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      Canadian Potential Healthcare and Societal Cost Savings from Consumption of Pulses: A Cost-Of-Illness Analysis

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          Abstract

          Consumption of dietary pulses, including beans, peas and lentils, is recommended by health authorities across jurisdictions for their nutritional value and effectiveness in helping to prevent and manage major diet-related illnesses of significant socioeconomic burden. The aim of this study was to estimate the potential annual healthcare and societal cost savings relevant to rates of reduction in complications from type 2 diabetes (T2D) and incidence of cardiovascular disease (CVD) following a low glycemic index (GI) or high fiber diet that includes pulses, or 100 g/day pulse intake in Canada, respectively. A four-step cost-of-illness analysis was conducted to: (1) estimate the proportions of individuals who are likely to consume pulses; (2) evaluate the reductions in established risk factors for T2D and CVD; (3) assess the percent reduction in incidences or complications of the diseases of interest; and (4) calculate the potential annual savings in relevant healthcare and related costs. A low GI or high fiber diet that includes pulses and 100 g/day pulse intake were shown to potentially yield Can$6.2 (95% CI $2.6–$9.9) to Can$62.4 (95% CI $26–$98.8) and Can$31.6 (95% CI $11.1–$52) to Can$315.5 (95% CI $110.6–$520.4) million in savings on annual healthcare and related costs of T2D and CVD, respectively. Specific provincial/territorial analyses suggested annual T2D and CVD related cost savings that ranged from up to Can$0.2 million in some provinces to up to Can$135 million in others. In conclusion, with regular consumption of pulse crops, there is a potential opportunity to facilitate T2D and CVD related socioeconomic cost savings that could be applied to Canadian healthcare or re-assigned to other priority domains. Whether these potential cost savings will be offset by other healthcare costs associated with longevity and diseases of the elderly is to be investigated over the long term.

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          Most cited references77

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          Dietary Guidelines for Chinese Residents (2016): comments and comparisons.

          A high quality diet is believed to play a functional role in promoting the healthy growth of mankind and preventing many kinds of chronic degenerative diseases, including cancer, cardiovascular disease, diabetes, and obesity. Adherence to a high quality diet has been strongly associated with a lower risk of mortality. To help promote healthy lifestyles and physical strength, the Chinese government has produced a new revised version of the Dietary Guidelines for Chinese Residents (2016) and the Chinese Food Pagoda, as guidance for dietary intake among its population. Similarly, the Japanese government has produced the Japanese Food Guide Spinning Top Model, and the US government has recently published revised dietary recommendations in its 2015-2020 eighth edition of Dietary Guidelines for Americans. The evidence from all respective cohort studies involved in producing these guidelines shows a reduced risk of many chronic diseases and mortality if the guidelines are followed. All scientific findings support encouraging the general population to consume a broad variety of food on the basis of nutrient and food intakes in order to prevent deficiency diseases and a surplus of energy and nutrients, and recommend daily physical activity for health promotion.
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            Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.

            Increasing evidence suggests an important role of carbohydrate quality in the development of type 2 diabetes. Our objective was to prospectively examine the association between glycemic index, glycemic load, and dietary fiber and the risk of type 2 diabetes in a large cohort of young women. In 1991, 91249 women completed a semiquantitative food-frequency questionnaire that assessed dietary intake. The women were followed for 8 y for the development of incident type 2 diabetes, and dietary information was updated in 1995. We identified 741 incident cases of confirmed type 2 diabetes during 8 y (716 300 person-years) of follow-up. After adjustment for age, body mass index, family history of diabetes, and other potential confounders, glycemic index was significantly associated with an increased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 1.15, 1.07, 1.27, and 1.59; 95% CI: 1.21, 2.10; P for trend = 0.001). Conversely, cereal fiber intake was associated with a decreased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 0.85, 0.87, 0.82, and 0.64; 95% CI: 0.48, 0.86; P for trend = 0.004). Glycemic load was not significantly associated with risk in the overall cohort (multivariate relative risks for quintiles 1-5, respectively: 1, 1.31, 1.20, 1.14, and 1.33; 95% CI: 0.92, 1.91; P for trend = 0.21). A diet high in rapidly absorbed carbohydrates and low in cereal fiber is associated with an increased risk of type 2 diabetes.
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              Cost-of-illness studies: a guide to critical evaluation.

              Cost-of-illness (COI) studies aim to assess the economic burden of health problems on the population overall, and they are conducted for an ever widening range of health conditions and geographical settings. While they attract much interest from public health advocates and healthcare policy makers, inconsistencies in the way in which they are conducted and a lack of transparency in reporting have made interpretation difficult, and have ostensibly limited their usefulness. Yet there is surprisingly little in the literature to assist the non-expert in critically evaluating these studies. This article aims to provide non-expert readers with a straightforward guide to understanding and evaluating traditional COI studies. The intention is to equip a general audience with an understanding of the most important issues that influence the validity of a COI study, and the ability to recognize the most common limitations in such work.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                22 July 2017
                July 2017
                : 9
                : 7
                : 793
                Affiliations
                [1 ]Department of Human Nutritional Sciences and Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, MB R3T 6C5, Canada; umabdul7@ 123456myumanitoba.ca (M.M.H.A.); Peter.Jones@ 123456umanitoba.ca (P.J.H.J.)
                [2 ]Department of Food Science and Nutrition, Kuwait University, Kuwait City 10002, Kuwait
                [3 ]Pulse Canada, Winnipeg, MB R2C 0A1, Canada; cmarinangeli@ 123456pulsecanada.com
                [4 ]Department of Agribusiness & Agricultural Economics, University of Manitoba, Winnipeg, MB R2C 0A1, Canada
                Author notes
                [* ]Correspondence: Jared_Carlberg@ 123456umanitoba.ca ; Tel.: +1-204-474-9827
                [†]

                These authors contributed equally to this work.

                Article
                nutrients-09-00793
                10.3390/nu9070793
                5537906
                28737688
                1e77d8f4-afd0-4f89-bcb7-fb99f395a49f
                © 2017 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 23 June 2017
                : 19 July 2017
                Categories
                Article

                Nutrition & Dietetics
                dietary pulses,diabetes,cardiovascular disease,healthcare cost savings,nutrition economics

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