainable: a case study of optimization modeling for New Zealand. PLoS ONE. 2013;8: e59648.

Alexy U, Bolzenius K, Köpper A, Clausen K, Kersting M. Diet costs and energy density in the diet of German children and adolescents. Eur J Clin Nutr. 2012;66:1362–3.

Stroebele N, Dietze P, Tinnemann P, Willich SN. Assessing the variety and pricing of selected foods in socioeconomically disparate districts of Berlin, Germany. J Public Health. 2011;19:23–8.

Albuquerque G, Moreira P, Rosário R, Araújo A, Teixeira VH, Lopes O, Moreira A, Padrão P. Adherence to the Mediterranean diet in children: Is it associated with economic cost? Porto biomedical journal. 2017;2:115–9.

Alves R, Lopes C, Rodrigues S, Perelman J. Adhering to a Mediterranean diet in a Mediterranean country: an excess cost for families? Br J Nutr. 2021;1–24.

Faria AP, Albuquerque G, Moreira P, Rosário R, Araújo A, Teixeira V, Barros R, Lopes Ó, Moreira A, Padrão P. Association between energy density and diet cost in children. Porto Biomed J. 2016;1:106–11.

Mackenbach JD, Dijkstra SC, Beulens JWJ, Seidell JC, Snijder MB, Stronks K, Monsivais P, Nicolaou M. Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study. Nutr J. 2019;18. N.PAG-N.PAG.

Waterlander WE, de Haas WE, van Amstel I, Schuit AJ, Twisk JWR, Visser M, Seidell JC, Steenhuis IHM. Energy density, energy costs and income - how are they related? Public Health Nutr. 2010;13:1599–608.

Rydén P, Mattsson Sydner Y, Hagfors L. Counting the cost of healthy eating: a Swedish comparison of Mediterranean-style and ordinary diets. Int J Consum Stud. 2008;32:138–46.

Rydén PJ, Hagfors L. Diet cost, diet quality and socio-economic position: how are they related and what contributes to differences in diet costs? Public Health Nutr. 2011;14:1680–92.

Keiko S, Kentaro M, Hitomi O, Livingstone MBE, Satomi K, Hitomi S, Satoshi S. Nutritional correlates of monetary diet cost in young, middle-aged and older Japanese women. J Nutr Sci. 2017;6:1–11.

Bolarić M, Šatalić Z. The relation between food price, energy density and diet quality. Croatian Journal of Food Science and Technology. 2013;5:39–45.

Parlesak A, Tetens I, Jensen JD, Smed S, Blenkuš MG, Rayner M, Darmon N, Robertson A. Use of linear programming to develop cost-minimized nutritionally adequate health promoting food baskets. PLoS ONE. 2016;11: e0163411.

Marty L, Dubois C, Gaubard MS, Maidon A, Lesturgeon A, Gaigi H, Darmon N. Higher nutritional quality at no additional cost among low-income households: insights from food purchases of “positive deviants.” Am J Clin Nutr. 2015;102:190–8.

Ng SW, Slining MM, Popkin BM. Turning point for US diets? Recessionary effects or behavioral shifts in foods purchased and consumed. Am J Clin Nutr. 2014;99:609–16.

Lee AJ, Kane S, Lewis M, Good E, Pollard CM, Landrigan TJ, Dick M. Healthy diets ASAP–Australian standardised affordability and pricing methods protocol. Nutr J. 2018;17:1–14.

Lee A, Lewis M. Testing the price of healthy and current diets in remote Aboriginal communities to improve food security: development of the Aboriginal and Torres Strait Islander Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods. Int J Environ Res Public Health. 2018;15:2912.

Ferguson M, O’Dea K, Chatfield M, Moodie M, Altman J, Brimblecombe J. The comparative cost of food and beverages at remote Indigenous communities, Northern Territory, Australia. Aust N Z J Public Health. 2016;40:S21–6.

Zorbas C, Gilham B, Boelsen-Robinson T, Blake MR, Peeters A, Cameron AJ, Wu JH, Backholer K. The frequency and magnitude of price-promoted beverages available for sale in Australian supermarkets. Aust N Z J Public Health. 2019;43:346–51.

Bourke L, Humphreys JS, Wakerman J, Taylor J. Understanding rural and remote health: a framework for analysis in Australia. Health Place. 2012;18:496–503.

Alston LV, Bolton KA, Whelan J, Reeve E, Shee AW, Browne J, Walker T, Versace VL, Allender S, Nichols M. Retail initiatives to improve the healthiness of food environments in rural, regional and remote communities. Med J Aust. 2020;213:S5.

