Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD21205, USA.
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 839, Baltimore, MD21205, USA.
Public Health Nutr. 2020 Jun;23(9):1609-1617. doi: 10.1017/S1368980019003999. Epub 2020 Mar 19.
To examine changes in sales of highly processed foods, including infant formulas, in countries joining free trade agreements (FTAs) with the US.
Annual country-level data for food and beverage sales come from Euromonitor International. Analyses are conducted in a comparative interrupted time-series (CITS) framework using multivariate random-effects linear models, adjusted for key confounders: gross domestic product (GDP) per capita, percent of the population living in urban areas and female labor force participation rate. Memberships in other FTAs and investment treaties are also explored as possible confounders.
Changes are assessed between 2002 and 2016.
Ten countries joining US FTAs are compared with eleven countries without US FTAs in force; countries are matched on national income level, world region and World Trade Organization membership.
After countries join a US FTA, sales are estimated to increase by: 0·89 (95 % CI 0·16, 1·6; P = 0·016) kg per capita per annum for ultra-processed products, 0·81 (95 % CI 0·47, 1·1; P < 0·001) kg per capita per annum for processed culinary ingredients and 0·17 (95 % CI 0·052, 0·29; P = 0·005) kg per capita under age 5 per annum for baby food. No significant change is estimated for minimally processed foods. In statistical models, large unexplained variations in country-specific trends suggest additional unmeasured country-level factors also impact sales trends following entry into US FTAs.
These findings strongly support the conclusion that joining US FTAs can contribute to detrimental changes in national dietary consumption that increase population risk of non-communicable diseases.
研究加入与美国签署自由贸易协定（FTA）的国家，高度加工食品（包括婴儿配方奶粉）销售的变化情况。
食品和饮料销售的年度国家数据来自欧睿国际（Euromonitor International）。采用多变量随机效应线性模型，在比较中断时间序列（CITS）框架中进行分析，并针对关键混杂因素进行调整：人均国内生产总值（GDP）、居住在城市地区的人口比例和女性劳动力参与率。还探讨了加入其他自由贸易协定和投资条约作为可能的混杂因素。
评估 2002 年至 2016 年之间的变化情况。
与 11 个没有生效的美国自由贸易协定的国家相比，10 个加入美国自由贸易协定的国家；这些国家在国民收入水平、世界区域和世界贸易组织成员资格方面相匹配。
在国家加入美国 FTA 后，预计以下产品的销售将增加：超加工产品人均每年增加 0.89 公斤（95%CI 0.16, 1.6；P = 0.016），加工烹饪原料人均每年增加 0.81 公斤（95%CI 0.47, 1.1；P < 0.001），5 岁以下婴儿食品人均每年增加 0.17 公斤（95%CI 0.052, 0.29；P = 0.005）。未加工食品的销售预计不会有显著变化。在统计模型中，各国特定趋势中存在较大的未解释变化，这表明在加入美国 FTA 后，其他未被测量的国家层面因素也会影响销售趋势。
这些发现有力地支持了这样的结论，即加入美国 FTA 可能导致国家饮食消费的不利变化，增加人口患非传染性疾病的风险。
