DOCSLIB.ORG

Baseline Serum Folate, Vitamin B12 and the Risk of Prostate and Breast Cancer Using Data from the Swedish AMORIS Cohort

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Baseline Serum Folate, Vitamin B12 and the Risk of Prostate and Breast Cancer Using Data from the Swedish AMORIS Cohort Cancer Causes & Control (2019) 30:603–615 https://doi.org/10.1007/s10552-019-01170-6 ORIGINAL PAPER Baseline serum folate, vitamin B12 and the risk of prostate and breast cancer using data from the Swedish AMORIS cohort Anneli Essén1 · Aida Santaolalla1 · Hans Garmo1,2 · Niklas Hammar3,4 · Göran Walldius5 · Ingmar Jungner6 · Håkan Malmström3,7 · Lars Holmberg1,8 · Mieke Van Hemelrijck1,3 Received: 9 July 2018 / Accepted: 11 April 2019 / Published online: 24 April 2019 © The Author(s) 2019 Abstract Purpose The roles of folate and vitamin B12 in prostate cancer (PCa) or breast cancer (BC) development are unclear. We investigated their roles using the prospective Swedish Apolipoprotein MOrtality RISk (AMORIS) study. Methods 8,783 men and 19,775 women with vitamin B12 and folate serum measurements were included. Their associations with PCa and BC risk categories were evaluated using Cox proportional hazards regression. Results During mean follow-up of 13 years, 703 men developed PCa. There was an inverse association between folate > 32 nmol/L and high-risk PCa [hazard ratio (HR) 0.12, 95% confdence interval (CI) 0.02–0.90], and a positive asso- ciation between folate < 5 nmol/L and metastatic PCa (HR 5.25, 95% CI 1.29–21.41), compared with folate 5–32 nmol/L. No associations with vitamin B12 were found. 795 women developed BC during mean follow-up of 14 years. When restricting to the fasting population, there was a positive association between folate > 32 nmol/L and BC (HR 1.47, 95% CI 1.06–2.04). Conclusion High folate levels may protect against PCa and low folate levels may increase risk of metastatic PCa. High fast- ing folate levels may be associated with an increased BC risk. Vitamin B12 was not found to be linked with risk of PCa or BC. Longitudinal studies with serum and dietary information could help defne new prevention targets and add information on the role of folate fortifcation. Keywords Prostate cancer (PCa) · Breast cancer (BC) · Vitamin B12 · Folate · Severity Abbreviations GGT​ Gamma glutamyl transferase 95% CI 95% Confdence interval HR Hazard ratio AMORIS Apolipoprotein MOrtality RISk NPCR National Prostate Cancer Register BC Breast cancer PCa Prostate cancer CALAB Central Automation Laboratory SES Socioeconomic status CCI Charlson comorbidity index Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s1055 2-019-01170 -6) contains supplementary material, which is available to authorized users. * Mieke Van Hemelrijck 5 Department of Cardiovascular Epidemiology, Institute [email protected] of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden 1 Research Oncology, Translational Oncology & Urology 6 Department of Clinical Epidemiology, Karolinska Institutet Research (TOUR), Guy’s Hospital, School of Cancer and CALAB Research, Stockholm, Sweden and Pharmaceutical Sciences, King’s College London, 3rd Floor, Bermondsey Wing, London SE1 9RT, UK 7 Biostatistics, Research & Development, Swedish Orphan Biovitrum AB, Stockholm, Sweden 2 Regional Cancer Centre, Uppsala, Sweden 8 Department of Surgical Sciences, Uppsala University, 3 Unit of Epidemiology, Institute of Environmental Medicine, Uppsala, Sweden Karolinska Institutet, Stockholm, Sweden 4 Medical Evidence & Observational Research, Global Medical Afairs, AstraZeneca, Mölndal, Sweden Vol.:(0123456789)1 3 604 Cancer Causes & Control (2019) 30:603–615 Introduction study in the US, with 712 cases and controls, found that high folate levels may reduce the risk of BC, especially Folate and vitamin B12 are important for cell growth and in women with high alcohol consumption [19]. Studies division. Abnormal levels of these vitamins have long on the efects of vitamin B12 on BC risk have also been been associated with the development of several malignan- inconclusive. A weak positive association between vitamin cies, such as colorectal [1, 2], pancreatic [3], lung [4] and B12 levels and BC risk in women who had a high con- cervix cancer [5]. Their potential role in carcinogenesis sumption of alcohol was found in one nested case–control is thought to be due to their part in the so-called “one- study, which included 2,491 cases and 2,521 controls from carbon metabolism pathway”. This pathway is important Europe [20]. However, another US nested case–control for DNA synthesis, repair and methylation [6]. Epigenetic study