Background Diet is an important risk factor for cancer that is amenable to intervention. Estimating the cancer burden associated with diet informs evidence-based priorities for nutrition policies to reduce cancer burden in the United States. Methods Using a comparative risk assessment model that incorporated nationally representative data on dietary intake, national cancer incidence, and estimated associations of diet with cancer risk from meta-analyses of prospective cohort studies, we estimated the annual number and proportion of new cancer cases attributable to suboptimal intakes of seven dietary factors among US adults ages 20 years or older, and by population subgroups. Results An estimated 80 110 (95% uncertainty interval [UI] = 76 316 to 83 657) new cancer cases were attributable to suboptimal diet, accounting for 5.2% (95% UI = 5.0% to 5.5%) of all new cancer cases in 2015. Of these, 67 488 (95% UI = 63 583 to 70 978) and 4.4% (95% UI = 4.2% to 4.6%) were attributable to direct associations and 12 589 (95% UI = 12 156 to 13 038) and 0.82% (95% UI = 0.79% to 0.85%) to obesity-mediated associations. By cancer type, colorectal cancer had the highest number and proportion of diet-related cases (n = 52 225, 38.3%). By diet, low consumption of whole grains (n = 27 763, 1.8%) and dairy products (n = 17 692, 1.2%) and high intake of processed meats (n = 14 524, 1.0%) contributed to the highest burden. Men, middle-aged (45–64 years) and racial/ethnic minorities (non-Hispanic blacks, Hispanics, and others) had the highest proportion of diet-associated cancer burden than other age, sex, and race/ethnicity groups. Conclusions More than 80 000 new cancer cases are estimated to be associated with suboptimal diet among US adults in 2015, with middle-aged men and racial/ethnic minorities experiencing the largest proportion of diet-associated cancer burden in the United States.

High‐profile international evidence reviews by the World Health Organization, the World Cancer Research Fund, the American Institute for Cancer Research, and the American Cancer Society concluded that processed meat consumption increases the risk of cancer. The red meat and processed meat industries are influential in the United States and in several other nations. The US federal government supports public‐private partnerships for commodity meat promotion and advertising. Four potential policy options to affect consumption of processed meat are taxation, reduced processed meat quantities in school meal standards, public service announcements, and warning labels. Feasibility of these options would be enhanced by an explicit and science‐based statement on processed meat in the 2020‐2025 Dietary Guidelines for Americans. Context The World Health Organization, the World Cancer Research Fund, and the American Cancer Society have each in recent years concluded that processed meats are probable carcinogens. The 2015‐2020 Dietary Guidelines for Americans did not separately evaluate health effects of processed meat, although it mentioned lower processed meat intakes among characteristics of healthy diets. Methods We summarized the international scientific literature on meat intake and cancer risk; described the scientific and political processes behind the periodic Dietary Guidelines for Americans; described the US red meat and processed meat industries and the economic structure of government‐supported industry initiatives for advertising and promotion; and reviewed and analyzed specific factors and precedents that influence the feasibility of four potential policy approaches to reduce processed meat intake. Findings Based on a review of 800 epidemiological studies, the World Health Organization found sufficient evidence in humans that processed meat is carcinogenic, estimating that each 50‐gram increase in daily intake increases the risk of colorectal cancer by 18%. Among the four policy responses we studied, legal feasibility is highest in the US for three policy options: reducing processed meat in school meals and other specific government‐sponsored nutrition programs; a local, state, or federal tax on processed meat; and public service announcements on health harms of processed meats by either the government or private sector entities. Legal feasibility is moderate for a fourth policy option, mandatory warning labels, due to outstanding legal questions about the minimum evidence required to support this policy. Political feasibility is influenced by the economic and political power of the meat industries and also depends on decisions in the next round of the Dietary Guidelines for Americans about how to assess and describe the link between processed meat consumption and cancer risk. Conclusions Public policy initiatives to reduce processed meat intake have a strong scientific and public health justification and are legally feasible, but political feasibility is influenced by the economic and political power of meat...

No abstract

Objective: Using a legal standard for scrutinising the regulation of food label claims, this study assessed whether consumers are misled about wholegrain (WG) content and product healthfulness based on common product labels. Design: First, a discrete choice experiment used pairs of hypothetical products with different amounts of WG, sugar and salt to measure effects on assessment of healthfulness; and second, a WG content comprehension assessment used actual product labels to assess respondent understanding. Setting: Online national panel survey. Participants: For a representative sample of US adults (n 1030), survey responses were collected in 2018 and analysed in 2019. Results: First, 29–47 % of respondents incorrectly identified the healthier product from paired options, and respondents who self-identified as having difficulty in understanding labels were more likely to err. Second, for actual products composed primarily of refined grains, 43–51 % of respondents overstated the WG content, whereas for one product composed primarily of WG, 17 % of respondents understated the WG content. Conclusions: The frequency of consumer misunderstanding of grain product labels was high in both study components. Potential policies to address consumer confusion include requiring disclosure of WG content as a percentage of total grain content or requiring disclosure of the grams of WG v. refined grains per serving.

