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Background The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people's diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the role they may play in the context of low- and middle-income countries (LMICs). We examined the associations of food environments on T2DM among adults and its heterogeneity by income and sex. Methods and findings We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018 and 2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300 m from study participant's home, and proximity was defined as having at least 1 outlet within 100 m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socioeconomic status (SES), health status, healthcare utilization, and physical activities. Data were analyzed in ArcMap 10.3 and STATA 15.1. A higher share of fast-food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p < 0.05). Having at least 1 FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p < 0.01). A 1% increase in the share of FFR near an individual's home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AMEs): 0.08; CI: 0.02, 0.14; p < 0.05). Having at least 1 FFR near home was associated with 16% (odds ratio [OR]: 1.16; CI: 1.01, 1.33; p < 0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p < 0.05) increases in the odds of higher blood glucose levels and diagnosed diabetes, respectively. The positive association between FFR density and blood glucose level was stronger among women than men, but the association between FFR proximity and blood glucose level was stronger among men as well as among those with higher incomes. One of the study's key limitations is that we measured exposure to food environments around residency geolocation; however, participants may source their meals elsewhere. Conclusions Our results suggest that the exposure to fast-food outlets may have a detrimental impact on the risk of T2DM, especially among females and higher-income earners. Policies should target changes in the food environments to promote better diets and prevent T2DM., Author(s): Dian Kusuma 1, Petya Atanasova 1, Elisa Pineda 1,2, Ranjit Mohan Anjana 3, Laksara De Silva 4, Abu AM Hanif 5, Mehedi Hasan 5, Md. Mokbul Hossain 5, Susantha [...]

Objective To model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met. Methods The 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015-2016 and on population structure and deaths from four major noncommunicable diseases over 1990-2016. We used the Preventable Risk Integrated ModEl tool to estimate the deaths averted if reformulation targets were met in full. We projected future trends in noncommunicable disease deaths using regression modelling and assessed whether Portugal was on track to reduce baseline premature deaths from noncommunicable diseases in the year 2010 by 25% by 2025, and by 30% before 2030. Findings If reformulation targets were met, we projected reductions in intake in 2015-2016 for salt from 7.6 g/day to 7.1 g/day; in total energy from 1911 kcal/day to 1897 kcal/day due to reduced sugar intake; and in total fat (% total energy) from 30.4% to 30.3% due to reduced trans-fat intake. This consumption profile would result in 248 fewer premature noncommunicable disease deaths (95% CI: 178 to 318) in 2016. We projected that full implementation of the industry agreement would reduce the risk of premature death from 11.0% in 2016 to 10.7% by 2021. Conclusion The co-regulation agreement could save lives and reduce the risk of premature death in Portugal. Nevertheless, the projected impact on mortality was insufficient to meet international targets. [phrase omitted] Objectif Modeliser la diminution des deces prematures attribues a des maladies non transmissibles lorsque les objectifs en matiere de reformulation des produits alimentaires transformes conjointement fixes par le ministere portugais de la Sante et l'industrie alimentaire sont atteints. Methodes L'accord de 2015 sur la coreglementation definit des objectifs volontaires pour reduire la teneur en sucre, en sel et en acides gras trans de divers produits d'ici a 2021. Nous avons obtenu des donnees publiques sur l'apport alimentaire en 2015-2016 et sur la structure de la population et les deces dus a quatre maladies non transmissibles majeures entre 1990 et 2016. Nous avons utilise l'outil <> pour estimer les deces qui pourraient etre evites si les objectifs en matiere de reformulation etaient pleinement atteints. Nous avons projete l'evolution future des deces dus a des maladies non transmissibles a l'aide d'une modelisation par regression et determine si le Portugal etait en bonne voie pour diminuer de 25% d'ici a 2025 et de 30% avant 2030 les deces prematures dus a des maladies non transmissibles par rapport a l'annee de reference, a savoir 2010. Resultats Si les objectifs en matiere de reformulation etaient atteints, nous avons projete que la consommation de sel en 2015-2016 passerait de 7,6 g/jour a 7,1 g/jour; l'energie totale de 1911 kcal/jour a 1897 kcal/ jour en raison d'une reduction de la consommation de sucre; et les matieres grasses totales (% de l'energie totale) de 30,4% a 30,3% en raison d'une reduction de la consommation de gras trans. Ce profil de consommation se traduirait