with 195 cases and controls found that low B12 lev- changes such as DNA hypo and hypermethylation, DNA els may increase the risk of BC [21], whereas an additional uracil misincorporation, and chromosomal rearrangements US nested case–control study with 848 cases and controls have been seen in many tumour tissues, including prostate found no association [22]. cancer (PCa) [7–9] and breast cancer (BC) [10]. This sug- In this study, we investigated the associations between gests that altered levels of these vitamins could potentially serum folate, vitamin B12, and risks of PCa and BC further promote cancer development. by including information on tumour characteristics. Some studies have investigated the association between folate, vitamin B12 and the risks of PCa and BC, with inconsistent results. Among other studies [11, 12], a Nor- Materials and methods wegian nested case–control study, which included 3,000 cases and 3,000 controls with blood samples collected Study population and data collection between 1973 and 2004, suggested that high levels of serum folate increase the risk of PCa [13]. A prospective All data were obtained from the Swedish Apolipoprotein- case–control study which included 29,133 male smok- related MOrtality RISk (AMORIS) cohort. This database ers aged 50–69 years in Finland between 1985 and 1988 contains blood samples from 812,073 individuals who did, however, not fnd any association between serum mainly came from the greater Stockholm area and were folate levels and PCa [14]. In another nested case–con- either having a general health check-up or were outpatients trol study, which included 6,875 cases and 8,104 controls, referred for laboratory testing. None of the participants were with blood samples collected between 1981 and 2008 and inpatients at the time of the blood sampling. The blood sam- with an average follow-up of 8.9 years, high folate lev- ples were analysed and evaluated in the Central Automation els were associated with an enhanced risk of high grade Laboratory (CALAB) in Stockholm, Sweden, from 1985 to PCa, suggesting that folate may play a role in the progres- 1996. In the AMORIS cohort, the CALAB database was sion of PCa [11]. In contrast, an Australian prospective linked to several Swedish national registries such as the cohort study, which included 964 men with a follow-up of Swedish National Cancer Register, the Hospital Discharge 20 years, found that decreased folate levels increased PCa Register, the Cause of Death Register, the consecutive Swed- mortality risk [15]. Vitamin B12 has, as well as folate, ish Censuses from 1970 to 1990, and the National Register been associated with the increased PCa risk in some stud- of Emigration using the Swedish 10-digit personal identity ies [11, 12]. A prospective Swedish study found that vita- number. These resources provided complete follow-up infor- min B12 may be associated with up to a threefold increase mation until death or the end of December 2011. A more in PCa risk [16]. Yet, the previously mentioned Finnish detailed description of the AMORIS cohort can be found study also looked at vitamin B12 and found no association elsewhere [23]. The study complies with the Declaration between vitamin B12 and PCa. of Helsinki, and the Ethics Review Board of the Karolinska For BC, both positive and negative associations have Institute has approved the study [23]. been found between serum folate levels and BC risk. Stud- In this study, we particularly used the Swedish National ies have suggested that high folate levels are associated Cancer Register [24], to which reporting is mandated, the with the increased BC risk in women with BRCA1/2 muta- National Prostate Cancer Register (NPCR) [25] and the tions [17] and also in women with estrogen receptor beta Stockholm Clinical Quality Register for Breast Cancer [26, negative BC [18]. The frst study was a prospective study 27], to extract information about the cancer diagnoses. which included 164 women with BRCA1/2 mutations in The NPCR includes 98% of all newly diagnosed PCa cases Canada, whereas the second study was a Swedish nested in the Swedish National Cancer Register. It was estab- case–control study which included 204 cases and 408 con- lished to provide data for quality assurance and has been trols. Conversely, another prospective nested case–control ofering the service nationwide since 1998 [25, 28]. We used data on date of diagnosis, age at diagnosis, serum 1 3 Cancer Causes & Control (2019) 30:603–615 605 concentration of PSA at time of diagnosis, TNM stage and In addition, we used information on a variety of biomark- Gleason score from