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(2) ADULT
LIFESTYLE INFLUENCES RISK OF
CARDIOVASCULAR
DISEASE MORE THAN
CHILDHOOD FACTORS
(3) NO
LINK BETWEEN ULTRASOUND AND RISK OF
CHILDHOOD LEUKAEMIA
(1) SHOULD V.A.T.
BE ADDED TO FATTY FOODS IN A
BID TO TACKLE HEART DISEASE?
(Exploring a fiscal food policy:
the case of diet and ischaemic
heart disease)
http://www.bmj.com/cgi/content/full/320/7230/301
Extending value added tax (VAT) to foodstuffs
which are
high in saturated fat, could save between
900 and 1000
premature deaths a year in the UK, suggests
Dr Tom
Marshall from the University of Birmingham
in this week's
BMJ.
In his education and debate article Marshall
considers the
impact that diet has on cholesterol concentrations
in the UK
population (which in turn determines the
prevalence of
ischaemic heart disease). He says that
cholesterol
concentrations are largely down to the
proportion of dietary
energy derived from saturated or polyunsaturated
fats and by
dietary intake of cholesterol and that
if this were reduced then
there would be a fall in the number of
people suffering from
ischaemic heart disease.
Marshall identifies the main sources of
saturated fat in the
British diet as whole (full fat) milk,
cheese, butter, biscuits,
buns, cakes, pastries, puddings and icecream.
He says that
currently, the pricing of foodstuffs encourages
the purchase
and consumption of a cholesterol raising
diet, particularly
among people who have a tight food budget.
At the moment,
most foodstuffs are exempt from VAT, states
the author.
However, if VAT were to be extended to
the principal
sources of dietary saturated fat, while
exempting cholesterol
neutral foods, he suggests that the public
would purchase the
cheaper, lower fat alternatives. He believes
that this would
have the greatest effect among lower income
groups who
tend to be more price sensitive and are
at greatest risk of
ischaemic heart disease from poor diet.
[The author
extensively explains the concept of price
elasticity in his
paper.]
The author says that the concept he proposes
is similar to the
"polluter pays" principle of making leaded
fuel more
expensive than unleaded. The additional
tax revenue
generated through such an initiative could
be used to finance
compensatory measures to raise the income
of low income
groups, suggests Marshall as these groups
will inevitably end
up paying more for their food bills under
such a system (just
as by raising the duty on tobacco the
group that bears the tax
burden is in the low income bracket).
The overall effect on
government finances would therefore be
neutral, he says.
The author concludes that if we are serious
about improving
nutrition a fiscal food policy is "worth
exploring".
"Interdisciplinary collaboration is needed
between
econometricians and nutritionists to investigate
- the effects of
price changes on the purchase of foodstuffs,"
he says.
In an accompanying commentary Dr Eileen
Kennedy and Dr
Susan Offutt from the US Department of
Agriculture write
that Marshall's concept is intriguing,
but they raise doubts as
to how successful such an approach would
be. Firstly, the
relation of diet and disease hinges on
an individual's genetic
make-up which is not accounted for in
Marshall's hypothesis.
Secondly, Kennedy and Offutt highlight
recent research
suggesting that the substitution of lower
fat foods (such as
skimmed milk for full fat milk) simply
results in an
approximate doubling of the quantity of
the lower fat
alternative consumed, in order that energy
levels are
maintained in the diet.
Kennedy and Offutt also question Marshall's
statement that
there is a sizeable difference in the
diets of the rich and poor -
they say that in the United States at
least, this is not true.
They also argue that price sensitivity
to the main sources of
dietary fat is not as great as Marshall
has suggested and
therefore an extension of value added
tax would lead to
smaller decreases in quantities consumed.
The authors of the commentary conclude
that a better
alternative to extending VAT would be
to introduce
foodstuffs which help to reduce cholesterol
but that do not
require a change in consumer dietary behaviour.
