Health Impact and Cost-Effectiveness of Achieving the National Salt and Sugar Reduction Initiative Voluntary Sugar Reduction Targets in the United States: A Microsimulation Study

Abstract

Background: High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative (NSSRI) proposed government supported voluntary national sugar reduction targets. This intervention's potential health and equity impacts, and cost-effectiveness are unclear. Methods: A validated microsimulation model, CVD-PREDICT, coded in C++, was used to estimate incremental changes in type 2 diabetes, cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs and cost-effectiveness of the NSSRI policy. The model was run at the individual-level, incorporating the annual probability of each person's transition between health status based on their risk factors. The model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across 3 cycles (2011-2016), added sugar-related diseases from meta-analyses, and policy costs and health-related costs from established sources. A simulated nationally representative US population was created and followed until age 100 years or death, with 2019 as the year of intervention start. Findings were evaluated over 10 years and a lifetime from healthcare and societal perspectives. Uncertainty was evaluated in a one-way analysis by assuming 50% industry compliance, and probabilistic sensitivity analyses via a second-order Monte Carlo approach. Model outputs included averted diabetes cases, CVD events and CVD deaths, QALYs gained, and formal healthcare cost savings, stratified by age, race, income and education. Results: Achieving the NSSRI sugar reduction targets could prevent 2.48 million CVD events, 0.49 million CVD deaths, and 0.75 million diabetes cases; gain 6.67 million QALYs; and save $160.88 billion net costs from a societal perspective over a lifetime. The policy became cost-effective (<150K/QALYs) at 6 years, highly cost-effective (< 50K/QALYs) at 7 years, and cost-saving at 9 years. Results were robust from a healthcare perspective, with lower (50%) industry compliance, and in probabilistic sensitivity analyses. The policy could also reduce disparities, with greatest estimated health gains per million adults among Black and Hispanic, lower income, and less educated Americans. Conclusions: Implementing and achieving the NSSRI sugar reformation targets could generate substantial health gains, equity gains and cost-savings.

The Metabolic Matrix: Re-engineering ultraprocessed foods to feed the gut, protect the liver, and support the brain

“…We have not performed either supply chain or economic modeling to demonstrate the cost effectiveness or environmental sustainability of this approach at an industrial level. Also, while we ( 114 ) and others ( 115 ) have previously performed microsimulation analyses to demonstrate the health and healthcare benefits of sugar reduction, a similar analysis on ultraprocessed foods has not yet been done. Lastly, we believe that employing the Metabolic Matrix will save governments healthcare costs resulting from the premature development of NCD’s.…”

Importance of Nutrition Security to CVD Prevention Efforts in the USA

“…For example, the US National Salt and Sugar Reduction Initiative [ 67 ] is meant to encourage food companies to reformulate products voluntarily in line with set standards and could address nutrition security directly by altering the quality of accessible foods. A microsimulation study has suggested that achieving such reformulation goals could lead to reductions in CVD events and mortality and increases in quality-adjusted life-years, even with imperfect compliance [ 68 ].…”

Family Food Insecurity, Food Acquisition, and Eating Behavior Over 6 Months Into the COVID-19 Pandemic

“…Given that income and food insecurity are associated with the quality of food consumed away from home, instead of restricting access to an important food source, future work could explore how to improve the quality of low-cost restaurant meals and convenience foods by implementing national sodium and sugar reduction initiatives. 36 Nutrition practitioners and researchers could also partner with restaurants to make balanced choices more accessible by providing healthier side dishes, replacing sugarsweetened beverages, and serving appropriately sized meals on children's menus.…”