the NPCR. The Stockholm Clinical ers which may be potential confounders for the associations Quality Register for Breast Cancer started in 1976 and is between vitamin B12, folate, and risk of PCa or BC. Total considered to have 97% coverage having been cross ref- cholesterol and triglycerides were measured enzymatically erenced with the Swedish National Cancer Register. This [34], and serum glucose was also measured enzymatically register was established to record the quality of care based with a glucose/peroxidase method [35]. Serum iron was on regional or national guidelines for BC management. measured via acidifcation with citric acid in order to dis- Individual information about date of diagnosis, detection sociate the Fe3+-transferring complex (coefcient of vari- mode, tumour characteristics, pathological tumour-stage ation < 5%) [36]. A colorimetric method was used for the and treatment for all the newly diagnosed BC patients has measurement of total serum calcium (coefcient of varia- been reported continuously by clinicians to the register.
Load more

Recommended publications
  • Hyperlipidemia
    HYPERLIPIDEMIA yperlipidemia or hyperlipoproteinemia •Children younger than 2 years of age should not typically refers to any elevation of have their fat or dietary cholesterol intake blood lipid levels (e.g., total choles- restricted because of the high energy required terol, triglycerides, or lipoproteins).1 during this time of rapid growth and development. HAlthough terms such as hypercholesterolemia are • Children 1 year of age and older should eat a often used interchangeably with hyperlipidemia, variety of foods to ensure adequate nutrition. At there are subtle differences. Hypercholesterolemia age 2, children gradually need to begin eating refers to elevated blood cholesterol. Dyslipopro- fewer high-fat foods, so that by age 5, they teinemia or dyslipidemia describes abnormal levels receive no more than 30 percent of their calories of blood lipoproteins (e.g., low levels of high-densi- from fat. ty lipoprotein [HDL cholesterol], elevated low-den- sity or very-low-density lipoprotein [LDL or VLDL • Children should be encouraged to maintain or cholesterol]). Table 11 lists the range of acceptable, increase their levels of regular physical activity. borderline, and high cholesterol levels for at-risk •Older children and adolescents need to be coun- children and adolescents. seled on the consequences of tobacco use and provided with strategies for avoiding it. Significance To promote lower cholesterol levels in all At least one-quarter of children and adoles- healthy children and adolescents ages 2 to 18, the cents are estimated to have borderline or high cho- following pattern of nutrient intake is lesterol levels.2 In adults, elevated blood- recommended:5 cholesterol levels are strongly associated with ath- • Saturated fat should be less than 10 percent of erosclerosis (hardening of the arteries) and death the total number of calories consumed.
    [Show full text]
  • No Time to Wait: the Healthy Kids Strategy
    No Time to Wait: The Healthy Kids Strategy Healthy Kids Panel Healthy Kids Panel Dear Minister, On behalf of all 18 members of Ontario’s Healthy Kids Panel, we are proud to submit to you our unanimous recommendations on how Ontario can best make a difference in promoting the health and well-being of children and youth – and thus lay the foundation for the future health and success of our province. We are presenting you with a comprehensive three-pronged strategy to address this complex issue: start all kids on the path to health, change the food environment and create healthy communities. For each of these elements, we have proposed realistic, achievable measures along with an action plan to turn ideas into reality. You appointed a very talented group of citizens to this panel. Because they came from so many different sectors and walks of life, they brought varied perspectives to the panel. During six months of intensive work, every member of the panel contributed considerable expertise to this report. But every single panel member also stayed open to new ideas, put evidence ahead of preconception and was willing to move away from the prevailing wisdom of their sector in order to put together an effective strategy. This is the formula for success for your government and for our province. We can only make progress on this issue – achieving the goal of a 20 per cent reduction in childhood obesity by 2018 – if policy-makers, thought leaders, businesses and professional groups stay genuinely open to thinking in new ways and considering uncomfortable ideas.
