Table 3. Estimated cardiometabolic deaths averted associated with F&V provision and SSB restriction in US schools1.
| 25% of dietary change sustained | 35% of dietary change sustained | 50% of dietary change sustained | |||||
|---|---|---|---|---|---|---|---|
| Current deaths, 20122 | No. of deaths averted per year (95% UI) | Proportion (%) of deaths averted per year (95% UI) |
No. of deaths averted per year (95% UI) | Proportion (%) of deaths averted per year (95% UI) | No. deaths averted per year (95% UI) | Proportion (%) deaths averted per year (95% UI) |
|
| Fruit | |||||||
| CHD | 371266 | 2262 (1810, 2779) |
0.6 (0.5, 0.7) |
3154 (2525, 3874) |
0.8 (0.7, 1.0) |
4479 (3587, 5499) |
1.2 (1.0, 1.5) |
| Stroke | 128294 | 3105 (2732, 3534) |
2.4 (2.1, 2.8) |
4309 (3793, 4903) |
3.4 (3.0, 3.8) |
6074 (5351, 6913) |
4.7 (4.2, 5.4) |
| Total CVD | 634394 | 5362 (4756, 6063) |
0.8 (0.7, 1.0) |
7457 (6615, 8428) |
1.2 (1.0, 1.3) |
10547 (9359, 11910) |
1.5 (1.3, 1.7) |
| Vegetables | |||||||
| CHD | 371266 | 316 (212, 437) |
0.1 (0.1, 0.1) |
443 (297, 612) |
0.1 (0.1, 0.2) |
632 (423, 874) |
0.2 (0.1, 0.2) |
| Stroke | 128294 | 385 (288, 510) |
0.3 (0.2, 0.4) |
539 (403, 714) |
0.4 (0.3, 0.6) |
768 (575, 1018) |
0.6 (0.4, 0.8) |
| Total CVD | 634394 | 702 (565, 870) |
0.1 (0.1, 0.1) |
983 (790, 1217) |
0.2 (0.1, 0.2) |
1402 (1128, 1736) |
0.2 (0.2, 0.2) |
| SSBs | |||||||
| CHD | 371266 | 9046 (6708, 11624) |
2.4 (1.8, 3.1) |
11121 (7463, 14328) |
3.0 (2.0, 3.9) |
11111 (6905, 15702) |
3.0 (1.9, 4.2) |
| Stroke | 128294 | 227 (187, 270) |
0.2 (0.1, 0.2) |
306 (253, 368) |
0.2 (0.2, 0.3) |
372 (295, 451) |
0.3 (0.2, 0.4) |
| Diabetes | 67914 | 2013 (1605, 2443) |
3.0 (2.4, 3.6) |
2514 (1904, 3088) |
3.7 (2.8, 4.5) |
2730 (2024, 3488) |
4.0 (3.0, 5.1) |
| Total CMD | 702308 | 11424 (9057, 14066) |
1.6 (1.3, 2.0) |
14132 (10453, 17365) |
2.0 (1.5, 2.5) |
14467 (10297, 19110) |
2.1 (1.5, 2.7) |
| Joint effects3 | |||||||
| CHD | 371266 | 11561 (9158, 14074) |
3.1 (2.5, 3.8) |
14601 (11128, 17949) |
3.9 (3.0, 4.8) |
16110 (11674, 20525) |
4.3 (3.1, 5.5) |
| Stroke | 128294 | 3696 (3321, 4143) |
2.9 (2.6, 3.2) |
5121 (4598, 5739) |
4.0 (3.6, 4.5) |
7155 (6415, 8044) |
5.6 (5.0, 6.3) |
| Diabetes | 67914 | 2013 (1605, 2443) |
3.0 (2.4, 3.6) |
2514 (1904, 3088) |
3.7 (2.8, 4.5) |
2730 (2024, 3488) |
4.0 (3.0, 5.1) |
| Total CMD | 702308 | 17390 (14978, 19975) |
2.5 (2.1, 2.8) |
22383 (18735, 25930) |
3.2 (2.7, 3.7) |
26210 (21741, 30818) |
3.7 (3.1, 4.4) |
Abbreviations: SSBs, sugar-sweetened beverage; F&V, fruit and vegetable; UI, uncertainty interval; CMD, cardiometabolic disease; HD, heart disease; CVD, cardiovascular disease; CHD, coronary heart disease
1 Estimated using a comparative risk assessment model. We assumed that the current US adult population had been exposed to these school environment policies during childhood from elementary school through high school. Our model also assumed that effects of school food environment interventions on diet would be additive across levels of schooling (elementary, middle, and high school) if current US adults had been exposed to these policies throughout childhood. In addition, we modeled 35% of dietary changes in childhood being sustained into adulthood, based on evidence in a systematic review on within-individual correlations of dietary habits in childhood and adulthood. In sensitivity analyses, we considered smaller (25%) and larger (50%) sustained changes in adulthood. The effects of dietary changes in adulthood on CMD mortality were obtained from meta-analyses of cohort studies, with updated relative risks and 95% CIs from our work in the 2010 Global Burden of Diseases Study. Point estimates and 95% uncertainty intervals were derived from probabilistic sensitivity analysis using 1000 Monte Carlo simulations.
2 Data on current CMD (ischemic heart disease, hypertensive heart disease, ischemic stroke, hemorrhagic and other non-ischemic stroke, and diabetes mellitus) deaths by age and sex derived from the National Center of Health Statistics, including a total of 702,308 CMD deaths in 2012.
3 Based on multiplicative attributable fractions for joint effects of changes in fruits, vegetables, and SSBs combined.