Association of Higher Consumption of Foods Derived From Subsidized Commodities With Adverse Cardiometabolic Risk Among US Adults | Cardiology | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Agriculture and Consumer Protection Act of 1973. Pub L No. 93-86, 87 Stat 221.
Ogden  CL, Carroll  MD, Flegal  KM.  Prevalence of obesity in the United States.  JAMA. 2014;312(2):189-190.PubMedGoogle ScholarCrossref
Mozaffarian  D, Benjamin  EJ, Go  AS,  et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee.  Heart disease and stroke statistics: 2015 update: a report from the American Heart Association [published correction appears in Circulation. 2015;131(24):e535.].  Circulation. 2015;131(4):e29-e322. doi:10.1161/CIR.0000000000000152.PubMedGoogle ScholarCrossref
Glickman  D, Veneman  AM.  The essential role of food and farm policy in improving health.  Health Aff (Millwood). 2013;32(9):1519-1521.PubMedGoogle ScholarCrossref
Mozaffarian  D, Fahimi  S, Singh  GM,  et al; Global Burden of Diseases Nutrition and Chronic Diseases Expert Group.  Global sodium consumption and death from cardiovascular causes.  N Engl J Med. 2014;371(7):624-634.PubMedGoogle ScholarCrossref
McGuire  S.  U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing Office; January 2011. PubMed
Franck  C, Grandi  SM, Eisenberg  MJ.  Agricultural subsidies and the American obesity epidemic.  Am J Prev Med. 2013;45(3):327-333.PubMedGoogle ScholarCrossref
Economic Research Service, US Department of Agriculture. Feed Grains Database. Accessed August 2012.
Basu  S, Seligman  HK, Gardner  C, Bhattacharya  J.  Ending SNAP subsidies for sugar-sweetened beverages could reduce obesity and type 2 diabetes.  Health Aff (Millwood). 2014;33(6):1032-1039.PubMedGoogle ScholarCrossref
Siegel  KR, McKeever Bullard  K, Ali  MK,  et al.  The contribution of subsidized food commodities to total energy intake among US adults.  Public Health Nutr. 2016;19(8):1348-1357.PubMedGoogle ScholarCrossref
National Center for Health Statistics, Centers for Disease Control and Prevention. Key concepts about NHANES survey design. Accessed August 2012.
Hu  FB, Rimm  E, Smith-Warner  SA,  et al.  Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire.  Am J Clin Nutr. 1999;69(2):243-249.PubMedGoogle Scholar
Institute of Medicine. Energy. In:  Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington, DC: National Academies Press; 2005:chap 5.
Center for Nutrition Policy and Promotion, US Department of Agriculture. Healthy Eating Index. Published in 2010. Accessed January 2016.
Pollan  M. The (agri)cultural contradictions of obesity. New York Times Magazine. October 12, 2003.
Nestle  M.  The ironic politics of obesity.  Science. 2003;299(5608):781.PubMedGoogle ScholarCrossref
Russo  M. Apples to Twinkies: comparing federal subsidies of fresh produce and junk food. Published 2011. Accessed August 2012.
Yach  D.  Nutritional change is not a simple answer to non-communicable diseases.  BMJ. 2011;343:d5097.PubMedGoogle ScholarCrossref
Alston  JM, Summer  DA, Vosti  SA.  Are agricultural policies making us fat? likely links between agricultural policies and human nutrition and obesity, and their policy implications.  Rev Agric Econ. 2006;28(3):313-322.Google ScholarCrossref
Rickard  BJ, Okrent  AM, Alston  JM.  How have agricultural policies influenced caloric consumption in the United States?  Health Econ. 2013;22(3):316-339.PubMedGoogle ScholarCrossref
Alston  JM, Summer  DA, Vosti  SA.  Farm subsidies and obesity in the United States: national evidence and international comparisons.  Food Policy. 2008;33(6):470-479.Google ScholarCrossref
Murray  CJ, Kulkarni  SC, Michaud  C,  et al.  Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States [published correction appears in PLoS Med. 2006;3(12):e545].  PLoS Med. 2006;3(9):e260. doi:10.1371/journal.pmed.0030260.PubMedGoogle ScholarCrossref
Narayan  KM, Boyle  JP, Thompson  TJ, Sorensen  SW, Williamson  DF.  Lifetime risk for diabetes mellitus in the United States.  JAMA. 2003;290(14):1884-1890.PubMedGoogle ScholarCrossref
Drewnowski  A.  Obesity and the food environment: dietary energy density and diet costs.  Am J Prev Med. 2004;27(3)(suppl):154-162.PubMedGoogle ScholarCrossref
Anekwe  TD, Rahkovsky  I.  The association between food prices and the blood glucose level of US adults with type 2 diabetes.  Am J Public Health. 2014;104(4):678-685.PubMedGoogle ScholarCrossref
Pietinen  P, Lahti-Koski  M, Vartiainen  E, Puska  P.  Nutrition and cardiovascular disease in Finland since the early 1970s: a success story.  J Nutr Health Aging. 2001;5(3):150-154.PubMedGoogle Scholar
Pekka  P, Pirjo  P, Ulla  U.  Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme: experiences from Finland.  Public Health Nutr. 2002;5(1A):245-251.PubMedGoogle ScholarCrossref
Kuusipalo  J, Mikkola  M, Moisio  S, Puska  P.  The East Finland Berry and Vegetable Project: a health-related structural intervention programme.  Health Promot Int. 1986;1(3):385-391.Google ScholarCrossref
Puska  P.  The North Karelia Project: nearly 20 years of successful prevention of CVD in Finland.  Hygie. 1992;11(1):33-35.PubMedGoogle Scholar
Puska  P, Vartiainen  E, Tuomilehto  J, Salomaa  V, Nissinen  A.  Changes in premature deaths in Finland: successful long-term prevention of cardiovascular diseases.  Bull World Health Organ. 1998;76(4):419-425.PubMedGoogle Scholar
Steinhauer  J. Farm Bill reflects shifting American menu and a senator’s persistent tilling. New York Times. March 8, 2014.
Trogdon  JG, Finkelstein  EA, Feagan  CW, Cohen  JW.  State- and payer-specific estimates of annual medical expenditures attributable to obesity.  Obesity (Silver Spring). 2012;20(1):214-220.PubMedGoogle ScholarCrossref
Original Investigation
August 2016