    [Show full text]
  • Health Packages
    Towards Better Health TEST PACKAGES 9999992020 011-45004200 www.drdangslab.com OUR PROMISE FOR QUALITY AND SAFETY : Quality Safety - Nabl accredited since 2001 - Mandatory guidelines for single use PPE - Triple quality check assured - Strict infection control protocols - Each test report viewed by a Dr. Dang - Regular screening of staff - Highest doctor to patient ratio and vaccination drives - Awarded FICCI healthcare excellence - Safe home collection services award in patient experience available all over delhi NCR Click here https://youtu.be/89t5u2E2l88- to know more. Contents 1. 2. 3. 4. 5. SMART CHECK ADVANCED SUPERIOR COMPREHENSIVE COMPREHENSIVE PROFILE SMART CHECK SMART CHECK HEATLH PROFILE HEATLH PROFILE PROFILE PROFILE WITH PSA 6. 7. 8. 9. 10. VITAMINS & FEMALE ARTHRITIS DIABETES / FEVER MINERALS HORMONE PROFILE HYPERTENSION PROFILE PROFILE PROFILE PROFILE BASIC 11. 12. 13. 14. 15. FEVER PROFILE ANEMIA STD PROFILE 1 STD PROFILE 2 FITNESS ADVANCED PROFILE PROFILE 1 WITH HPLC 16. 17. 18. FITNESS ALLERGY COMMENTS PROFILE 2 SCREENING PROFILE Smart SMART CHECK PROFILE (SMAC) Check This is a basic yet powerful package which gives a bird’s eye view of your inner metabolism. It has Complete Blood Count which in itself provides a wealth of information regarding anemia(Hemoglobin), infections(TLC, DLC), blood cancers; Profile lipids; blood sugar evaluations; kidney and liver evaluations; Magnesium - a key mineral, deficiency of which causes fatigue and a muscle marker CPK. Read more... ∙ CBC with ESR ∙ Liver Function Test ∙ Blood Glucose Fasting* ∙ Magnesium ∙ Lipid Profile* ∙ C.P.K. ∙ Kidney Function Test Click here to book Indicative of extent of test coverage. a home collection 1 Note: - Tests marked with * require minimum 10-12 hours fasting.
    [Show full text]
  • Pork a Healthy Choice
    Canada’s Food Guide recommends choosing lean meat, like pork, more often. Since 1999, pork has been a proud participant in the Health Check ™ food information program. The Heart and Stroke Foundation of Canada created Health Check ™, a national food information program, to help Canadians make wise food choices at the grocery store. The Health Check ™ program makes it easy to identify healthy food choices with a simple and recognizable Health Check ™ symbol displayed on food packages. PORK , A H EALTHY CHOICE Check for Health Check ™ Health Check ™ Criteria for Fresh Meat The Health Check ™ symbol on Different food products have to meet the package means that the different criteria to be part of the Health product’s nutrition information Check™ program. For example, the has been reviewed by the criteria for breads focuses on fat and Foundation and that it meets the established fibre, while criteria for milk focuses on fat and nutrient criteria based on Eating Well with calcium. Fresh meat must qualify based on the Canada's Food Guide. Choosing Health Check ™ criteria listed in the boxes below. products will help contribute to healthy eating for you and your family. Lean Extra Lean Lean Ground 10% fat or less 7.5% fat or less 17% fat or less All trimmed fresh pork Lean ground pork cuts (excluding ribs) www.PutPorkOnYourFork.com A Healthy Choice! Extra Lean and Lean Pork Choices Trimmed 100g raw Pork provides energy and many nutrients such as high Pork Cuts serving Calories Protein (g) Fat (g) Tenderloin* 110 22 1.5 quality protein, six essential B-vitamins and four important minerals (phosphorus, magnesium, zinc and Leg Inside* 110 22 2.0 iron), that are all important for the maintenance of good Loin Centre Cut* 120 24 2.5 health.
