@article{Basu:2018:10.1371/journal.pmed.1002700,
author = {Basu, S and Yudkin, JS and Berkowitz, SA and Jawad, M and Millett, C},
doi = {10.1371/journal.pmed.1002700},
journal = {PLOS Medicine},
title = {Reducing chronic disease through changes in food aid: A microsimulation of nutrition and cardiometabolic disease among Palestinian refugees in the Middle East},
url = {http://dx.doi.org/10.1371/journal.pmed.1002700},
volume = {15},
year = {2018}
}

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TY  - JOUR
AB  - BackgroundType 2 diabetes mellitus and cardiovascular disease and have become leading causes of morbidity and mortality among Palestinian refugees in the Middle East, many of whom live in long-term settlements and receive grain-based food aid. The objective of this study was to estimate changes in type 2 diabetes and cardiovascular disease morbidity and mortality attributable to a transition from traditional food aid to either (i) a debit card restricted to food purchases, (ii) cash, or (iii) an alternative food parcel with less grain and more fruits and vegetables, each valued at $30/person/month.Methods and findingsAn individual-level microsimulation was created to estimate relationships between food aid delivery method, food consumption, type 2 diabetes, and cardiovascular disease morbidity and mortality using demographic data from the United Nations (UN; 2017) on 5,340,443 registered Palestinian refugees in Syria, Jordan, Lebanon, Gaza, and the West Bank, food consumption data (2011–2017) from households receiving traditional food parcel delivery of food aid (n = 1,507 households) and electronic debit card delivery of food aid (n = 1,047 households), and health data from a random 10% sample of refugees receiving medical care through the UN (2012–2015; n = 516,386). Outcome metrics included incidence per 1,000 person-years of hypertension, type 2 diabetes, atherosclerotic cardiovascular disease events, microvascular events (end-stage renal disease, diabetic neuropathy, and proliferative diabetic retinopathy), and all-cause mortality. The model estimated changes in total calories, sodium and potassium intake, fatty acid intake, and overall dietary quality (Mediterranean Dietary Score [MDS]) as mediators to each outcome metric. We did not observe that a change from food parcel to electronic debit card delivery of food aid or to cash aid led to a meaningful change in consumption, biomarkers, or disease outcomes. By contrast, a shift to an alternative foo
AU  - Basu,S
AU  - Yudkin,JS
AU  - Berkowitz,SA
AU  - Jawad,M
AU  - Millett,C
DO  - 10.1371/journal.pmed.1002700
PY  - 2018///
TI  - Reducing chronic disease through changes in food aid: A microsimulation of nutrition and cardiometabolic disease among Palestinian refugees in the Middle East
T2  - PLOS Medicine
UR  - http://dx.doi.org/10.1371/journal.pmed.1002700
UR  - http://hdl.handle.net/10044/1/64616
VL  - 15
ER  - 

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