Cafer AM, Kaiser ML. An analysis of differences in predictors of food affordability between rural and urban counties. J Poverty. 2016;20:34–55.

Drysdale C, Sykes E, Honeysett C. WHO urges governments to promote healthy food in public facilities. 2021;2022.

Willet W. Summary report of the EAT-Lancet Commission on healthy diets from sustainable food systems. E.-L. Commission, ed. (Eat-Lancet Commission ). 2019.

Food and Organization A. The State of Food Security and Nutrition in the World 2021. (Food and Agriculture Organization Rome). 2021.

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Open Access funding enabled and organized by CAUL and its Member Institutions CR is supported by an Australian Government Research Training Scholarship. This funder had no involvement in any aspect of the study. JW is funded by a Deakin University Dean’s Postdoctoral Research Fellowship. JW is also supported by the National Health and Medical Research Council (NHMRC) funded Centre of Research Excellence in Food Retail Environments for Health (RE-FRESH) (APP1152968). The opinions, analysis, and conclusions in this paper are those of the authors and should not be attributed to the NHMRC.

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Russell, C., Whelan, J. & Love, P. Assessing the Cost of Healthy and Unhealthy Diets: A Systematic Review of Methods. Curr Nutr Rep 11 , 600–617 (2022). https://doi.org/10.1007/s13668-022-00428-x

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ORIGINAL RESEARCH article

Association between composite dietary antioxidant index and metabolic dysfunction associated steatotic liver disease: result from nhanes, 2017-2020.

Zhaofu Zhang

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The development of metabolic dysfunction associated steatotic liver disease (MASLD) has been associated with lipid accumulation, oxidative stress, endoplasmic reticulum stress, and lipotoxicity. The Composite Dietary Antioxidant Index (CDAI) is a comprehensive score representing an individual intake of various dietary antioxidants, including vitamin A, vitamin C, vitamin E, selenium, zinc, and carotenoids. This study investigated the association between CDAI and MASLD.Clinical and demographic data, as well as ultrasound transient elastography measurements at baseline, were collected from the National Health and Nutrition Examination Survey 2017-2020 (NHANES 2017(NHANES -2020)). The controlled attenuation parameter was utilized to diagnose the presence of hepatic steatosis and to categorize individuals into those with and without MASLD. Liver stiffness was measured by ultrasound transient elastography, and subjects were classified as those with and without advanced liver fibrosis.Results: This study included 5,884 adults, of whom 3,433 were diagnosed with MASLD, resulting in a weighted prevalence of 57.3%. After adjusting for covariates, the odds ratios for MASLD were 0.96 (95% CI: 0.82, 1.12) in the second quartile, 0.80 (95% CI: 0.68, 0.95) in the third quartile and 0.60 (95% CI: 0.49, 0.73) in the fourth quartile, respectively. CDAI, however, was not significantly associated with advanced liver fibrosis.These findings suggested that scores on the CDAI were linearly and negatively associated with the prevalence of MASLD in the United States adults.

Keywords: Metabolic dysfunction associated steatotic liver disease1, Composite dietary antioxidant index2, Oxidative Stress3, liver stiffness4, Restricted cubic spline5

Received: 05 Apr 2024; Accepted: 11 Jul 2024.

Copyright: © 2024 Zhang, Wang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Youpeng Chen, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China

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If you’re looking to freshen up your food habits, summer is the season to do it. Farmers’ markets are overflowing. Backyard grills are firing. Picnic blankets are unfurling. And school pickups have slowed to a halt, giving us more time to cook and enjoy relaxed outdoor meals with friends.

Whatever your food goals, you’re bound to find at least a few morsels of wisdom in some of our favorite nutrition articles of 2024 — whether it’s learning to take the latest TikTok health hack with a grain of salt, or actually cutting back on salt.

Here are 10 important nutrition takeaways from the year, so far.

1. A Mediterranean eating pattern may be worth a try.

There’s a reason the Mediterranean diet is so beloved by nutrition experts: Decades of research have linked it to various health benefits, including reduced risks of cardiovascular disease, Type 2 diabetes, cognitive decline and certain types of cancer. And best of all, it’s not a “diet” in the colloquial sense: There’s no counting calories or cutting out foods.

If you’re interested in adopting this way of eating — which focuses on whole grains , fruits and vegetables , legumes , nuts and seeds , and healthy fats — check out the guide we created with our colleagues at NYT Cooking.

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A few decades ago, it was commonly understood that a daily glass or two of red wine was good for your heart. It was an appealing idea that was backed by research at the time. But the science has since changed , experts say, and the latest evidence suggests that the risks of drinking alcohol — including red wine — outweigh any potential benefits.

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