    [Show full text]
  • Sugar Coated [Feature]
    Sugar Coated [Transcript] Caption: Longmont, Colorado Text on Screen: In the past 30 years, obesity rates have doubled to 600 million. Diabetes rates have tripled to 347 million worldwide. GARY TAUBES: You know, if you think about this as a court case: So, the crime committed is something in the environment is causing diabetes, and heart disease, and obesity, we don't know what it is, maybe it's just that people eat too much, maybe it's that we're not physically active enough, maybe it's a dietary fad. Maybe it's the sugar. They do an investigation, find there's a lot of evidence to implicate sugar. But it's a little ambiguous, there's no smoking gun, you know, we've got some witnesses, and they're always at the scene of the crime. And they never have an alibi, but the evidence are not definitive. What do you do? The fundamental life blood of their industry was holding on to this fact that there's no definitive evidence that sugar is a death dealing disease. So as long as they could hold onto that, as long as they could keep the evidence ambiguous, they get to stay alive. If the evidence gets definitive, they're done. What do you do? Is it possible that sugar's toxic? How do you even discuss it without appearing that you're a fear mongerer? We're talking about a substance that makes people very happy. It's how we manifest love, and joy, and happiness in the world, and now you go after sugar, which is something that we give our one year olds on their first birthday? It's not that simple to know what the right thing is.
    [Show full text]
  • Nutrition & Healthy Eating
    Healthy Eating & Nutrition In this resource packet you will find: • Healthy Targets Take Aim • Step Up to Nutrition and Health • Fruit &Veggie Checklist • Sample Grocery List • Shopping List • Meals to Remember • Grocery Store Tour • Healthy Eating on a Budget • Size Up Your Nutrition Label • Portion Sizes • What Counts as a Serving • Fast Food Survival Guide • Making Smart Drink Choices Visit the following websites for more tips & resources • Fit City Challenge: www.fitcitychallenge.org • Eat Smart Move More: www.myeatsmartmovemore.com Mecklenburg County Health Department Daily Dietary Recommendations Eat 400-500 calories at any one meal Eat 100-200 calories at any one snack Eat <30% of your total calories from fat (40-60 grams) Eat <10% of your total calories from saturated fat (15-20 grams) Eat 25-30 grams of fiber Drink 8 cups of water Healthy Eating Tips Eat regular meals to avoid binge eating Separate eating from other activites (Don’t eat and watch TV) Plan “treat” foods into your calorie allowance Eat a variety of foods with all nutrients Keep a food diary to identify patterns that trigger overeating or unhealthy eating Limit your intake of fast foods Cut restaurant meals in half – bring home leftovers to enjoy as another meal Healthy Living Tips Get off the couch & away from the TV! (limit to no more than 2 hours a day) Get more steps into your routine – take the stairs, park further away, take the longer way Schedule time for physical activity into your week (plan a walk or group exercise class with a friend) Learn a new skill or sport you’ve always wanted to try Give yourself credit for changes you’ve made Step Up to Nutrition and Health ake the steps towards better nutrition and health.
    [Show full text]
  • Sugar Coated (Abridged Version)
    Sugar Coated (Abridged Version) [Transcript] Caption: Longmont, Colorado Text on Screen: In the past 30 years, obesity rates have doubled to 600 million. Diabetes rates have tripled to 347 million worldwide. GARY TAUBES: If you think about this as a court case: So, the crime committed is something in the environment is causing diabetes, and heart disease, and obesity, we don't know what it is, maybe it's just that people eat too much, maybe it's that we're not physically active enough, maybe it's a dietary fad. Maybe it's the sugar. They do an investigation, find there's a lot of evidence to implicate sugar. But it's a little ambiguous, there's no smoking gun, you know, we've got some witnesses, and they're always at the scene of the crime. And they never have an alibi, but the evidence are not definitive. What do you do? The fundamental life blood of their industry was holding on to this fact that there's no definitive evidence that sugar is a death dealing disease. So as long as they could hold onto that, as long as they could keep the evidence ambiguous, they get to stay alive. If the evidence gets definitive, they're done. What do you do? Is it possible that sugar's toxic? How do you even discuss it without appearing that you're a fear mongerer? We're talking about a substance that makes people very happy. It's how we manifest love, and joy, and happiness in the world, and now you go after sugar, which is something that we give our one year olds on their first birthday? It's not that simple to know what the right thing is.