Contact:
Dr Tom Marshall, Honorary Clinical Lecturer,
Department of
Public Health and Epidemiology, University
of Birmingham,
Birmingham
Email: marshatp@hsrc1.bham.ac.uk
Dr Eileen Kennedy, Deputy Under Secretary,
Office of
Research, Education and Economics, US
Department of
Agriculture, Washington
Email: eileen.kennedy@usda.gov
(2) ADULT LIFESTYLE
INFLUENCES RISK OF
CARDIOVASCULAR DISEASE MORE THAN
CHILDHOOD FACTORS
(Risk of cardiovascular disease measured
by carotid
intima-media thickness at age 49-51:
lifecourse study)
http://www.bmj.com/cgi/content/full/320/7230/273
Contrary to many previous studies, early
life factors, such as
birth weight and socioeconomic position
in childhood, are not
important predictors of the risk of cardiovascular
disease in
middle age, say researchers from the University
of Newcastle
in this week's BMJ.. In fact adult lifestyles
are more
important than early life experiences
in determining the risk of
cardiovascular disease, say the authors.
Dr Douglas Lamont and colleagues studied
154 men and 193
women who were born in 1947 (at who had
been part of the
Newcastle "Thousand Families" study established
during that
year). The research team ascertained the
risk of
cardiovascular disease in the study group
between October
1996 and December 1998 (aged 49 - 51 years),
by
measuring the thickness of the walls of
their carotid arteries
[the thicker the artery wall the greater
the risk of
cardiovascular disease].
Lamont et al then evaluated these measurements
in the
context of early life experiences (socioeconomic
circumstances; adverse life events; illnesses;
birth weight and
growth) and adult socioeconomic position
and lifestyle
(number of cigarettes smoked; alcohol
consumption; diet and
physical activity). They found that adult
lifestyle and biological
risk markers measured in adulthood (such
as obesity and high
blood pressure) had a greater effect on
the thickness of the
carotid artery walls in middle age and
therefore the risk of
cardiovascular disease, than early life
experiences.
The authors conclude that even though it
is clearly important
to promote good maternal and child health
and to reduce
socioeconomic deprivation in childhood,
to decrease the risk
of cardiovascular disease in middle age
the main focus of
intervention should be on trying to alter
adult lifestyles.
Contact:
Dr Douglas Lamont, Senior Research Associate
in
Epidemiology, Department of Child Health,
University of
Newcastle, Sir James Spence Institute
of Child Health, Royal
Victoria Infirmary, Newcastle upon Tyne
Email: d.w.lamont@ncl.ac.uk
Or
Professor Alan Craft, Professor of Child
Health, Department
of Child Health, University of Newcastle,
Sir James Spence
Institute of Child Health, Royal Victoria
Infirmary, Newcastle
upon Tyne
Email: a.w.craft@ncl.ac.uk
(3) NO LINK BETWEEN
ULTRASOUND AND RISK OF
CHILDHOOD LEUKAEMIA
(Prenatal ultrasound examinations
and risk of childhood
leukaemia: case-control study)
http://www.bmj.com/cgi/content/full/320/7230/282
Reassuring research conducted by a team
in Sweden and
published in this week's BMJ finds no
association between
prenatal exposure to ultrasound and childhood
leukaemias.
Dr Estelle Naumburg and colleagues from
Uppsala University
and the Karolinska Institute say that
previously there have
been concerns over a possible association
between exposure
to ultrasound in utero and an increased
risk of childhood
malignancies. But they have not been substantiated,
say the
authors and so they set out to establish
whether there was
any evidence to suggest a link.
In their nationwide study Naumburg et al
found similar rates
of leukaemia in children who had and in
those who had not
been exposed ultrasound scanning. Based
on their findings
they conclude that there is no evidence
to suggest that single
or repeated exposure to ultrasound, early
or late in
pregnancy, influences the risk of subsequent
development of
childhood leukaemia.
Contact:
Dr Estelle Naumburg, Paediatrician, Department
of
Women's Health, Section for Paediatrics,
Uppsala
University, Sweden
Email: Estelle.Naumburg@pediatrik.uu.se
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