Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis

Little is known about the potential health economic impact of increasing the proportion of total grains consumed as whole grains to align with Dietary Guidelines for Americans (DGA) recommendations. Health economic analysis estimating difference in costs developed using (1) relative risk (RR) estimates between whole grains consumption and outcomes of cardiovascular disease (CVD) and a selected component (coronary heart disease, CHD); (2) estimates of total and whole grains consumption among US adults; and (3) annual direct and indirect medical costs associated with CVD. Using reported RR estimates and assuming a linear relationship, risk reductions per serving of whole grains were calculated and cost savings were estimated from proportional reductions by health outcome. With a 4% reduction in CVD incidence per serving and a daily increase of 2.24 oz-eq of whole grains, one-year direct medical cost savings were estimated at US$21.9 billion (B) (range, US$5.5B to US$38.4B). With this same increase in whole grains and a 5% reduction in CHD incidence per serving, one-year direct medical cost savings were estimated at US$14.0B (US$8.4B to US$22.4B). A modest increase in whole grains of 0.25 oz-eq per day was associated with one-year CVD-related savings of $2.4B (US$0.6B to US$4.3B) and CHD-related savings of US$1.6B (US$0.9B to US$2.5B). Increasing whole grains consumption among US adults to align more closely with DGA recommendations has the potential for substantial healthcare cost savings.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiovascular Healthcare Cost Savings Associated with Increased Whole Grains Consumption among Adults in the United States

Murphy

Schmier

2020

“…Targeting the fibre intake of lower SES groups has the potential to bring about greater health and economic benefits, since lower SES groups have higher levels of health risk factors in Australia [ 9 ]. Modelling evidence has estimated that increasing the cereal fibre intake of the lower SES groups of Australian adults results in greater economic savings than implementing the same measure for the higher SES groups [ 10 ]. The perceived monetary cost of a healthy diet has been identified as a key factor in the socio-economic differences in dietary intakes [ 63 , 64 , 65 ].…”

Section: Discussionmentioning

confidence: 99%

“…In dose-response meta-analyses of prospective cohort studies, additional 7–10 g of fibre per day was associated with a 9% reduction in cardiovascular disease (CVD) [ 6 ], a 9% reduction in type 2 diabetes (T2D) [ 7 ], a 10% reduction in colorectal cancer [ 8 ], and an 11% reduction in all-cause mortality [ 4 ]. In Australia, chronic diseases are the leading cause of morbidity and mortality [ 9 ], and a recent cost-of-illness analysis reported that if the intake of fibre in Australia increased using cereal fibre, economic savings of AUD$17.8 million–1.6 billion for CVD and AUD$18.2 million–1.7 billion for T2D could be realised in healthcare expenditure and productivity costs [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Dietary Fibre Intake in Australia. Paper I: Associations with Demographic, Socio-Economic, and Anthropometric Factors

Fayet‐Moore¹,

Cassettari²,

Tuck³

et al. 2018

Self Cite

Dietary fibre is important for regular laxation and reduces chronic disease risk. The National Health and Medical Research Council outlines daily fibre intake targets, yet the proportion of the population that meets these targets is unknown. Using the 2011–2012 National Nutrition and Physical Activity Survey, we profiled fibre intake among Australian children and adults. Data from one-day dietary recalls were analysed (n = 12,153, ≥2 years) as well as demographic and anthropometric factors. The median fibre intake was 18.2 g (interquartile range [IQR] 13.2–25.0) in children and 20.7 g (IQR 14.3–28.7) in adults. We found that 42.3% (95% CI 40.5–44.1%) of children and 28.2% (95% CI 27.3–29.1%) of adults met the Adequate Intake (AI), and less than 20% of adults met the Suggested Dietary Target (SDT) to reduce the risk of chronic disease. Older children (aged 14–18 years), girls, young adults (19–30 years), males, and those of lower socio-economic status were less likely to meet the AI (p < 0.001). Those with a higher energy intake were more likely to meet the AI. Anthropometric measures were not associated with fibre intake or the likelihood of meeting the AI. Fibre is a nutrient of concern in Australian diets, with most children and adults falling short of recommendations. Adolescents, girls, young adults, men, and those of lower socio-economic status were less likely to meet the recommendations and may benefit most from public health interventions.

“…A recent review of studies worldwide, which included the 2007 Australian National Children’s Nutrition and Physical Activity Survey, reported that fibre intakes was lower than recommended in all adult and most childhood populations [ 6 ]. In the most recent 2011–2012 National Nutrition and Physical Activity Survey (NNPAS) in Australia, more than 1 in 2 children and more than 7 in 10 adults had fibre intakes below the Adequate Intake (AI) (14–28 g for children, 25 g for adult females, and 30 g for adult males), and more than 4 in 5 adults did not meet the Suggested Dietary Target to reduce chronic disease risk (28 g for women and 38 g for men) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Dietary Fibre Intake in Australia. Paper II: Comparative Examination of Food Sources of Fibre among High and Low Fibre Consumers

Fayet‐Moore¹,

Cassettari²,

Tuck³

et al. 2018

Self Cite

Intakes of dietary fibre in Australia are lower than recommended. An understanding of food choices associated with fibre intake can help to inform locally relevant dietary interventions that aim to increase its consumption. This study aimed to profile the relationship between dietary choices and fibre intake of Australians. Using Day 1 data from the 2011–2012 National Nutrition and Physical Activity Survey (n = 12,153, ≥2 years), dietary fibre intake was classified by quartiles for children (2–18 years) and adults (≥19 years). Intakes of the Australian Dietary Guidelines (ADG) food groups were calculated, as well as the major, sub-major, and minor food groups from the Australian Food Composition Database. Each of these food groups provide a progressively greater level of detail. Associations with ADG food groups and major food groups were determined, and the leading sub-major and minor food group sources of fibre for low (Quartile 1) and high (Quartile 4) fibre consumers were profiled. Energy-adjusted intakes of wholegrain and/or high fibre but not refined grain (cereal) foods, vegetables, and fruit were positively associated, and discretionary foods negatively associated, with quartile of fibre intake (p < 0.001). The top three sub-major food group sources of fibre were regular breads, cereal mixed dishes, and ready-to-eat breakfast cereals in high fibre consumers and regular breads, cereal mixed dishes, and potatoes in low fibre consumers. White breads was the leading minor food group contributor in low fibre consumers, and apples and lower sugar wheat based breakfast cereal were the leading fibre contributors in high fibre consumers in children and adults, respectively. Higher intakes of wholegrain, fruits, and vegetables, and a lower discretionary intake were associated with higher fibre intake. Encouraging these foods as part of any public health intervention is likely to be effective for increasing dietary fibre intakes.