    [Show full text]
  • High Blood Cholesterol
    2020 EDITION High blood cholesterol This risk is higher if you are older, are of Maori, Pacific or Indo-Asian ethnicity, have diabetes, high blood pressure, smoke, or have a close family member (such as a parent or a sibling) with heart disease. ‘Bad’ and ‘good’ cholesterol Cholesterol cannot move around the blood stream by itself, so attaches to carrier molecules called lipoproteins. A cholesterol test measures two of these lipoproteins, low density lipoprotein (LDL) and high density lipoprotein (HDL), as well as triglycerides and total cholesterol. LDL – ‘bad’ cholesterol LDLs carry cholesterol around the body depositing it in the artery walls. It is important to have low levels of LDL. It is important that your cholesterol is kept at a healthy level. HDL – ‘good’ cholesterol Your doctor or nurse can check your levels as part of your HDLs carry cholesterol back to the liver where it is broken ‘Cardiovascular Risk Assessment’ (your heart health check). down. It is good to have high levels of HDL in your blood or a high proportion (ratio) of HDL within your total cholesterol. What is cholesterol? Triglycerides The most common form of fat in our body. High Cholesterol is a white, waxy substance which, despite triglycerides are associated with many diseases, including its bad reputation, is essential for life. It is used by our bodies heart disease and stroke. to make important hormones, to help absorb fat-soluble HDL/total cholesterol ratio vitamins, and in the formation of cells. Your liver makes This ratio is used to calculate your risk of heart attack about 70% to 80% of the cholesterol circulating in your or stroke.
    [Show full text]
  • Restricting Trans Fat: a Consumer Guide
    British Columbia has a New Trans Fat Regulation Restricting Trans Fat: A Consumer Guide Why is Trans Fat Harmful to Your Health? What is Trans Fat? Industrially produced trans fat increases your risk of heart Trans fat is a type of fat found in disease by raising the levels of bad cholesterol (LDL) and certain foods. There are two kinds of lowering the levels of good cholesterol (HDL), which can clog trans fat in the diet: arteries and affect overall health. Saturated fat is also harmful to heart health and should be limited in the diet. Industrially produced trans fat is “man-made” and is found in partially hydrogenated fat and oil BC Has a New Regulation That Restricts Trans Fat. and any food made with these such as crackers, cookies, donuts, What Does This Mean For Me? cakes, pastries, muffins, British Columbia is the first province in Canada to croissants, snack foods and fried adopt a province-wide trans fat restriction. As of foods. Industrially produced September 30th, 2009, all foods and ingredients trans fat is more harmful to heart used in food service establishments, including health than any other type of fat. restaurants, in store delis, school cafeterias, and many bakeries, must meet the following restrictions: Naturally occurring trans fat is found in certain meat and dairy 2% trans fat (of total fat) or less for soft spreadable products including beef, lamb, margarines and oils. butter and cream. It does not 5% trans fat (of total fat) or less for all other foods. have the same harmful effect to heart health as industrially You should not notice a difference in the taste or texture of produced trans fat.