par 248 deces prematures en moins dus a des maladies non transmissibles (IC a 95%: de 178 a 318) en 2016. Nous avons projete que la pleine mise en oeuvre de l'accord avec l'industrie permettrait de faire passer le risque de deces premature de 11,0% en 2016 a 10,7% en 2021. Conclusion Laccord sur la coreglementation pourrait sauver des vies et reduire le risque de deces premature au Portugal. L'impact prevu sur la mortalite etait neanmoins insuffisant pour atteindre les objectifs internationaux. Objetivo Modelizar la reduccion de muertes prematuras atribuidas a las enfermedades no transmisibles si se cumplen los objetivos de reformulacion de los alimentos procesados acordados entre el Ministerio de Salud portugues y la industria alimentaria. Metodos El acuerdo de corregulacion de 2015 establece objetivos voluntarios para reducir el azucar, la sal y los acidos grasos trans en una serie de productos para 2021. Se obtuvieron datos gubernamentales sobre la ingesta alimentaria en 2015-2016 y sobre la estructura de la poblacion y las muertes por cuatro enfermedades no contagiosas principales en el periodo entre 1990 y 2016. Se utilizo la herramienta Preventable Risk Integrated ModEl (Modelo integrado de riesgos evitables) para estimar las muertes que se evitarian si se cumplian plenamente los objetivos de la reformulacion. Se proyectaron las tendencias futuras de las muertes por enfermedades no transmisibles utilizando modelos de regresion y se evaluo si Portugal estaba en camino de reducir las muertes prematuras de referencia por enfermedades no contagiosas del ano 2010 en un 25% para 2025 y en un 30% antes de 2030. Resultados Si se cumplieran los objetivos de la reformulacion, se proyecto una reduccion de la ingesta de sal en 2015-2016 de 7,6 g/dia a 7,1 g/dia; de la energia total de 1911 kcal/dia a 1897 kcal/dia debido a la reduccion de la ingesta de azucar; y de grasa total (% de la energia total) del 30,4% al 30,3% debido a la reduccion de la ingesta de grasas trans. Este perfil de consumo resultaria en 248 muertes prematuras por enfermedades no transmisibles menos (IC del 95%: 178 a 318) en 2016. Se estimo que la plena aplicacion del acuerdo de la industria reduciria el riesgo de muerte prematura del 11,0% en 2016 al 10,7% en 2021. Conclusion El acuerdo de corregulacion podria salvar vidas y reducir el riesgo de muerte prematura en Portugal. No obstante, los efectos previstos sobre la mortalidad son insuficientes para alcanzar las metas internacionales., Introduction In 2017, 88% (96 587) of 109 758 deaths in the Portuguese population of 10 291 027 were attributed to noncommunicable diseases. (1) Portugal has committed to the United [...]

The COVID-19 pandemic has seen dramatic demand surges for hospital care that have placed a severe strain on health systems worldwide. As a result, policy makers are faced with the challenge of managing scarce hospital capacity to reduce the backlog of non-COVID patients while maintaining the ability to respond to any potential future increases in demand for COVID care. In this paper, we propose a nationwide prioritization scheme that models each individual patient as a dynamic program whose states encode the patient's health and treatment condition, whose actions describe the available treatment options, whose transition probabilities characterize the stochastic evolution of the patient's health, and whose rewards encode the contribution to the overall objectives of the health system. The individual patients' dynamic programs are coupled through constraints on the available resources, such as hospital beds, doctors, and nurses. We show that the overall problem can be modeled as a grouped weakly coupled dynamic program for which we determine near-optimal solutions through a fluid approximation. Our case study for the National Health Service in England shows how years of life can be gained by prioritizing specific disease types over COVID patients, such as injury and poisoning, diseases of the respiratory system, diseases of the circulatory system, diseases of the digestive system, and cancer. This paper was accepted by Chung-Piaw Teo, optimization. Funding: G. Forchini acknowledges funding from Jan Wallanders and Tom Hedelius Foundation and the Tore Browaldh Foundation, funding from MRC Centre for Global Infectious Disease Analysis [Reference MR/R015600/1], jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth and Development Office (FCDO), under the MRC/FCDO Concordat agreement, part of the EDCTP2 program supported by the European Union; and acknowledges funding by Community Jameel. D. Rizmie acknowledges partial funding from the MRC Centre for Global Infectious Disease Analysis [Reference MR/R015600/1]. J. C. D'Aeth acknowledges funding from the Wellcome Trust [Reference 102169/Z/13/Z]. S. Moret acknowledges partial support from the Swiss National Science Foundation (SNSF) under [Grant P2ELP2_188028]. S. Ghosal was funded by the Imperial College President's PhD Scholarship. F. Grimm was funded by the Health Foundation as part of core staff member activity. This research was funded in whole, or in part, by the Wellcome Trust [Grant 102169/Z/13/Z]. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2023.4679. [ABSTRACT FROM AUTHOR]