Association of Higher Consumption of Foods Derived From Subsidized Commodities With Adverse Cardiometabolic Risk Among US Adults

Author Affiliations
  • 1Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
  • 3Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia
JAMA Intern Med. 2016;176(8):1124-1132. doi:10.1001/jamainternmed.2016.2410

Importance  Food subsidies are designed to enhance food availability, but whether they promote cardiometabolic health is unclear.

Objective  To investigate whether higher consumption of foods derived from subsidized food commodities is associated with adverse cardiometabolic risk among US adults.

Design, Setting, and Participants  Cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2001 to 2006. Our final analysis was performed in January 2016. Participants were 10 308 nonpregnant adults 18 to 64 years old in the general community.

Exposure  From a single day of 24-hour dietary recall in the National Health and Nutrition Examination Survey, we calculated an individual-level subsidy score that estimated an individual’s consumption of subsidized food commodities as a percentage of total caloric intake.

Main Outcomes and Measures  The main outcomes were body mass index (calculated as weight in kilograms divided by height in meters squared), abdominal adiposity, C-reactive protein level, blood pressure, non–high-density lipoprotein cholesterol level, and glycemia.

Results  Among 10 308 participants, the mean (SD) age was 40.2 (0.3) years, and a mean (SD) of 50.5% (0.5%) were male. Overall, 56.2% of calories consumed were from the major subsidized food commodities. United States adults in the highest quartile of the subsidy score (compared with the lowest) had increased probabilities of having a body mass index of at least 30 (prevalence ratio, 1.37; 95% CI, 1.23-1.52), a ratio of waist circumference to height of at least 0.60 (prevalence ratio, 1.41; 95% CI, 1.25-1.59), a C-reactive protein level of at least 0.32 mg/dL (prevalence ratio, 1.34; 95% CI, 1.19-1.51), an elevated non–high-density lipoprotein cholesterol level (prevalence ratio, 1.14; 95% CI, 1.05-1.25), and dysglycemia (prevalence ratio, 1.21; 95% CI, 1.04-1.40). There was no statistically significant association between the subsidy score and blood pressure.

Conclusions and Relevance  Among US adults, higher consumption of calories from subsidized food commodities was associated with a greater probability of some cardiometabolic risks. Better alignment of agricultural and nutritional policies may potentially improve population health.