    [Show full text]
  • Health Check Report Card Was Created by Melissa Mcdole, Medical Student at Florida State University College of Medicine
    “Tracking the Way to a Healthier You” Center on Better Health & Life, Florida State University Health for Hearts United Leadership Institute C2200 University Center, P. O. Box 3062641 A Church-Based Project in Gadsden and Leon Counties Tallahassee, FL 32306-2641 Funded by the National Institute on Minority Health & Health Disparities Phone: 850-645-8110 National Institutes of Health The Health Check Report Card was created by Melissa McDole, medical student at Florida State University College of Medicine Health Check Report Card This tool is easy to use and will help you develop healthy habits such as healthy eating and increased physical activity. It will also help you to balance the amount and type of foods you eat. Instructions: Please complete the Health Check Food Report Card each day for 1 week. Use the Go, Slow/Stop Foods, and Fruit and Vegetable lists to help you. Each food from the lists is worth one point each. For physical activity, place a number from 2 – 8 corresponding to the length of time for physical activity. Use the Physical Activity List to help you. At the end of the week, add the numbers in each category for each day and place the number in the “weekly total” box. If you reached your goal for a particular category, place a sticker in the “I reached my goal” box. Goals Sunday Monday Tuesday Wednesday Thursday Friday Saturday Weekly I reached Total my goal!! 21 or more GO Foods per week Less than SLOW/STOP 21 per week Foods Fruits & 21 or more per week Vegetables Physical 42 points or more per Activity week (at least 30 min.
    [Show full text]
  • Public‐Private Roles
    Public-Private Roles Farm and Food Policy and Obesity May 22, 2010 Ellen Goddard, Jeewani Fernando, Wenzhao Huang Public Private • Various actions taken by government can result in reactions by firms within a market – not clear about net nutritional outcomes • Other players in the market include non- governmental organizations such as Heart and Stroke Foundation (HSF) in Canada (cancer = 5 a day) • In Canada HSF tries to encourage government action – trans-fats, sodium are two examples Canada U.S. Australia Health Check in Canada • Food companies and restaurants can apply to HSF for approval of products – pay an application fee; if approved pay an annual fee to have the logo on their product/restaurant menu • Question remains about how effective the strategy is in enhancing health – controversy about standards HSF (do they adjust quickly enough) uses; about the fees; about the lack of comparison across all products in outlets • Other questions – does the pervasiveness of the use of this logo in Canada reduce pressure to develop FOP signal? Types of Health Check Impact • Assuming people understand and rely on such signalling the impact of Health Check can be on: – sales of individual products (increase), – on substitution of products (increase with the Health Check, decrease without), • Both within and across firms – on halo associated with company (retailer, processor or restaurant) • Increase sales of all firm’s products because some have the logo Actions/Reactions • Firm 1 – uses Health Check on some or all products • Firm 2 – could
    [Show full text]
  • THE C21st HEALTH CHECK - II
    Identification number [ ] [ ] [ ] [ ] THE C21st HEALTH CHECK - II The C21st Health Check – II is purpose designed for use by additionally trained nurses, with adults with learning disabilities It is advisable that the adult with learning disabilities has a relative, support worker, friend or advocate supporting her / him during the health check The nurse should expand, rephrase and clarify prompts as required, in order to fully explore each item to be rated Version II © The Glasgow CEDD, 2006 1 Identification number [ ] [ ] [ ] [ ] CONTENTS Page Part I: Review of General Practitioner Case-notes 4 A. Personal information 5 B. Procedures and investigations 6 C. Blood tests 7 D. Development and ability 9 E. General health 10 F. Secondary health care services 17 G. Adults with Incapacity (Scotland) Act, 2000 18 H. Any other important points 19 Part II: Health Check (The A – Z of Health) 20 A. About the health check 21 B. Personal details 21 C. Social supports 22 D. Professional supports 27 E. Overview of health problems and drugs 28 F. Mental health 32 G. Breathing 49 H. Communication 51 I. Stomach, bowel and nutrition 51 J. Heart and circulation 53 K. Urinary system 55 L. Muscles, joints and locomotor 56 M. Skin 57 N. Epilepsy 57 O. Nervous system (other than epilepsy) 59 P. Women’s health 59 Q. Men’s health 62 R. Ability and development 63 S. Vision 66 T. Hearing 67 U. Additional information 67 V. Health promotion 68 W. Immunisation 74 2 Identification number [ ] [ ] [ ] [ ] X. Past medical history 77 Y. Family medical history 77 Z. Physical examination 78 Part III: Summary & Action Plan 85 A.
    [Show full text]