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      Expected population weight and diabetes impact of the 1-peso-per-litre tax to sugar sweetened beverages in Mexico

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          Abstract

          Study question

          What effect on body mass index, obesity and diabetes can we expect from the 1-peso-per-litre tax to sugar sweetened beverages in Mexico?

          Methods

          Using recently published estimates of the reductions in beverage purchases due to the tax, we modelled its expected long-term impacts on body mass index (BMI), obesity and diabetes. Microsimulations based on a nationally representative dataset were used to estimate the impact of the tax on BMI and obesity. A Markov population model, built upon an age-period-cohort model of diabetes incidence, was used to estimate the impact on diagnosed diabetes in Mexico. To analyse the potential of tax increases we also modelled a 2-peso-per-litre tax scenario.

          Study answer and limitations

          Ten years after the implementation of the tax, we expect an average reduction of 0.15 kg/m 2 per person, which translates into a 2.54% reduction in obesity prevalence. People in the lowest level of socioeconomic status and those between 20 and 35 years of age showed the largest reductions in BMI and overweight and obesity prevalence. Simulations show that by 2030, under the current implementation of 1-peso-per-litre, the tax would prevent 86 to 134 thousand cases of diabetes. Overall, the 2-peso-per-litre scenario is expected to produce twice as much of a reduction. These estimates assume the tax effect on consumption remains stable over time. Sensitivity analyses were conducted to assess the robustness of findings; similar results were obtained with various parameter assumptions and alternative modelling approaches.

          What this study adds

          The sugar-sweetened beverages tax in Mexico is expected to produce sizable and sustained reductions in obesity and diabetes. Increasing the tax could produce larger benefits. While encouraging, estimates will need to be updated once data on direct changes in consumption becomes available.

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          Most cited references32

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          Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

          In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction

            Objectives To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. Design Systematic review and meta-analysis. Data sources and eligibility PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n=1932 representing 44.7 million). Synthesis methods Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. Results Prespecified information was extracted from 17 cohorts (38 253 cases/10 126 754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I2 for heterogeneity=89%) and 13% (6% to 21%, I2=79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I2=70%) and 8% (2% to 15%, I2=64%); and for fruit juice, 5% (−1% to 11%, I2=58%) and 7% (1% to 14%, I2=51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79 000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). Conclusions Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showd positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes.
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              Solving Differential Equations inR: PackagedeSolve

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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                17 May 2017
                2017
                : 12
                : 5
                : e0176336
                Affiliations
                [1 ]Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
                [2 ]Instituto de Matemáticas, Universidad Nacional Autónoma de México, Mexico City, Mexico
                [3 ]Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
                [4 ]General Direction, National Institute of Public Health, Cuernavaca, Mexico
                [5 ]Centre for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
                [6 ]Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States of America
                Cinvestav-Merida, MEXICO
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: TBG JRD ACA ELP MHA.

                • Data curation: ERR RZT TBG RM RRM.

                • Formal analysis: ERR RZT TBG RM RRM.

                • Funding acquisition: JRD MHA.

                • Investigation: RRM ACA RZT TBG ELP.

                • Methodology: ERR RZT TBG ACA RM RRM MHA.

                • Project administration: TBG RM.

                • Software: RZT TBG RRM JRD ACA RM.

                • Supervision: TBG JRD ELP MHA.

                • Validation: RZT TBG MHA RRM.

                • Visualization: RZT.

                • Writing – original draft: ERR TBG RZT RM.

                • Writing – review & editing: ERR TBG RZT RM MHA ELP JRD ACA RRM.

                Author information
                http://orcid.org/0000-0002-0826-9106
                Article
                PONE-D-16-46702
                10.1371/journal.pone.0176336
                5435164
                28520716
                0b266ca4-b312-434e-b38b-d84cac893133
                © 2017 Barrientos-Gutierrez et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 24 November 2016
                : 10 April 2017
                Page count
                Figures: 0, Tables: 5, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100007500, Bloomberg Family Foundation;
                Award ID: P30DK092926
                Award Recipient :
                Funded by: Michigan Center for Translational Research
                Award ID: P30DK092926
                Award Recipient :
                Funded by: Harvard University (US)
                Award ID: Lown Scholarship
                Award Recipient :
                This work was supported by grants from Bloomberg Philanthropies ( https://www.bloomberg.org/), the Michigan Centre for Diabetes Translational Research (Grant P30DK092926 http://www.med.umich.edu/intmed/endocrinology/research/mcdtr.htm) and the National Institute of Public Health of Mexico. In addition, Tonatiuh Barrientos-Gutierrez received support from Harvard University through the Lown Scholar’s program ( https://www.hsph.harvard.edu/lownscholars/scholars/). The funders had no role in the study design or the analysis and interpretation of the data. All authors and their institutions reserve intellectual freedom from the funders.
                Categories
                Research Article
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Social Sciences
                Political Science
                Public Policy
                Taxes
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Biology and Life Sciences
                Nutrition
                Diet
                Beverages
                Medicine and Health Sciences
                Nutrition
                Diet
                Beverages
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                People and Places
                Population Groupings
                Ethnicities
                Mexican People
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                People and places
                Geographical locations
                North America
                Mexico
                Custom metadata
                All data files not included in the manuscript are available from the DOI 10.17605/OSF.IO/KHKWP | ARK c7605/osf.io/khkwp.

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