No abstract

Objectives. To assess stakeholder perceptions of the impact and feasibility of 21 national, state, and local nutrition policies for cancer prevention across 5 domains in the United States. Methods. We conducted an online survey from October through December 2018. Participants were invited to take the survey via direct e-mail contact or an organizational e-newsletter. Results. Federal or state Medicare/Medicaid coverage of nutrition counseling and federal or state subsidies on fruits, vegetables, and whole grains for participants in the Supplemental Nutrition Assistance Program were the policies rated as having the highest perceived impact and feasibility. Overall, the 170 respondents rated policy impact higher than policy feasibility. Polices at the federal or state level had a higher perceived impact, whereas local policies had higher perceived feasibility. Conclusions. Our findings might guide future research and advocacy that can ultimately motivate and target policy actions to reduce cancer burdens and disparities in the United States.

Objectives Processed meat is associated with increased risk of colorectal and stomach cancer, but health and economic impacts of policies to discourage processed meat consumption are not well-established. This paper aims to estimate cancer outcomes, costs, and cost-effectiveness of implementing two population-level policies on processed meat: 1) 10% excise tax and 2) mandatory warning label. Methods We developed a probabilistic cohort-state transition model, including short-term and lifetime horizon, US healthcare and societal perspective, and 3% annual discount rates for costs and health outcomes. Our model simulated 32 subgroups by age, gender, and race/ethnicity from the US adult population and integrated nationally representative 2011–2014 data on processed meat consumption with etiologic effects of processed meat on cancer incidence, medical and indirect societal costs, and policy costs. Data sources for input parameters included NHANES, US Cancer Statistics, meta-analyses, and other published literature. Main outcomes were cancer incidence, quality-adjusted life-years (QALYs), policy and healthcare costs, productivity benefits, incremental cost-effectiveness ratios. Results Over a lifetime, the 10% excise tax would prevent 77,000 colorectal (95% uncertainty interval: 56,800–114,000) and 12,400 stomach (6860–24,700) cancer cases, add 591,000 (418,000–856,000) QALYs, and generate net savings of $20.5B from healthcare and $23.4B from societal perspectives. The warning label policy would avert 84,500 (56,800–141,000) and 14,700 (6880–34,500) colorectal and stomach cancer cases and add 648,000 (416,000–1080,000) QALYs with net savings of $24.1B from healthcare and $27.3B from societal perspectives. In sensitivity analyses, greater health and economic benefits accrued to 1) younger populations, 2) subpopulations with greater cancer risk, and 3) those with higher baseline processed meat consumption. Conclusions Our model shows that implementing an excise tax or warning label on processed meats would be a cost-saving strategy with substantial health and economic benefits. Our findings will encourage policymakers to consider nutrition-related policies to reduce cancer burden. Funding Sources NIH/NIMHD. Supporting Tables, Images and/or Graphs

Consumer confusion about wholegrain content and healthfulness in product labels: reply Madam We are glad to respond to the recent letter expressing interest in our research on consumer confusion about wholegrain (WG) content and healthfulness (1). The letter said, 'we noticed several inconsistencies regarding the study design that need to be addressed', but it identified no such inconsistencies. First, the letter discussed our side-by-side comparisons of hypothetical cereal products: (a) a less healthful product with higher sugar and lower WG content, accompanied by explicit or implicit front-of-pack WG labelling and (b) a more healthful product with lower sugar and higher WG content, accompanied by no WG labelling. As is the case for real products in the marketplace, we did not disclose an exact WG content in g, but the consumer could get some information from the Nutrition Facts Panel and the ingredient list, which were presented in identical format for both products. The labels were consistent with products having the following actual WG content: (a) a less healthful product with approximately 8 g of WG content and 13 g of added sugars and (b) a more healthful product with >9 g of WG content and 3 g of added sugars. There is no inconsistency. Second, the letter said, 'asking study participants to compare the WG content of two mixed-ingredient products is near impossible, because the information necessary for making that determination simply is not available'. However, this is not an 'inconsistency', but merely a correct observation about the impossible challenge facing consumers under current labelling rules. The letter's authors say that consumers can better understand WG content if the label lists the WG gram amount, 'providing consumers with information that would otherwise be inaccessible to them'. We agree. There is no inconsistency. Third, the letter said, 'the hypothetical Whole Grain Stamped products used in the discrete choice experiment are not reflective of the products that carry the Whole Grain Stamp'. The letter's authors say, for example, that 79 % of products registered for the industry-supported WG Stamp 'make at least half their grains whole'. This estimate seems plausible to us. It means that, even in the most rigorously defined case of the industry-supported stamp, about 21 % of the products with such WG labelling are predominantly composed of refined grains. This percentage is sufficiently high to be a policy-relevant problem, which